Significant Subgroup Differences Research Articles

Higher cystatin C level increases the risk of delayed cerebral ischemia after endovascular treatment of aneurysmal subarachnoid hemorrhage: a case-control study.

Cystatin C (CysC) has been found to be associated with hemorrhagic and ischemic stroke in many studies. However, the association between CysC level and the risk of delayed cerebral ischemia after endovascular treatment of aneurysmal subarachnoid hemorrhage has been reported rarely. Our study was proposed to explore this association. Consecutive patients from June 2015 to February 2021 in this single-center retrospective study were selected. Univariate and multivariate analyses were used to identify potential prognostic risk factors for delayed cerebral ischemia, and the stability of the association was demonstrated by several statistical methods, such as subgroup analysis, interaction testing, generalized linear models, and propensity score matching. A total of 424 patients were included in the analysis. Cystatin C was independently associated with delayed cerebral ischemia. The independent effects of CysC on delayed cerebral ischemia were shown in generalized linear models with a logit link, and the results were relatively stable in crude, partial, and full models with ORs (95% CIs) for delayed cerebral ischemia. Subgroup analysis showed no significant subgroup differences in the effect of CysC on delayed cerebral ischemia. There was also no interaction effect between CysC and other confounders. Patients in the high CysC group had a higher risk of delayed cerebral ischemia than those in the low CysC group before and after propensity score matching. CysC level could be an independent predictor for the risk of delayed cerebral ischemia after endovascular treatment of aneurysmal subarachnoid hemorrhage.

Correlation between diffusion kurtosis and intravoxel incoherent motion derived (IVIM) parameters and tumor tissue composition in rectal cancer: a pilot study.

To correlate non-invasive quantitative diffusion kurtosis imaging (DKI) and intravoxel incoherent motion-derived (IVIM) parameters with rectal cancer composition assessed by the expression of caudal-type homeobox 2 (CDX-2), Vimentin (VIM), CD34 and Ki-67 on resected tissues, as well as the tumor stroma ratio (TSR) and the results of H&E and Masson staining. A prospective study of 26 patients with rectal cancer who underwent magnetic resonance (MR) imaging, including DKI with 4 b values and IVIM at 3.0T prior to surgery. Primary tumor was harvested and fixed for H&E, immunohistochemistry and Masson staining. One-way ANOVA was used to test the differences. Pearson correlation coefficients and multiple linear regression analyses were applied to evaluation the correlations. The apparent diffusion coefficient (ADCDKI) and MKDKI all exhibited significant differences in subgroups with different T stages (P < 0.05) and among high- and low- grade rectal cancer (P < 0.05). MDDKI showed a moderate negative correlation with CDX-2 (r = - 0.42, P = 0.040) and a moderate positive correlation with CD34 (r = 0.42, P = 0.041). ADCIVIM exhibited a moderate positive correlation with Masson staining (r = 0.426, P = 0.048) DIVIM showed a moderate negative correlation with CDX-2 (r = - 0.58, P = 0.005). [Formula: see text] showed a moderate positive correlation with VIM (r = 0.445, P = 0.033). ADCDKI and MKDKI demonstrated a higher correlation with T stages and histologic grades. MDDKI showed significant correlations with CDX-2 and CD34. ADCIVIM showed significant correlation with Masson. DIVIM showed significant correlations with CDX-2 and [Formula: see text] showed significant correlation with VIM. These findings should be validated in a larger study.

Prevalence of Secondary Hypertension in Otherwise Healthy Youths with a New Diagnosis of Hypertension: A Meta-Analysis

To estimate the prevalence of secondary hypertension among otherwise healthy children with hypertension diagnosed in the outpatient setting. The MEDLINE, PubMed Central, Embase, Web of Science, and Cochrane Library databases were systematically searched for observational studies reporting the prevalence of secondary hypertension in children who underwent evaluation for hypertension and had no known comorbidities associated with hypertension at the time of diagnosis. Two authors independently extracted the study-specific prevalence of secondary hypertension in children evaluated for hypertension. Prevalence estimates for secondary hypertension were pooled in a random-effects meta-analysis. Nineteen prospective studies and 7 retrospective studies including 2575 children with hypertension were analyzed, with a median of 65 participants (range, 9-486) in each study. Studies conducted in primary care or school settings reported a lower prevalence of secondary hypertension (3.7%; 95% CI, 1.2%-7.2%) compared with studies conducted in referral clinics (20.1%; 95% CI, 11.5%-30.3%). When stratified by study setting, there were no significant subgroup differences according to study design, country, participant age range, hypertension definition, blood pressure device, or study quality. Although the studies applied different approaches to diagnosing secondary hypertension, diagnostic evaluations were at least as involved as the limited testing recommended by current guidelines. The low prevalence of secondary hypertension among children with a new diagnosis of hypertension identified on screening reinforces clinical practice guidelines to avoid extensive testing in the primary care setting for secondary causes in most children with hypertension.

Effects of replacement therapies with clotting factors in patients with hemophilia: A systematic review and meta-analysis

Different prophylactic and episodic clotting factor treatments are used in the management of hemophilia. A summarize of the evidence is needed inform decision-making. To compare the effects of factor replacement therapies in patients with hemophilia. We performed a systematic search in PubMed, Central Cochrane Library, and Scopus. We included randomized controlled trials (RCTs) published up to December 2020, which compared different factor replacement therapies in patients with hemophilia. Random-effects meta-analyses were performed whenever possible. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. The study protocol was registered in PROSPERO (CRD42021225857). Nine RCTs were included in this review, of which six compared episodic with prophylactic treatment, all of them performed in patients with hemophilia A. Pooled results showed that, compared to the episodic treatment group, the annualized bleeding rate was lower in the low-dose prophylactic group (ratio of means [RM]: 0.27, 95% CI: 0.17 to 0.43), intermediate-dose prophylactic group (RM: 0.15, 95% CI: 0.07 to 0.36), and high-dose prophylactic group (RM: 0.07, 95% CI: 0.04 to 0.13). With significant difference between these subgroups (p = 0.003, I2 = 82.9%). In addition, compared to the episodic treatment group, the annualized joint bleeding rate was lower in the low-dose prophylactic group (RM: 0.17, 95% CI: 0.06 to 0.43), intermediate-dose prophylactic group (RM of 0.14, 95% CI: 0.07 to 0.27), and high-dose prophylactic group (RM of 0.08, 95% CI: 0.04 to 0.16). Without significant subgroup differences. The certainty of the evidence was very low for all outcomes according to GRADE methodology. The other studies compared different types of clotting factor concentrates (CFCs), assessed pharmacokinetic prophylaxis, or compared different frequencies of medication administration. Our results suggest that prophylactic treatment (at either low, intermediate, or high doses) is superior to episodic treatment for bleeding prevention. In patients with hemophilia A, the bleeding rate seems to have a dose-response effect. However, no study compared different doses of prophylactic treatment, and all results had a very low certainty of the evidence. Thus, future studies are needed to confirm these results and inform decision making.

Teletherapy Versus In-Person Psychotherapy for Depression: A Meta-Analysis of Randomized Controlled Trials.

Introduction: The recent surge in telehealth service delivery represents a promising development in the field's ability to address access gaps in health care across underserved populations. Telehealth also carries the potential to help reduce the societal burden of mental illnesses such as major depression, which often go untreated. There is now a sufficiently large corpus of randomized controlled trials to examine the comparative effectiveness of teletherapy and in-person services meta-analytically. Methods: We searched the PubMed, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for articles from January 1, 2000 to February 1, 2021 to identify randomized head-to-head trials of video-based versus in-person delivery of psychotherapy to reduce depressive symptoms. We conducted a random-effects meta-analysis to evaluate potential differences in efficacy rates. We calculated and meta-analyzed odds ratios to examine differential attrition rates between video and in-person conditions. Finally, we conducted subgroup analyses based on the primary treatment focus (depression or another condition) of each trial. Results: Primary study analyses yielded evidence that video-based psychotherapy is roughly comparable in efficacy with in-person psychotherapy for reducing depressive symptoms (g = 0.04, 95% confidence interval [CI = -0.12 to 0.20], p = 0.60, I2 = 5%). Likewise, attrition rates between the two conditions were not significantly different (odds ratio = 1.07, 95% CI = [0.78 to 1.49], p = 0.63, I2 = 25%). Finally, we did not observe significant subgroup differences in either efficacy (p = 0.38) or attrition (p = 0.94). Conclusions: The present findings suggest that video-based teletherapy may be a feasible and effective alternative to in-person services for reducing depressive symptoms. Continued research on the effectiveness of telehealth in clinically depressed samples, and further elucidation of the access barriers entailed by each delivery modality, can help the field better determine which patients will derive the greatest benefit from each mode of intervention.

Association of Smoking Status with Efficacy of First-line Immune Checkpoint Inhibitors in Advanced Non-small Cell Lung Cancers: A Systematic Review and Meta-analysis.

Background: Although smoking status has potential as a biomarker for immune checkpoint blockade in advanced non-small cell lung cancer (NSCLC), its clinical significance remains obscure. This meta-analysis aims to assess the impact of the smoking status on the efficacy of first-line immunotherapy and to find better treatment in never-smoker and ever-smoker patients.Methods: We searched the MEDLINE, EMBASE, and Cochrane database for trials comparing immunotherapy with conventional chemotherapy as front-line treatment for advanced NSCLC. Random-effects models were used to pool estimates of hazard ratios (HRs) for overall survival with 95% confidence intervals (CIs). Predefined subgroup analysis was performed to investigate the difference in the efficacy between the single checkpoint blockade and checkpoint inhibitor plus chemotherapy combination in the never-smokers and current/former smokers.Results: Twelve trials involving 6,446 patients were included in the analysis. A statistically significant overall survival benefit over conventional chemotherapy was found for both checkpoint inhibitor monotherapy (HR, 0.71; 95% CI, 0.59-0.85) and checkpoint inhibitor plus chemotherapy (HR, 0.75; 95% CI, 0.63-0.90) in the current/former smoker group. There was no subgroup difference between monotherapy and combination treatment (p=0.67). However, there was an inconsistent survival outcome in the never-smoker group; checkpoint blockade monotherapy did not show significantly better efficacy than chemotherapy alone (HR, 1.05; 95% CI, 0.81-1.37), but combination treatment showed an overall survival benefit (HR, 0.64; 95% CI, 0.43-0.94). A significant subgroup difference existed between monotherapy and combination therapy (p=0.04). Similarly, there was a significant difference in efficacy of monotherapy between the current/former smoker and never-smoker group (p=0.01), but the efficacy of the combination treatment was comparable between the two groups (p=0.45).Conclusion: Smoking status, which is easily available information, could be used as a guide in clinical practice to choose better treatment in the front-line setting for advanced NSCLC patients.

Risk of cardiovascular events in patients with non-alcoholic fatty liver disease: a systematic review and meta-analysis.

Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent disease and has been repeatedly associated with an increased risk of cardiovascular disease. However, the extent of such association is unclear. We conducted a systematic review and meta-analysis of the literature to evaluate the risk of myocardial infarction (MI), ischaemic stroke (IS), atrial fibrillation (AF), and heart failure (HF) in NAFLD patients. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically searched PubMed and EMBASE, from inception to 6 March 2021, and included all studies reporting the incidence of MI, IS, AF, and HF in patients with and without NAFLD. Random-effect fmodels were used to estimate pooled odds ratio (OR), 95% confidence intervals (CI), and 95% prediction intervals (PI); subgroup analyses, meta-regressions, and sensitivity analyses were additionally performed. Among 3254 records retrieved from literature, 20 studies were included. Non-alcoholic fatty liver disease was associated with an increased risk of MI (OR: 1.66, 95% CI: 1.39-1.99, 95% PI: 0.84-3.30), IS (OR: 1.41, 95% CI: 1.29-1.55, 95% PI 1.03-1.93), AF (OR: 1.27, 95% CI: 1.18-1.37, 95% PI: 1.07-1.52), and HF (OR: 1.62, 95% CI: 1.43-1.84, 95% CI: 1.04-2.51). We identified significant subgroup differences according to geographical location, study design, NAFLD definition, and risk of bias; meta-regressions identified mean age, male sex, and study-level characteristics as potential moderators of the risk of MI and IS. Non-alcoholic fatty liver disease was associated with increased risk of MI, IS, AF, and HF. Age, sex, and study characteristics may moderate the strength of this association. Further studies are required to evaluate specific cardiovascular prevention strategies in patients with NAFLD.

The state of response of autonomic nervous system in children with mitral valve prolapse

The article presents summarized materials on connective tissue dysplasia of the heart, primary mitral valve prolapse, dysfunction of the autonomic system. Aim of research: to estimate the condition of autonomic nervous system in children with primary mitral valve prolapse. We examined 106 children with mitral valve prolapse aged from 13 to 17 years old on the clinical base of city hospital “Center of mother and child” in Vinnitsya. Research included time and frequency domain (evaluation with cardiointervalography. Final results were compared with the control group records. The results showed no statistical significance among time domain parameters in the main group of children. All these indices displayed tendency to sympathetic and parasympathetic autonomic nervous system tonus increase in boys. However, sympathicotonia tendency was noted in girls only. Frequency domain parameters showed similar results, compared with the previous. Nevertheless, very low frequency parameters had statistically significant difference in both subgroups of patience with mitral valve prolapse, including males (3205.8±190.9 against 1717±154, р&lt;0.05) and females (3280±220.1 against 1433±811, р&lt;0.05). There were no statistically significant difference among other frequency domain parameters. Conclusions: we estimated that children with mitral valve prolapse have imbalanced autonomic homeostasis manifested by tone disturbances of both autonomic vegetative system branches with sympathetic predominance. Patients with primary mitral valve prolapse generally have increased sympathetic tone - both boys and girls - according to spectral analysis of heart rate variability indices, heart rate oscillation power of a very low frequency in particular (p&lt;0.05). In children with mitral valve prolapse, the tone of parasympathetic nervous system is generally normal; there is a tendency to its increase in boys and decrease in girls. These children should be under close medical supervision by pediatricians and cardiologists.

Intensive care unit versus high-dependency care unit for patients with acute heart failure: a nationwide propensity score-matched cohort study

BackgroundA structure and staffing model similar to that in general intensive care unit (ICUs) is applied to cardiac intensive care unit (CICUs) for patients with acute heart failure. However, there is limited evidence on the structure and staffing model of CICUs. The present study aimed to assess whether critical care for patients with acute heart failure in the ICUs is associated with improved outcomes than care in the high-dependency care units (HDUs), the hospital units in which patient care levels and costs are between the levels found in the ICU and general ward.MethodsThis nationwide, propensity score-matched, retrospective cohort study was performed using a national administrative inpatient database in Japan. We identified all patients who were hospitalized for acute heart failure and admitted to the ICU or HDU on the day of hospital admission from April 2014 to March 2019. Propensity score-matching analysis was performed to compare the in-hospital mortality between acute heart failure patients treated in the ICU and HDU on the day of hospital admission.ResultsOf 202,866 eligible patients, 78,646 (39%) and 124,220 (61%) were admitted to the ICU and HDU, respectively, on the day of admission. After propensity score matching, there was no statistically significant difference in in-hospital mortality between patients who were admitted to the ICU and HDU on the day of admission (10.7% vs. 11.4%; difference, − 0.6%; 95% confidence interval, − 1.5% to 0.2%). In the subgroup analyses, there was a statistically significant difference in in-hospital mortality between the ICU and HDU groups among patients receiving noninvasive ventilation (9.4% vs. 10.5%; difference, − 1.0%; 95% confidence interval, − 1.9% to − 0.1%) and patients receiving intubation (32.5% vs. 40.6%; difference, − 8.0%; 95% confidence interval, − 14.5% to − 1.5%). There were no statistically significant differences in other subgroup analyses.ConclusionsCritical care in ICUs was not associated with lower in-hospital mortality than critical care in HDUs among patients with acute heart failure. However, critical care in ICUs was associated with lower in-hospital mortality than critical care in HDUs among patients receiving noninvasive ventilation and intubation.

Endogenous Oxytocin Levels in Autism-A Meta-Analysis.

Oxytocin (OT) circuitry plays a major role in the mediation of prosocial behavior. Individuals with autism spectrum disorder (ASD) are characterized by impairments in social interaction and communication and have been suggested to display deficiencies in central OT mechanisms. The current preregistered meta-analysis evaluated potential group differences in endogenous OT levels between individuals with ASD and neurotypical (NT) controls. We included 18 studies comprising a total of 1422 participants. We found that endogenous OT levels are lower in children with ASD as compared to NT controls (n = 1123; g = −0.60; p = 0.006), but this effect seems to disappear in adolescent (n = 152; g = −0.20; p = 0.53) and adult populations (n = 147; g = 0.27; p = 0.45). Secondly, while no significant subgroup differences were found in regard to sex, the group difference in OT levels of individuals with versus without ASD seems to be only present in the studies with male participants (n = 814; g = −0.44; p = 0.08) and not female participants (n = 192; g = 0.11; p = 0.47). More research that employs more homogeneous methods is necessary to investigate potential developmental changes in endogenous OT levels, both in typical and atypical development, and to explore the possible use of OT level measurement as a diagnostic marker of ASD.

Examining Ways to Improve Weight Control Programs' Population Reach and Representativeness: A Discrete Choice Experiment of Financial Incentives.

BackgroundBoth theoretical and empirical evidence supports the potential of modest financial incentives to increase the reach of evidence-based weight control programs. However, few studies exist that examine the best incentive design for achieving the highest reach and representativeness at the lowest cost and whether or not incentive designs may be valued differentially by subgroups that experience obesity-related health disparities.MethodsA discrete choice experiment was conducted (n = 1232 participants; over 90% of them were overweight/obese) to collect stated preference towards different financial incentive attributes, including reward amount, program location, reward contingency, and payment form and frequency. Mixed logit and conditional logit models were used to determine overall and subgroup preference ranking of attributes. Using the National Health and Nutrition Examination Survey data sample weights and the estimated models, we predicted US nationally representative participation rates by subgroups and examined the effect of offering more than one incentive design. External validity was checked by using a completed cluster randomized control trial.ResultsThere were significant subgroup differences in preference toward incentive attributes. There was also a sizable negative response to larger incentive amounts among African Americans, suggesting that higher amounts would reduce participation from this population. We also find that offering participants a menu of incentive designs to choose from would increase reach more than offering higher reward amounts.ConclusionsWe confirmed the existence of preference heterogeneity and the importance of subgroup-targeted incentive designs in any evidence-based weight control program to maximize population reach and reduce health disparities.

The change of gut microbiota-derived short-chain fatty acids in diabetic kidney disease.

BackgroundPrevious studies found the dysbiosis of intestinal microbiota in diabetic kidney disease (DKD), especially the decreased SCFA‐producing bacteria. We aimed to investigate the concentration of the stool and serum short‐chain fatty acids (SCFAs), gut microbiota‐derived metabolites, in individuals with DKD and reveal the correlations between SCFAs and renal function.MethodsA total of 30 participants with DKD, 30 participants with type 2 diabetes mellitus (DM), and 30 normal controls (NC) in HwaMei Hospital were recruited from 1/1/2018 to 12/31/2019. Participants with DKD were divided into low estimated glomerular filtration rate (eGFR)(eGFR<60ml/min, n=14) and high eGFR (eGFR≥60ml/min, n=16) subgroups. Stool and serum were measured for SCFAs with gas chromatograph‐mass spectrometry.ResultsThe DKD group showed markedly lower levels of fecal acetate, propionate, and butyrate versus NC (p<0.001, p<0.001, p=0.018, respectively) [1027.32(784.21–1357.90)]vs[2064.59(1561.82–2637.44)]μg/g,[929.53(493.65–1344.26)]vs[1684.57(1110.54–2324.69)]μg/g,[851.39(409.57–1611.65)] vs[1440.74(1004.15–2594.73)]μg/g, respectively, and the lowest fecal total SCFAs concentration among the groups. DKD group also had a lower serum caproate concentration than that with diabetes (p=0.020)[0.57(0.47–0.61)]vs[0.65(0.53–0.79)]μmol/L. In the univariate regression analysis, fecal and serum acetate correlated with eGFR (OR=1.013, p=0.072; OR=1.017, p=0.032). The correlation between serum total SCFAs and eGFR showed statistical significance (OR=1.019, p=0.024) unadjusted and a borderline significance (OR=1.024, p=0.063) when adjusted for Hb and LDL. The decrease in serum acetate and total SCFAs were found of borderline significant difference in both subgroups (p=0.055, p=0.050).ConclusionThis study provides evidence that in individuals with DKD, serum and fecal SCFAs levels (fecal level in particular) were lowered, and there was a negative correlation between SCFAs and renal function.

The need and duration of BB therapy in post MI patients with preserved left ventricular ejection fraction: a meta-analysis

Abstract Background Oral beta-blockers have beneficial effect on long-term mortality in high-risk as low left ventricular ejection fraction (LVEF) patients with MI, but the effect and duration of use of Beta-blockers in post-AMI patients with preserved LVEF is still unknown. Methods We performed a systematic search in Cochrane library, Embase, Medline, Pubmed, Scopus, Web of Science, clinical trial registries, and for eligible studies (26,431 patients). Data for outcomes were pooled as Hazard ratios (HRs), with 95% confidence interval, using RevMan software for windows. Results The pooled effect-estimate showed significant decrease in all cause mortality in beta-blocker group (HR 0.71, 95% CI 0.62–0.82). A subgroup analysis regarding duration of use of BB (≤1 year or &amp;gt;1 year), age (≤65 or ≥65),sex, use of CCB, presence of HTN or DM, and LVEF (≥50 or ≥40) was done. No significant subgroup differences were detected: duration of use of BB (p=0.32), age (p=0.23), sex (p=0.84), CCBs (p=0.28), HTN (p=0.32), DM (p=0.92),and LVEF (p=0.06). No significant differences between bet-blocker vs. no beta-blockers in terms of cardiac death (HR 0.69, 95% CI 0.33–1.46), re-infarction (HR1.00, 95% CI 0.68–1.48), re-hospitalization (HR1.08, 95% CI 0.32–3.68), and revascularization (HR 0.94, 95% CI 0.76–1.16). Conclusion Beta-blockers might reduce mortality of post-AMI patients with preserved LVEF, but failed to prevent cardiac events. The upcoming trials (REBOOT, BETAMI, DANBLOCK, and ABYSS) will define the use of Beta-blockers in post AMI patients with preserved Left ventricular ejection fraction. Funding Acknowledgement Type of funding sources: None.

Prevalence and impact of frailty in patients with atrial fibrillation: a systematic review and meta-analysis

Abstract Background Frailty is a clinical syndrome characterized by a reduced physiologic function, increased vulnerability to stressors, and an increased risk of adverse outcomes. Patients with Atrial Fibrillation (AF) are often burdened with a high number of comorbidities and prone to frailty. The prevalence of frailty, its management and association with major outcomes in patients with AF are still unclear. Purpose To estimate the pooled prevalence of frailty in patients with AF, as well as its association with AF-related risk factors and comorbidities, oral anticoagulants (OAC) prescription, and major outcomes. Methods We systematically searched PubMed and EMBASE, from inception to 31st January 2021, for studies reporting the prevalence of frailty (irrespective of the tool used for assessment). Pooled prevalence, odds ratio (OR), and 95% Confidence Intervals (CI) were computed using random-effect models; heterogeneity was assessed through the inconsistency index (I2). This study was registered in PROSPERO: CRD42021235854. Results A total of 1,116 studies were retrieved from the literature search, and 31 were finally included in the systematic review (n=842,521 patients). The frailty pooled prevalence was 39.6% (95% CI=29.2%-51.0%, I2=100%; Figure 1). Significant subgroup differences were observed according to geographical location (higher prevalence found in European-based cohorts; p=0.003) and type of tool used for the assessment (higher prevalence in studies using the Clinical Frailty Scale and Tilburg Frailty Index tools; p&amp;lt;0.001). Meta-regressions showed that study-level mean age and prevalence of hypertension, diabetes, and history of stroke were directly associated with frailty prevalence. Frailty was significantly associated with a 29% reduced probability of OAC prescription in observational studies (OR=0.71, 95% CI=0.62–0.81). Frail patients with AF were at higher risk of all-cause death (OR=4.12, 95% CI=3.15–5.41), ischemic stroke (OR=1.55, 95% CI=1.01–2.38), and bleeding (OR=1.55, 95% CI=1.12–2.14), compared to non-frail patients with AF. Conclusions In this systematic review and meta-analysis analysis, the prevalence of frailty was high in patients with AF, and associated with study-level mean age and prevalence of several stroke risk factors. Frailty may influence the management of patients, and worsening the prognosis for all major AF-related outcomes. Funding Acknowledgement Type of funding sources: None. Prevalence of Frailty among AF patients

BAUN score, a better predictive model of in-hospital and long-term outcomes in acute heart failure?

Abstract Introduction Patients hospitalized due to acute heart failure (AHF) compose a heterogeneous population whose prognosis is difficult to forecast. Previously, BAUN score has proven to be able to accurately predict in-hospital mortality (IHM) in AHF. We aimed to evaluate BAUN score performance in the prediction of long-term outcomes in this population, comparing it to the recently validated Get With The Guidelines (GWTG) score. Methods A retrospective analysis of 1052 patients admitted to a Cardiology ward due to AHF was performed. 268 patients were excluded due to data omission or therapy with sacubitril/valsartan. Using the variables systolic blood pressure, urea, brain natriuretic peptide and sodium at admission, BAUN score was calculated, ranging from 0–28 points. GWTG score was also calculated at the index event. ROC curve analysis was used to compare the predictive value of the two scores for IHM. Kaplan-Meyer and Cox-regression analysis were performed to evaluate BAUN score prediction ability for 24-month mortality (24-MM) and for the composite endpoint of 24-month rehospitalization or death (24-MH). Results Mean patient age was 77 (±10) years; 51% were men. Mean left ventricle ejection fraction (EF) was 49% (±16.4). An EF&amp;lt;40% was present in 31% of patients. IHM, 24-MM and 24-HM were 6.5%, 17.1% and 57.8%, respectively. Mean BAUN score was 7 (±5.64). Mean GWTG score was 49.7 (±9.8). ROC curve analysis for IHM prediction revealed a better performance of the BAUN score (AUC: 0.738p, &amp;lt;0.001) in comparison with GWTG score (AUC: 0.687, p&amp;lt;0.001). Patients were stratified into subgroups according to BAUN risk score – very-high risk (≥22), high risk (16–21), intermediate risk (5–15) and low risk (&amp;lt;5). Kaplan-Meyer analysis revealed a significant difference in 24-MM according to risk subgroup (very high: 35%, high: 26.7%, intermediate: 19.5%, low risk: 12.7%, χ2=16.304, p=0.001). When stratified by non-reduced or reduced EF (≥40% or &amp;lt;40%), there was still a significant mortality difference in subgroups with reduced (p=0.007) and borderline significant in patients with nonreduced EF (p=0.05). Kaplan-Meyer analysis also revealed a significant difference between subgroup risk for 24-MH (51%; 63.8%; 63.3% and 75%, respectively, for low, intermediate, high and very-high risk, χ2=21.237, p&amp;lt;0.001). Cox regression analysis demonstrated that BAUN score independently predicts 24-MM (HR: 1.056, p=0.043) and 24-MH (HR: 1.033, p=0.048), even after adjustment for other prognostic markers, such as atrial fibrillation, coronary artery disease, previous myocardial infarction, age, EF and GWTG score. Conclusion BAUN outperforms GWTG score for IHM prediction in AHF. It also independently predicts 24-MM and 24-MH. Its use may identify patients with high risk of mortality/readmission, in need of specialized care, and those patients with low risk of death, who might be candidates for lenient surveillance. Funding Acknowledgement Type of funding sources: None.

1389 Axillary Staging in Ductal Carcinoma in Situ with Microinvasion: A Systematic Review

Abstract Introduction Ductal carcinoma in situ with microinvasion (DCISM) is a rare subtype of DCIS, with a foci of tumour cells penetrating through the basement membrane. A conundrum for surgeons is that definitive diagnosis is made upon histological examination of the final specimen. In the UK, there are no specific guidelines on the role of axillary staging in the management of DCISM cases. Method A systematic review was conducted on the databases MEDLINE and Embase using the keywords: breast, DCISM, microinvasion, “ductal carcinoma in situ with microinvasion”, sentinel lymph node biopsy, SLNB, axillary staging was performed. 23 studies were selected for analysis. Primary outcome was the positivity of lymph node metastases; secondary outcome looked at characteristics of DCISM that may affect node positivity. Results 2959 patients were included. Significant heterogeneity was observed amongst the studies with regards to metastases (I2=61%; P &amp;lt; 0.01). Lymph node macrometastases was estimated to be 2%. Significant subgroup difference was not observed between SLNB technique and lymph node macrometastases (Q = 0.74; p = 0.69). Statistical significance was observed between the focality of the DCISM and lymph node macrometastases (Q = 8.71; p = 0.033). Conclusions DCISM is not linked with higher rates of clinically significant metastasis to axillary lymph nodes. Survival rates are very similar to those seen in cases of DCIS. Current evidence suggests that axillary staging in cases of DCISM will not change their overall management. A conscientious multidisciplinary team approach evaluating pre-operative clinical and histological information to tailor the management specific to individual cases of DCISM would be a preferred approach than routine axillary staging.

Effectiveness of Telehealth Interventions for Women With Postpartum Depression: Systematic Review and Meta-analysis

BackgroundPostpartum depression (PPD) is a prevalent mental health problem with serious adverse consequences for affected women and their infants. Clinical trials have found that telehealth interventions for women with PPD result in increased accessibility and improved treatment effectiveness. However, no comprehensive synthesis of evidence from clinical trials by systematic review has been conducted.ObjectiveThe aim of this study is to evaluate the effectiveness of telehealth interventions in reducing depressive symptoms and anxiety in women with PPD. To enhance the homogeneity and interpretability of the findings, this systematic review focuses on PPD measured by the Edinburgh Postnatal Depression Scale (EPDS).MethodsPubMed, The Cochrane Library, CINAHL, PsycINFO, CNKI, and Wanfang were electronically searched to identify randomized controlled trials (RCTs) on the effectiveness of telehealth interventions for women with PPD from inception to February 28, 2021. Data extraction and quality assessment were performed independently by two researchers. The quality of included studies was assessed using the Cochrane risk-of-bias tool, and meta-analysis was performed using RevMan 5.4 software.ResultsFollowing the search, 9 RCTs with a total of 1958 women with PPD were included. The EPDS (mean difference=–2.99, 95% CI –4.52 to –1.46; P<.001) and anxiety (standardized mean difference=–0.39, 95% CI –0.67 to –0.12; P=.005) scores were significantly lower in the telehealth group compared with the control group. Significant subgroup differences were found in depressive symptoms according to the severity of PPD, telehealth technology, specific therapy, and follow-up time (P<.001).ConclusionsTelehealth interventions could effectively reduce the symptoms of depression and anxiety in women with PPD. However, better designed and more rigorous large-scale RCTs targeting specific therapies are needed to further explore the potential of telehealth interventions for PPD.Trial RegistrationPROSPERO CRD42021258541; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258541

Between- and within-Group Differences in Fruit and Vegetable Purchases, Consumption, and BMI among Hispanic Farmers' Market Shoppers Who Use SNAP.

(1) Background: Despite considerable efforts to increase farmers’ market access (FM) and improve household fruit and vegetable (FV) purchasing in low-income communities, little is known about the FV purchasing and consumption characteristics of low-income Hispanic farmers’ market shoppers. (2) Methods: A secondary analysis of baseline data from a farmers’ market study conducted between 2015 and 2017 (n = 2825) was performed. Participants who also received supplemental nutrition assistance program (SNAP) completed a 31-item online survey assessing demographics, health characteristics, and FV purchasing and consumption habits. Descriptive statistics and bivariate analyses were used to assess between- and within-group differences amongst Hispanic and non-Hispanic households. Regression analyses were used to examine associations among BMI, FV purchasing and consumption, and household size for Hispanic and non-Hispanic households as well as for Hispanic subgroups. (3) Results: The sample included 515 Hispanic and 2310 non-Hispanic SNAP-using FM shoppers in 13 states. Despite experiencing significantly higher food insecurity (89% vs. 81%, non-Hispanic), Hispanic shoppers consumed similar amounts of FV (3.04 cups/day) and spent less doing so. Significant subgroup differences were identified for FV purchasing. (4) Conclusions: Findings emphasize the importance of food insecurity and household size in FV interventions and underscore the capacity of Hispanic families to maintain FV consumption.

Ethnic differences in response to lifestyle intervention for the prevention of type 2 diabetes in adults: A systematic review and meta-analysis.

The risk of type 2 diabetes mellitus (T2DM) varies by ethnicity, but ethnic differences in response to diabetes prevention interventions remain unclear. This systematic review and meta-analysis assessed ethnic differences in the effects of lifestyle interventions on T2DM incidence, glycemic outcomes (fasting glucose, 2-h glucose, HbA1c ), anthropometric measures (weight, BMI, waist circumference), and lifestyle behaviors (physical activity, energy intake, energy from fat, fiber intake). MEDLINE, EMBASE, and other databases were searched (to June 15, 2020) for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American, and African groups. Forty-four studies were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in T2DM incidence, glycemic outcomes, anthropometric measures, physical activity, and energy intake (all P < 0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI, and waist circumference (all P < 0.05) but not for T2DM incidence, fasting glucose, HbA1c , and physical activity (all P > 0.05). Few studies in non-European groups reported dietary intake. Lifestyle interventions in different ethnic groups may have similar effects in reducing incidence of T2DM although this needs to be confirmed in further studies.

1386Ethnic differences in lifestyle interventions for diabetes prevention: a systematic review and meta-analysis

Abstract Background The risk of type 2 diabetes varies by ethnicity, but ethnic differences in response to lifestyle interventions for diabetes prevention remain unclear. This systematic review and meta-analysis aimed to assess differences in the effects of lifestyle interventions on diabetes incidence, glycemic outcomes and anthropometric measures between ethnic groups. Methods MEDLINE, EMBASE, Pubmed, CINAHL, PsycInfo and EBM Reviews were searched (to June 2020) with no language restriction for randomized and non-randomized controlled trials on lifestyle interventions involving diet and/or physical activity in adults at risk of type 2 diabetes. Ethnicity was categorized into European, South Asian, Other Asian, Middle Eastern, Latin American and African groups based on the World Bank regions. Risk ratios for diabetes incidence and mean differences for glycemic outcomes (fasting glucose, 2-h glucose, HbA1c) and anthropometric measures (weight, BMI, waist circumference) were pooled using random-effects meta-analysis. Results Sixty articles representing 43 studies (18,691 participants) were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in diabetes incidence, glycemic outcomes and anthropometric measures compared with controls (all P&amp;lt;0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI and waist circumference (all P&amp;lt;0.05) but not for diabetes incidence, fasting glucose and HbA1c (all P&amp;gt;0.05). Conclusions Lifestyle interventions are similarly effective in reducing diabetes incidence, fasting glucose and HbA1c for all ethnic groups, however, 2-h glucose and anthropometric outcomes should be optimized in certain ethnic groups. Key messages Lifestyle intervention is likely effective in preventing the progression to type 2 diabetes equally across all ethnic groups.