Prevalence Of Other Comorbidities Research Articles

Abstract TMP53: Mexican Americans and Non-Hispanic Whites Have Different Prestroke Comorbidity Profiles: Results From the Brain Attack Surveillance in Corpus Christi Project

Introduction: Multiple comorbid conditions (MCC) explain variation in stroke outcomes beyond the damage caused by the stroke. Mexican Americans (MAs) and non-Hispanic Whites (NHWs) may have a different spectrum and severity of MCC, which may contribute to ethnic differences in stroke outcomes. We sought to determine the clustering of MCC in ischemic stroke patients as well as ethnic differences. Methods: MA and NHWs with ischemic stroke (2008-2017) from the Brain Attack Surveillance in Corpus Christi Project were studied. Twenty-two prestroke comorbidities (prevalence >1%) were identified using ICD codes and medical records from acute hospitalizations. Latent class analysis was used to identify comorbidity clusters (class). Multinomial logistic regression was used to assess age-adjusted ethnic differences in class membership. Results: Of 1,670 patients, 49% were male, 68% were MA, mean age was 69 (SD=13). MAs were younger, more likely to be obese, and have hypertension, diabetes, and renal and liver failure, but less likely to have arrhythmia and chronic pulmonary disease. Three latent classes were identified (Figure). Class 1 had a high prevalence of uncomplicated hypertension and diabetes but low prevalence of other comorbidities. Class 2 and 3 had similarly higher prevalence for most comorbidities, except that the prevalence of renal failure, and complicated hypertension and diabetes in Class 2 and arrhythmia in Class 3 were relatively higher. Compared with NHWs, MAs were more likely to be in Class 1 (OR 1.72, 95%CI: 1.15-2.56) and Class 2 (OR 2.18, 95%CI: 1.63-3.10) versus Class 3. Conclusion: Distinct MCC clusters, patterned by ethnicity, were identified. Efforts to target specific minority populations to reduce stroke disparities may benefit from addressing the ethnic-specific MCC clusters.

Impact of Chronic Kidney Disease on the Presentation and Outcome of Patients Hospitalized With Atrial Fibrillation: Insights From Qatar.

Atrial fibrillation (AF) with coexistent chronic kidney disease (CKD) is poorly described in the literature. We compared the presenting symptoms, clinical characteristics, treatment, and outcome of patients hospitalized with AF with and without CKD in a large clinical registry. Data of patients hospitalized with AF between 1991 and 2012 in Qatar were analyzed. Of 5201 patients hospitalized for AF, 264 (5.1%) had CKD. Patients with AF and CKD were older with higher prevalence of other comorbidities and left ventricular dysfunction and were more likely to present with shortness of breath and chest pain compared with patients with AF alone who were more likely to present with palpitation. The crude in-hospital mortality was 3 times higher in patients with dual disease. On multivariable adjustments, CKD was an independent predictor of mortality (odds ratio: 2.84; 95% confidence interval: 1.33-6.08, P = .001). Further studies are warranted to try to reduce the increased mortality observed in this high-risk population.

Higher nocturnal systolic blood pressure in patients with restless legs syndrome compared with patients with insomnia

BackgroundThere is evidence linking restless legs syndrome (RLS) with increased blood pressure (BP), but the mechanism of this relation remains unclear. Is the BP increased due to some features of RLS or to deterioration of sleep caused by RLS? This study compared values of nocturnal BP in patients with RLS and patients with insomnia. If increased BP in RLS is a consequence of disordered sleep, then it should be similar to increased BP in insomnia. MethodsPolysomnographic recordings of patients admitted to a sleep center with RLS or insomnia were analyzed. Demographic and clinical data, objective sleep parameters, and nocturnal BP were compared. ResultsRecordings of 35 patients with RLS and 33 patients with insomnia were analyzed. The groups did not significantly differ in terms of demographic traits or prevalence of other comorbidities. Patients with RLS had significantly higher systolic BP during the night (122.4 ± 13.8 vs 116.3 ± 13.4; p = 0.03) and during sleep (121.4 ± 13.3 vs 115.7 ± 13.3; p = 0.04). The only significant difference in sleep architecture was an increased number of periodic limb movements in sleep (PLMS) and PLMS with arousal in the RLS group (25.5 ± 24.6 vs 13.9 ± 22.7; p = 0.02 and 4.7 ± 5.4 vs 2.1 ± 3.4; p = 0.01). ConclusionOur results suggest that patients with RLS have higher nocturnal BP than patients with insomnia, and that increased PLMS is related to the increase in BP.

73 Comparison of serum selenium levels among hypertensive and normotensive pregnant women from southern brazil: A Case control-study

Introduction The hypertensive disorders of pregnancy (HDP) are the leading cause of maternal death in the world; however, its pathogenesis is not fully understood. It is believed that a dysfunction in the placentation process leads to oxidative stress, thus antioxidants like selenium could be a protective factor Objectives To correlate serum selenium levels with HDP in our population, considering a possible protective factor of this mineral. Methods This case-control study included 32 normotensive pregnant women, 20 with hypertension (chronic and gestational hypertension) and 38 patients with preeclampsia. All patients were derived from antenatal or obstetric admission of a tertiary hospital Southern Brazil. Serum selenium was measured at the time of inclusion in the study. Patients were followed until hospital discharge after delivery. The significance level was 5% (p ⩽ 0.05) and analyzes were performed using SPSS version 18. Values were expressed as mean ± standard deviation. Chi-square test was utilized for the categorical variables. Continuous variables were first tested using the Shapiro–Wilk test and then applied an independent-sample t test, Mann–Whitney U test, one-way analysis of variance (with post hoc Student–Newman–Keul) or Kruskal–Wallis test according with the groups. Results The patients did not differ with regard to maternal age, ethnicity, years of education, parity, and smoking prevalence. Normotensive patients had lower body mass index and were included in the study earlier. In addition, these patients had a higher prevalence of other comorbidities excluding hypertension. Patients with preeclampsia had higher levels of systolic blood pressure on admission. Continuous use of medication and HDP history in previous pregnancies were more common in patients with preeclampsia. Serum selenium levels were not significantly different between groups, with an average of 56.4 ± 15,3 μg/L in the control group, 53.2 ± 15,2 μg/L in the hypertension group and 53.3 ± 16,8 μg/L in the group with preeclampsia (P = 0.67). Of patients with preeclampsia, 52.6% had severe preeclampsia. Serum selenium levels of these patients did not differ significantly from the control group (P = 0.77). Preeclampsia was associated with earlier interruption of pregnancy and lower birth weight (P Conclusions There was no significant difference in the concentration of serum selenium between normotensive and hypertensive women, thus not being possible to establish selenium as a protective factor. Besides, we found that our population is extremely selenium deficient. One may speculate that population-wide low plasma concentrations of selenium may be one etiology accounting for the higher incidence of preeclampsia and may conjecture that selenium supplementation might lower this incidence.

Temporal trends in survival after out-of-hospital cardiac arrest in patients with and without underlying chronic obstructive pulmonary disease

AimSurvival after out-of-hospital cardiac arrest (OHCA) has tripled during the past decade in Denmark as a likely result of improvements in cardiac arrest management. This study analyzed whether these improvements were applicable for patients with chronic obstructive pulmonary disease (COPD). MethodsPatients ≥18 years with OHCA of presumed cardiac cause were identified through the Danish Cardiac Arrest Registry, 2001–2011. Patients with a history of COPD up to ten years prior to arrest were identified from the Danish National Patient Register and compared to non-COPD patients. ResultsOf 21,480 included patients, 3056 (14.2%) had history of COPD. Compared to non-COPD patients, COPD patients were older (75 vs. 71 years), less likely male (61.2% vs. 68.5%), had higher prevalence of other comorbidities, and were less likely to have: arrests outside private homes (17.7% vs. 28.3%), witnessed arrests (48.7% vs. 52.9%), bystander cardiopulmonary resuscitation (25.8% vs. 34.8%), and shockable heart rhythm (15.6% vs. 29.9%), all p<0.001; while no significant difference in the time-interval from recognition of arrest to rhythm analysis by ambulance-crew; p=0.24. From 2001 to 2011, survival upon hospital arrival increased in both patient-groups (from 6.8% to 17.1% in COPD patients and from 8.2% to 25.6% in non-COPD patients, p<0.001). However, no significant change was observed in 30-day survival in COPD patients (from 3.7% to 2.1%, p=0.27), in contrast to non-COPD patients (from 3.5% to 13.0%, p<0.001). ConclusionsDespite generally improved 30-day survival after OHCA over time, no improvement was observed in 30-day survival in COPD patients.

What's Age Got to do with it? A Review of Contemporary Revascularization in the Elderly.

Currently a quarter of all patients treated with percutanous coronary intervention (PCI) are aged >75 years, with this proportion steadily growing. This subset of patients have a number of unique characteristics, such as a greater number of cardiovascular risk factors and frequently a larger burden of coronary artery disease, when compared to younger patients, therefore potentially deriving increased benefit from revascularization. Nonetheless this population are also more likely to experience procedural complications, secondary to age-related physiological alterations, increased frailty and increased prevalence of other co-morbidities. This article reviews the various aspects and data available to clinicians pertaining to and guiding revascularization in the elderly, including the use of adjuvant pharmacotherapy, specific considerations when considering age-related physiology, and revascularization in acute coronary syndromes.

Bariatric surgery in old age: a comparative study of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an Asia centre of excellence.

Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients, but data is still lacking in the elderly population. The aim of our study was to compare the safety and efficacy of laparoscopic Roux–en-Y gastric bypass (LRYGB) and sleeve gastrectomy (LSG) in patients aged more than 55 years. We performed a retrospective review of a prospectively collected database. All patients with body mass index (BMI) ≧32 kg/m2 and aged more than 55 years undergoing LRYGB or LSG in BMI Surgery Centre, E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the analysis. Demography, peri-operative data, weight loss and surgical complications were all recorded and analyzed. Mean age and BMI of these 68 patients (22 males and 46 female) were 58.8 years (55–79 years) and 39.5 kg/m2 (32.00–60.40 kg/m2). LRYGB was performed in 44 patients and LSG in 24 patients. The two groups were comparable in their preoperative BMI, American Society of Anaesthesia (ASA) score and gender distribution. LSG patients were significantly older than patients receiving LRYGB. The proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients (88.63% vs. 50%; P < 0.01). The prevalence of other co-morbidities was similar and comparable between the groups. Mean BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 kg/m2 and 28.2 kg/m2, respectively, and there was no statistically significant difference in mean percentage of excess weight loss (%EWL) at 1 year. The percentage of resolution of diabetes was significantly higher in LRYGB (69.2%) as compared to LSG (33.3%). On the other hand, there was no statistical difference in the percentage of resolution of hypertension, hyperlipidemia and fatty liver hepatitis. The overall morbidity and re-operation rate was higher in LRYGB patients. In morbidly elderly patients, both surgeries achieved good weight loss and resolution of comorbidities. LRYGB is superior to LSG in terms of diabetes remission but carries higher complication rates even at high volume centres.

Obesity dilemma in the global burden of cardiovascular diseases

Obesity is a well-known risk factor in the cardiovascular disease continuum. However, its clinical effects are multimodal, perplexed and non-unanimously understood. Our aim was to assess the prevalence and effects of obesity on the cardiometabolic risk factors and systolic function of left ventricle ejection fraction (LVEF) in patients scheduled for cardiovascular rehabilitation. A cohort of 302 consecutive patients recently treated for ischaemic or valvular heart disease was matched according to the existence of obesity, defined with body mass index (BMI ≥ 30 kg/m(2) ; n = 90 vs. 212), and the advanced grade of obesity (BMI ≥ 35 kg/m(2) ; n = 19 vs. 283). Nutritional risk screening was performed using the standardised NRS-2002 tool. The mean age of patients was 62.4 ± 11.2 (range 23-86) years; there were more men than women 244 (80.8%) : 58 (19.2%). Group of obese conveyed higher prevalence of ischaemic heart disease than non-obese (OR = 2.69; 95% CI: 1.01-7.20; p = 0.048); while the difference was insignificant for the advanced grade of obesity (n = 17; 89.5%) vs. controls (n = 233; 82.3%; p > 0.05). There was no significant difference in prevalence of other comorbidities (diabetes, glucose intolerance, hypercholesterolaemia, chronic renal and chronic obstructive pulmonary disease) between studied groups (p > 0.05). Utilisation of lipid-lowering drugs was of similar range between the studied groups (p > 0.05), respectively. LVEF (%) was 50.5 ± 8.2 vs. 50.7 ± 7.7 (p > 0.05) and 50.6 ± 7.8 vs. 49.6 ± 10.9 (p > 0.05; Rho = 0.001; p > 0.05), respectively. In studied set of patients, BMI positively correlated with left ventricle dimension and thickness. No significant connection of obesity was found with the prevalence of chronic comorbidities, increased nutritional risk, laboratory diagnostics or systolic function of left ventricle. Existence of obesity paradox in clinical practice was in part reaffirmed with our study.

Disease associations in alpha-1-antitrypsin deficiency

In addition to emphysema alpha-1-antitrypsin deficiency (AATD) has been shown to be associated with several inflammatory conditions, including bronchiectasis, vasculitis, (in particular Wegener's granulomatosis), and panniculitis, suggesting neutrophil proteinases also play a role in their pathophysiology. However, it remains unknown whether other inflammatory diseases are also more prevalent in AATD than the general population. The current study describes the prevalence of other co-morbidities in AATD with particular emphasis on inflammatory bowel disease. The case notes of 651 PiZZ or PiZnull patients attending the UK national centre for AATD between 1996 and 2011 were reviewed. The prevalence of inflammatory bowel disease (1.5%) was higher than that predicted in the UK (0.4%). Ten patients had a confirmed diagnosis of ulcerative colitis, and 1 had Crohn's disease. In 2 cases there was a family history of inflammatory bowel disease and all but 1 patient were ex or never smokers. There was also a higher prevalence of hypothyroidism in this patient group than expected for the UK population - 26 cases (7.2% of females and 1.3% of males). The current study of the UK cohort of patients with AATD confirmed a higher prevalence of ulcerative colitis than would be expected in the general population, providing further evidence of a potential link between these 2 conditions. In addition, the data suggested a potential link between hypothyroidism and AATD.

Prevalence of anemia in Chinese nursing home older adults: Implication of age and renal impairment

There is little data regarding the prevalence and associated comorbidities of anemia in Chinese nursing home older adults. The objective of this study was to investigate the prevalence and associated comorbidities of anemia in Chinese nursing home older adults. We carried out a retrospective cross-sectional study in nine nursing homes in Hong Kong. The hemoglobin (Hb) level, mean corpuscular volume (MCV), serum creatinine and comorbidities data of residents were examined. Older adults were regarded as anemic according to the World Health Organization criteria (Hb <13 g/dL for men and <12 g/dL for women). The glomerular filtration rate (eGFR) was estimated by the Modification of Diet in Renal Disease Study (MDRD [Chinese-adjusted]) equation. Patients with chronic renal impairment were defined as having eGFR <60 mL/min/1.73 m(2) . A total of 812 residents were included (mean age 86.0 ± 7.6 years). The mean hemoglobin was 12.0 ± 1.8 g/dL in men and 11.4 ± 1.6g/dL in women. The mean eGFR was 75.1 ± 31.7 mL/min/1.73 m(2) . A total of 67.0% of residents had anemia (70.5% in men and 65.2% in women). Anemic older adults were older and had a higher prevalence of renal impairment than non-anemic older adults (P<0.001). There was no significant difference between the two groups regarding the prevalence of other comorbidities. When stratified into different age groups, there were significant correlations between anemia and renal impairment in all subgroups (age ≤ 80 years, P<0.05; age 81-90 years, P<0.01; age >90 years, P<0.05). The same correlation was found between normocytic anemia and renal impairment. Conversely, when stratified according to eGFR (≥ 60 mL/min/1.73 m(2) vs <60 mL/min/1.73 m(2) ), we did not observe a significant correlation between anemia and age group. In conclusion, anemia is prevalent in Chinese nursing home residents and is strongly associated with renal impairment. Further studies of early identification and management of anemia with renal impairment are recommended in this population.

Clinical Impact and Cost of Monitoring for Asymptomatic Laboratory Abnormalities among Patients Receiving Antiretroviral Therapy in a Resource‐Poor Setting

Laboratory monitoring for toxicity among patients receiving antiretroviral therapy (ART) in less-developed settings is technically challenging and consumes significant resources. We conducted a cohort study of the 1800 adult patients who initiated ART at the Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO) in Haiti from 2003 to 2006, using baseline data to establish the prevalence and using follow-up data to establish the incidence of hepatitis, renal insufficiency, hyperglycemia, anemia, neutropenia, and thrombocytopenia. We determined how frequently routine (not symptom-driven) testing detected significant laboratory abnormalities and calculated the cost per disability-adjusted life year (DALY) averted by detection of these events in the asymptomatic stage, compared with a strategy of symptom-prompted testing only. Forty-eight patients (3.5%) had severe anemia at baseline testing and consequently did not receive zidovudine. Fifty-three patients receiving zidovudine therapy developed severe anemia during follow-up (incidence, 2.5 cases/100 person-years). Monitoring for asymptomatic anemia with hematocrit testing was cost-saving at baseline and had a cost-effectiveness ratio of US$317/DALY averted during follow-up; with a complete blood count, costs increased to US$1182 and $10,781/DALY averted, respectively. With glucose monitoring, 11 patients were diagnosed with new-onset hyperglycemia during follow-up (incidence, 0.7 cases/100 person-years), resulting in a cost-effectiveness ratio of US$9845 per DALY averted. Monitoring for asymptomatic hepatitis and renal insufficiency was expensive and rarely affected care. Resource-poor countries should select which laboratory tests to perform on the basis of the cost-effectiveness of each test. This will depend on the national ART drug regimen and the prevalence of other comorbidities. Routine monitoring with multitest hematological and chemistry panels is unlikely to be cost-effective.

Pregnancy Outcome in Systemic Lupus Erythematosus (SLE) is Improving: Results from a Case Control Study and Literature Review

ObjectivesFor women who suffer from systemic lupus erythematosus (SLE), pregnancy can be a concern, placing the mother and fetus at risk. Our objectives were to assess the risk of adverse pregnancy outcome, disease flares, fertility rate, and co-morbidities in SLE women compared to healthy controls. We also systematically reviewed the literature available on pregnancy outcome in SLE to compare our results to other published data. Our hypothesis was that pregnancy outcome in SLE is improving over time.MethodsA case-control study comparing self-report of the above-mentioned parameters in SLE (N=108) vs healthy controls or patients with non-inflammatory musculoskeletal (MSK) disorders (N=134) was performed. Data were collected using a self-administered questionnaire. Proportions, means and odds ratios were calculated. We searched and quantified the literature on pregnancy outcome, lupus reactivation and fertility rate. Data were summarized and presented in mean % ± SEM and median % with interquartile range (IQR).ResultsGynecological history, fertility rate and age at first pregnancy in SLE patients were comparable to controls. Eighteen percent of SLE patients reported a flare and 18% reported an improvement of symptoms during pregnancy. Twenty-four percent of lupus patients had at least one preterm delivery vs 5% in controls (OR =8.32, p = 0.0008), however other pregnancy outcomes (miscarriage, therapeutic abortion, stillbirth and neonatal death rate) did not differ between the groups. Thyroid problems were reported to be more likely in SLE patients (p = 0.02), but the prevalence of other co-morbidities was similar to controls. A literature review demonstrated that fertility was not affected in SLE patients. Lupus reactivations are common during pregnancy (36.5% ± SEM 3.3%). Most agreed that SLE pregnancies had more fetal loss (19.5% ± SEM 1.6%) and preterm births (25.5% ± SEM 2.2%) when compared to the general population. Over time, the rate of SLE peripartum flares has improved (p = 0.002) and the proportion of pregnancies resulting in live birth has increased (p = 0.024). The frequency of fetal death has not significantly changed. Our findings from the case-control study were, in general, consistent with the literature including the frequency of fetal death, neonatal death, live births and pregnancy rate.ConclusionPrematurity (25.5% ± SEM 2.2%) and fetal death (19.5% ± SEM 1.6%) in SLE pregnancy are still a concern. However, new strategies with respect to pregnancy timing and multidisciplinary care have improved maternal and fetal outcome in SLE.

Poster 178: Comorbidities of Lower-Extremity Lymphedema in Patients With and Without Cancer as the Etiology

Objective: Although comorbidities associated with upper-extremity lymphedema have been described to some extent, less is known with respect to lower-extremity lymphedema. The objective of this study was to identify the most common comorbidities in patients with cancer and non-cancer related lower-extremity lymphedema. Design: Retrospective chart review. Setting: Lymphedema clinic in the physical medicine and rehabilitation department of an academic medical center. Participants: 34 individuals with lower-limb lymphedema of various etiologies. Interventions: Not applicable. Main Outcome Measures: Demographic data (age and sex); lymphedema severity and laterality; causes (cancer/noncancer); comorbidities (pain, skin problems, weakness, infection, depression, contractures, obesity, neuropathy, tendinopathy). Results: There were 7 men and 27 women. 20 patients (59%) had cancer diagnoses and 14 (41%) had noncancer diagnoses. More than one third (35%) exhibited severe lymphedema and more than one half (55%) exhibited bilateral involvement. Overall, most patients had more than 1 comorbidity with the most common being obesity (68%), pain (62%), and skin problems (38%). The cancer group tended to be women (90% vs 64%, P=0.07) and older (58.6 vs 50.1, P=0.10) with lower incidence of severe lymphedema (25% vs 50%, P=0.13). The prevalence of obesity was higher in the noncancer group (93% vs 56%, P<0.01). Patients in the noncancer group also tended to have higher prevalence of skin problems (57% vs 25%, P=0.06) and pain (79% vs 55%, P=0.09). The prevalence of other comorbidities was similar between groups. Conclusions: The majority of patients with lower-extremity lymphedema in this series were women, with the most common comorbidities being obesity, pain, and skin problems. The cancer group tended to be women and older with less severe lymphedema. The noncancer group was more likely to exhibit obesity, and to a lesser extent, a pain and skin problems.

Comprehensive geriatric assessment (CGA) in elderly women with early breast cancer

19641 Background: Advancing age is a major risk factor for breast cancer. Long-term follow up is recommended after diagnosis and treatment of early breast cancer. With older age, the risk of comorbid conditions and functional impairment is increased. A useful tool in the management and follow-up of these elderly patients could be a CGA Methods: Purpose of the study: Descriptive, transversal study of the prevalence of other comorbidities and of the functional impairment in elderly patients on follow-up after curative treatment of early breast cancer. Patients: Women aged ≥ 70 years at time of diagnosis, with removed early breast cancer. Attended in a outpatient unit from January 2005 to June 2006. No disease recurrences were allowed. Methods: CGA was conducted in an oncology unit. The assessment used usual screening instruments (ADL, IADL, POMA, GDS, MMSE, MNA) as well as the performance status (PS). Co-morbidity was classified using the Charlson score. Results: 91 pts underwent CGA. Mean age at surgery of primary tumour: 76 (70–92). Mean age at time of CGA: 80 (71–95). &gt; 75% of patients had more than 84 years at time of GCA: Median follow up: 5 years (1–12). 47% PS 0. 9% PS 2. 83% were fully independent for ADL and 71% for IADL. IADL most affected was the ability to drive/use public transport. Median Charlson Score was 2 (1–6). ≥ 75% of patients had score ≥4. Most frequent comorbidity: cardiovascular disease (hypertension). Cognitive deterioration: 15%, depression: 16%. Only 28% were thin (BMI&lt; 22). 75% were polymedicated (&gt; 6 drugs). 28% had geriatric syndromes. 23% were “frail” (at least one of the following items): ADL &lt; 80; ≥ 3 comorbidities, performance status &lt; 60, ≥ 1 geriatric syndrome. Conclusions: Our results are better than reports from other geriatric teams using CGA, in terms on functional status and frailty. A high prevalence of comorbidity in our study, similar to other reports. A selection bias cannot be excluded, as the fitter patients are those that usually keep on with the follow-up. While those frail patients that do not due to their functional impairment are usually lost. Older patients with early breast cancer on follow-up have a high prevalence of comorbidity. However, in our serie, function and independence is maintained. No significant financial relationships to disclose.