Propensity-matched Control Group Research Articles

Health Behaviors of Breast Cancer Survivors with Hypertension: A Propensity Analysis of KNHANES III-V (2005-2012).

ObjectiveThis study examines health behaviors of breast cancer survivors with hypertension and compares them with those of non-cancer individuals with hypertension.MethodsIn this cross-sectional study, a total of 10,996 hypertensive adults (≥ 19 years) who participated in the 2005-2012 Korean National Health and Nutrition Examination Survey (KNHANES) were considered. Data on alcohol consumption, smoking, physical activity, antihypertensive medication adherence, self-reported diet control, and sodium intake were collected through self-report questionnaire. A total of 64 breast cancer survivors with hypertension and 10,932 non-cancer participants with hypertension were identified. To better compare health behaviors of the two groups, 56 breast cancer survivors and 280 non-cancer participants were selected through the 1:5 nearest available matching based on estimated propensity scores. Multivariate analysis was conducted to determine any differences between the two groups.ResultsAccording to multivariate analysis, breast cancer survivors with hypertension (n = 56) were significantly less likely to consume alcohol (odds ratio (OR): 3.75; 95% confidence interval (CI): 1.06-13.29) but significantly more likely to have sodium intake of more than 2400 mg (OR: 2.98; 95% CI: 1.27-6.97) than the propensity-matched control group (n = 280). There was no significant difference in other health behaviors between the two groups.ConclusionsBreast cancer survivors require active interventions for healthy behaviors related to the management of comorbid conditions such as hypertension to reduce the risk of cardiovascular disease and improve their overall survival rate.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Tricuspid annuloplasty concomitant with mitral valve surgery: Effects on right ventricular remodeling

Tricuspid valve annuloplasty (TVP) has been advocated concomitantly with left-sided cardiac surgery in case of more than moderate tricuspid regurgitation (TR) or tricuspid annular dilation (TAD) (diameter >40 mm or 21 mm/m²) even in the absence of significant TR. Data on postoperative right ventricular (RV) remodeling are lacking in such patients. Preoperative and postoperative echocardiography data from 45 consecutive TVP procedures, performed in mitral valve surgery in a single tertiary center, were retrospectively analyzed and compared with a propensity-matched control group of 33 procedures without concomitant TVP. RV function and geometry was analyzed by measuring RV size, fractional area change, and end-diastolic sphericity index (RVSI=long-axis length/short-axis width) and compared at baseline versus follow-up. At a mean follow-up of 5 months, a favorable change in RV geometry was observed in TVP patients (RVSI increased from 1.99 ± 0.33 to 2.21 ± 0.42; P=.001), whereas the opposite was observed in the control group (RVSI decreased from 2.34 ± 0.52 to 2.17 ± 0.13; P=.05). Only in control patients, indexed RV end-diastolic area increased significantly (P=.003). In TVP patients, when comparing patients with baseline more than moderate TR (n=13) to patients with isolated TAD (n=32), there was a significant decrease in RV end-diastolic area only in the group with more than moderate TR (from 12.9 ± 3.5 cm(2)/m(2) to 10.3 ± 1.9 cm(2)/m(2); P=.009). Adding TVP to mitral valve surgery in patients with more than moderate TR or TAD leads to favorable changes in RV geometry and prevents postoperative RV dilation. This is most pronounced in patients with more than moderate TR at baseline.

Transapical transcatheter aortic valve implantation vs conventional aortic valve replacement in high-risk patients with previous cardiac surgery: a propensity-score analysis†

The present analysis compared clinical and mid-term outcomes of patients with previous cardiac surgery undergoing transapical transcatheter aortic valve implantation (TAVI) with propensity-matched patients undergoing conventional redo aortic valve replacement (cAVR). Since 2008, 508 patients were treated with TAVI. Fifty-three of these patients presented with a history of cardiac surgery and underwent transapical TAVI using the Edwards SAPIEN bioprosthesis. A propensity-matched control group of 53 patients receiving cAVR was generated out of the hospital's database. The mean age for all the patients was 77.8 ± 4.5 years. The logistic EuroSCORE was 28.4 ± 13.6% in mean, and mean EuroSCORE II was 8.56 ± 3.93%. The mean follow-up time was 245 ± 323 days, which equated to a total of 700 patient-months. The observed hospital mortality did not differ significantly between TAVI and cAVR (TAVI: 9.4% and cAVR: 5.7%; P = 0.695). Six-month survival was 83.0% for the TAVI and 86.8% for the cAVR patients (P = 0.768). Postoperative bleedings (TAVI: 725 ± 1770 ml and cAVR: 1884 ± 6387; P = 0.022), the need for transfusion (TAVI: 1.7 ± 5.3 vs cAVR: 6.2 ± 13.7 units packed red blood cells (PRBC); P = 0.030), consecutive rethoracotomy (TAVI: 1.9% vs cAVR: 16.9%; P = 0.002) and postoperative delirium (TAVI: 11.5% vs cAVR: 28.3%; P = 0.046) were more common in the cAVR patients. The TAVI patients suffered more frequently from respiratory failure (TAVI: 11.3% vs cAVR: 0.0%; P = 0.017) and mean grade of paravalvular regurgitation (TAVI: 0.8 ± 0.2 vs cAVR: 0.0; P = 0.047). Although primary ventilation time (P = 0.020) and intensive care unit stay (P = 0.022) were shorter in the TAVI patients, mean hospital stay did not differ significantly (P = 0.108). Transapical TAVI as well as surgical aortic valve replacement provided good clinical results. The pattern of postoperative morbidity and mortality was different for both entities, but the final clinical outcome did not differ significantly. Both techniques can be seen as complementary approaches by means of developing a tailor-made and patient-orientated surgery.

Adherence to COPD guidelines in general practice: impact of an educational programme delivered on location in Danish general practices

The general practitioner (GP) is often the first healthcare contact for patients with chronic obstructive pulmonary disease (COPD). To determine whether participating in a standardised educational programme delivered in the GP's own practice is associated with adherence to COPD guidelines. A nationwide register-based observational before and after study was undertaken with a control group of propensity-matched practices (follow-up period 6 months). COPD was defined as age 40+ years and at least two prescriptions for inhaled medication. The educational programme consisted of a 3-hr teaching lesson with a respiratory specialist and five visits by a representative from the sponsoring pharmaceutical company focusing on assessment and management of patients including written algorithms. A one-to-one propensity-matched control group of practices was selected. Register data were used to compare the rate of spirometry testing, preventive consultations, and influenza vaccinations provided to COPD patients and the rate of spirometry testing in non-COPD individuals, assumed to reflect diagnostic activity. Data for 102 participating GP practices were analysed. Participating clinics had a significant increase in preventive consultations and influenza vaccinations (p<0.05). For the control group, a significant change was observed only for influenza vaccinations. No significant change was found when comparing participating and control clinics in the difference-in-difference estimator. However, a significant improvement was observed for the subgroup of 48 clinics with the lowest starting point of spirometry testing. Focused education of GPs and their staff delivered in the GPs' own practices may improve adherence to COPD guidelines, not least for clinics with a high potential for improvement.

Impact of oseltamivir on the incidence of secondary complications of influenza in adolescent and adult patients: results from a retrospective population-based study

ABSTRACTObjective: To assess the effectiveness of oseltamivir in reducing the risks of influenza-related secondary complications in otherwise healthy adolescent and adult patients aged ≥ 13 years.Research design and methods: Retrospective cohort analysis utilizing health insurance claims data in the USA (Thomson MarketScan Research Database) from six influenza seasons (October–March) between 2000 and 2006 to identify adults and adolescents (≥ 13 years) with influenza. Patients who received a prescription for oseltamivir within ±1 day of diagnosis were compared with a propensity-matched control group receiving no antiviral treatment. The first claim evidence of influenza was used to establish the study index date. Differences in outcomes were determined using Cox proportional hazards regression and expressed in terms of hazard ratios (HR) with 95% confidence intervals (CI).Main outcome measures: Diagnosis of pneumonia, any respiratory condition, otitis media and its complications, hospitalizations due to pneumonia, and hospitalization for any reason within 14 days of the index date. Healthcare expenditure within 30 days of the index date was also analyzed.Results: The oseltamivir and untreated control groups each included 36 751 eligible patients. Oseltamivir use reduced the risks of otitis media and its complications by 23% (HR=0.77; 95% CI: 0.65, 0.93), any respiratory disease by 18% (HR 0.82; 95% CI: 0.79, 0.86), and hospitalization for any reason by 22% (HR 0.78; 95% CI: 0.67, 0.91). There were no differences in any other clinical outcomes, including hospitalization for respiratory disease. Healthcare expenditure did not differ between the two groups.Limitations: The retrospective nature of the study meant that the findings may be susceptible to missing or lost data. The results obtained here represent individuals enrolled in private healthcare plans and may not, therefore, be representative of the entire US population. The lack of a virologic diagnosis of influenza, and an index date based on the first diagnosis of influenza rather than first exposure or symptom onset, may have resulted in a conservative estimate of treatment effect.Conclusions: Secondary complications of influenza, such as respiratory disease and otitis media, were reduced in patients treated with oseltamivir. The risk of hospitalization for respiratory diseases was not reduced, although there was a reduction in the risk of hospitalization for any reason. Clinical benefits observed with oseltamivir were not associated with a change in healthcare costs.