Six-year Mortality Research Articles

Surgical ablation, left atrial appendage occlusion or both? Nationwide registry analysis of cardiac surgery patients with underlying atrial fibrillation.

The aim of this study was to evaluate in-hospital outcomes and long-term survival of patients undergoing cardiac surgery with preoperative atrial fibrillation (AF). We compared different strategies, including no-AF treatment, left atrial appendage occlusion (LAAO) alone, concomitant surgical ablation (SA) alone or both. A retrospective analysis using the KROK registry included all patients with preoperative diagnosis of AF who underwent cardiac surgery in Poland between between January 2012 and December 2022. Risk adjustment was performed using regression analysis with inverse probability weighting of propensity scores. We assessed 6-year survival with Cox proportional hazards models. Sensitivity analysis was performed based on index cardiac procedure. Initially, 42510 patients with preoperative AF were identified, and, after exclusion, 33949 included in the final analysis. A total of 1107 (3.26%) received both SA and LAAO, 1484 (4.37%) received LAAO alone, 3921 (11.55%) SA alone and the remaining 27437 (80.82%) had no AF-directed treatment. As compared to no treatment, all strategies were associated with survival benefit over 6-year follow-up. A gradient of treatment was observed with the highest benefit associated with SA + LAAO followed by SA alone and LAAO alone (log-rank P < 0.001). Mortality benefits were reflected when stratified by surgery type with the exception of aortic valve surgery where LAAO alone fare worse than no treatment. Among patients with preoperative AF undergoing cardiac surgery, surgical management of AF, particularly SA + LAAO, was associated with lower 6-year mortality. These findings support the benefits of incorporating SA and LAAO in the management of AF during cardiac surgery.

Association Between Self-Perception of Aging and Long-Term Mortality in Elderly Patients with Hypertension in Rural China: A Possible Beneficial Effect of Nut Intake.

Previous research has consistently shown that self-perception of aging (SPA) is an important predictor of health and longevity, while Chinese rural elderly patients with hypertension had poorer SPA. Whether it was associated with their mortality kept unknown. The objective of this study was to investigate the long-term mortality and analyze the association between SPA and this mortality in the specific context of rural elderly patients with hypertension. This study is a longitudinal investigation of the mortality in elderly patients with hypertension in rural Suzhou, China. Sociodemographic and clinical data, SPA, and six-year mortality were investigated. We used binary logistic regression and subgroup analyses to assess the effect of SPA at baseline on six-year mortality. A total of 280 hypertensive patients aged 60 years and older participated in the study, of whom 21 died, with a six-year mortality rate of 7.5%. After controlling for covariates, the "Emotional representation" dimension (OR=2.824, 95% CI:1.034-7.712) in SPA remained a risk factor for death. In subgroup analyses of the group aged 75 years and older, high scores on the "Timeline cyclical" (OR=14.125, 95% CI: 1.258-158.593) and "Emotional representations" (OR=2.567, 95% CI:1.066-6.182) dimensions were associated with a higher risk of death, while weekly nut intake may have mitigated the negative SPA effect on mortality. Poorer self-perception of aging was associated with a high risk of mortality in rural elderly patients with hypertension, while the habit of weekly nut intake might help reduce this risk in the group aged 75 years or older.

Six-year mortality associated with living alone and loneliness in Swedish men and women born in 1930

BackgroundThis study examined how living alone and loneliness associate with all-cause mortality in older men and women.MethodsBaseline data from the Gothenburg H70 Birth Cohort Studies, including 70-year-olds interviewed in 2000 and 75-year-olds (new recruits) interviewed in 2005 were used for analyses (N = 778, 353 men, 425 women). Six-year mortality was based on national register data.ResultsAt baseline, 36.6% lived alone and 31.9% reported feelings of loneliness. A total of 72 (9.3%) participants died during the 6-year follow-up period. Cumulative mortality rates per 1000 person-years were 23.9 for men and 9.6 for women. Mortality was increased more than twofold among men who lived alone compared to men living with someone (HR 2.40, 95% CI 1.34–4.30). Elevated risk remained after multivariable adjustment including loneliness and depression (HR 2.56, 95% CI 1.27–5.16). Stratification revealed that mortality risk in the group of men who lived alone and felt lonely was twice that of their peers who lived with someone and did not experience loneliness (HR 2.52, 95% CI 1.26–5.05). In women, a more than fourfold increased risk of mortality was observed in those who experienced loneliness despite living with others (HR 4.52, 95% CI 1.43–14.23).ConclusionsLiving alone was an independent risk factor for death in men but not in women. Mortality was doubled in men who lived alone and felt lonely. In contrast, mortality was particularly elevated in women who felt lonely despite living with others. In the multivariable adjusted models these associations were attenuated and were no longer significant after adjusting for mainly depression in men and physical inactivity in women. Gender needs to be taken into account when considering the health consequences of living situation and loneliness.

NEUROPSYCHIATRIC SYMPTOMS AND MORTALITY FOR COGNITIVELY NORMAL OLDER MEXICAN AMERICANS

Abstract Objectives Neuropsychiatric symptoms (NPS) present in older adults with Alzheimer’s disease (AD) and other dementias are related to mortality. Research on the relationship between NPS and mortality in a non-dementia population has not been conducted. This study examines NPS as a predictor of six-year mortality among community dwelling Mexican Americans aged 80 years and older. Methods Data included 466 cognitively normal participants from wave 7 of the Hispanic Established Population for the Epidemiologic Study of Elderly. NPS were measured using the Neuropsychiatric inventory (NPI). Cox proportional hazard modes were used to estimate the hazard ratio (HR) of mortality. Results The hazard ratio death at six years was 1.02 (95 % CI, 1.00-1.04) as a function of having any NPI score and 1.09 (95% CI 1.02-1.17) for number of NPI conditions, controlling for demographic and health characteristics. Apathy, irritability, and aberrant motor behavior were all independently predictors of mortality. Conclusions NPS may be modifiable risk factors to increase survival time or may by indicative of underlying healthy problems. NPS may be related to underlying health conditions among older adults with normal cognitive functioning.

FC 103: Matched Control Study on Applied Long-Term Anti-Thrombotic Therapies and Clinical Outcome of Atrial Fibrillation in HD-Patients Based on German Network Data

Abstract BACKGROUND AND AIMS Hemodialysis (HD) patients (pts) with atrial fibrillation (AF) are at high risk for cardiovascular events, severe bleeding and rapid vascular/valvular calcification. Thus, antivitamin-K based oral anticoagulation (VK-OAC) for HD patients is debated, since prospective trials are missing and US register studies are often limited to 3–6 months OAC use. We studied AF risk-factors, long-term antithrombotic therapies and clinical outcomes in a large German HD cohort. METHOD We analysed pseudonymized benchmarking data in a German out-patient dialysis center network (Verband Deutsche Nierenzentren, DN) based on quarterly electronically transmitted data. Diagnoses coded by ‘International Classification of Diseases (ICD)’ and ‘Anatomical Therapeutical Chemical (ATC)’ drug codes of adult HD patients 2013–2018. RESULTS In 2013, 2753 (18%) of 15 682 HD-pts had AF as coded diagnosis. Baseline CHA2DS2-VASc (4.0/1.5 mean/SD) and HAS-BLED (3.2/0.9) risk-scores indicated high risk for embolism and bleeding. Charlson Comorbidity Index (CCI) was high (6.4/2.8) and median observation was 2.1 years (range 0.01–6 years). Beside HD-related heparin, four main OAC approaches were applied: no active therapy, VK-OAC+/-aspirin/clopidogrel (VK-OAC+/-Asp/Clop), heparin-based therapy (heparin+/-Asp/Clop) or 1–2 antithrombocyte drugs (Asp/Clop). A total of 959 pts (35%) changed therapy, but 1794 pts (65%) had no change in OAC regime during the 6 year study period and were used for final therapy-related outcome analysis (Table 1). Both AF risk-scores overestimated de-novo events. Total 6-year event rate was low (7.5%; &amp;lt;1.3% per year) and comparable for all anticoagulant therapies, especially for cerebral ischemic events (2.8%; range 1.2–3.7; NS). All three antithrombotic therapies had similar overall events as without active therapy (7.6 versus 7.3%), including cerebral adverse events (ischemic: 3.0 versus 2.6%; bleeding: 0.7 versus 0.6%; NS). Survival (Kaplan–Meier) was analysed for matched controls by propensity-score based on mortality risk factors in multivariate Cox regression: age (HR 1.05), sex (female HR 0.78), CCI (HR 1.07) and albumin (HR 0.93). Six-year mortality rates were high (63%) and matched analysis showed significant lower survival (P &amp;lt; 0.001) without anticoagulant (median 1.8 years) or on heparin-based therapy (1.7 years) than on Asp/Clop (2.9 years) or VK-OAC based therapy (2.8 years). This relation was similar for subgroups on age, CCI or changed therapy. CONCLUSION Our large study showed that baseline CHA2DS2-VASc and HAS-BLED scores had no predictive value for clinical events in HD pts with AF. Cerebral ischemic event rates over 6 years were low (&amp;lt;0.7%/year) and similar for all three antithrombotic therapies and even no active therapy, suggesting major benefit of regular dialysis-related heparin supply. Since median survival on Asp/Clop is similar to VK-OAC therapy and even 1 year better than on no active or heparin-based therapy, we conclude that antithrombotic therapy in HD patients with AF can effectively be done with Asp/Clop and VK-OAC should be avoided. For future prospective trials, we recommend to apply Asp/Clop as first-line control therapy evaluating new direct-acting oral anticoagulants (DOAK) and/or interventional approaches (i.e. left atrial appendage closure) in HD patients with AF.

Long-term prognostic impact of new-onset atrial fibrillation in patients with preserved and mildly reduced ejection fraction following myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Background/aim It is well known that atrial fibrillation (AF) significantly increases risk of short- and long-term mortality in patients with ST-elevation myocardial infarction (STEMI), especially in those with reduced left ventricular ejection fraction (EF), but its prognostic impact in patients with STEMI and preserved or mildly reduced EF is not well defined. The aim of this study was to analyse the prognostic impact of new-onset AF on long-term mortality in patients with preserved and mildly reduced EF after STEMI. Method we included 1874 consecutive STEMI patients treated with primary percutaneous coronary intervention (pPCI). New-onset AF was defined as electrocardiographic or monitoring evidence of a AF lasting at least 30 seconds in patients with no medical history of previous AF. Echocardiographic examination was performed before discharge, EF was calculated using bi-plane method. Preserved EF was defined as ≥50% and midly reduced EF was defined as EF 41-49%. Patients with cardiogenic shock at admission and patients with previous AF of any form (paroxysmal, persistent or permanent) were excluded. The follow-up period was 6 years. Results Among all analysed patients 491 (26.6%) patients were women and 1375 (73.4%) were men. The median age of all analysed patients was 58 (IQR 46, 69) years and median EF was 52% (IQR 45%, 57%). New-onset AF was registered in 78 (4.2%) patients. Among them 27 (34.6%) patients had AF at admission and 51 (65.4%) patients develop AF later at a median time 4 (IQR 1, 25) hours. Median duration of AF was 17 (IQR 6, 25) hours. All of the analyzed patients with new-onset AF were converted into sinus rhythm with medication (amiodarone) or they converted spontaneously upon myocardial revascularization. As compared with patients without AF, those with AF were older and presented more often with Killip class II and III; they had lower systolic blood pressure and creatinine clearance at admission; they had more often 3-vessel coronary artery disease (at initial angiogram), preprocedural flow TIMI=0 and postprocedural flow TIMI&amp;lt;3. EF values were similar among patients with and without AF 50% (IQR 44%, 55%) and 51% (IQR 45%, 55%) respectively, p=0.93. Six-year mortality was significantly higher in patients with new-onset AF as compared with patients without AF (14.1% vs 2.6%, respectively, p&amp;lt;0.001) as shown in Figure 1. In Cox regression model new-onset AF was an independent predictor of 6-year mortality–HR 4.53 (95% CI 2.29-8.94), p&amp;lt;0.001. Other independent predictors for 6-year mortality were older age, Killip class II and III at admission and baseline creatinine clearance &amp;lt;60ml/min/m2. Conclusion New-onset AF was a strong indepedent predictor for 6-year mortality in analyzed patients with preserved and mildly reduced EF after STEMI.

Comparison of Cardiovascular Risk and Events among Spanish Patients with and without Ocular Pseudoexfoliation.

The purpose of this study was to calculate and compare individual cardiovascular risk (CVR) and the development of cardiovascular events and mortality in patients with and without ocular pseudoexfoliation (PEX). A cohort study was carried out to compare two groups of patients who underwent cataract surgery: patients with (n = 99) and without PEX (n = 239). The CVR factors were recorded for all the subjects, and CVR was calculated for each individual using ERICE risk assessment charts. After a six-year follow-up, the cardiovascular events and mortality rates were compared between the two groups. The mean CVR was 36.41% in the PEX group and 33.72% in the non-PEX group (p = 0.13). High blood pressure was detected in significantly more PEX patients (71.4%) than non-PEX patients (58.6%, p = 0.035), yet no differences were found in the other CVR factors. The prevalence of cardiovascular events in the PEX and non-PEX patients was 17.1% and 12.5%, respectively (p = 0.26), with 5% of patients in the PEX group and 5% in the non-PEX group suffering an acute coronary event (p = 0.9). Moreover, 12% of the PEX patients and 7.5% of the non-PEX patients experienced a stroke (p = 0.17), and the six-year mortality rate was 29.3% in the PEX group and 25.9% in the non-PEX group (p = 0.52). PEX was associated with high blood pressure in our cohort of patients, although cardiovascular risk was not shown to be higher in this group. In addition, patients with PEX did not experience more cardiovascular events or have a higher mortality rate than patients without PEX during the period studied.

Anatomical and clinical risk stratification tool for mortality risk assessment following revascularization for multivessel coronary artery disease

ObjectiveThis study aimed to assess the prognostic ability of SYNTAX score II in left main and/or 3-vessel disease patients undergoing revascularization either by coronary artery bypass grafting or percutaneous coronary intervention in a national registry. MethodsThis prospective registry included consecutive patients with multivessel disease enrolled between January and April 2013 from all 22 hospitals in Israel that perform coronary angiography. Of the 1112 study patients, 368 patients (33%) had a low (<25), 372 (33%) had an intermediate (25-35) and 372 patients (33%) a high (≥35) SYNTAX score II. ResultsPatients with a high SYNTAX score II had higher 30-day mortality compared with those with an intermediate or low SYNTAX score II (2.8% vs 0.6% vs 0% respectively, P = .001). Each 1-unit increment in SYNTAX score II increased the odds for death at 30 days by 11% (95% CI, 1.02-1.22; P = .026). Six-year mortality was higher among patients with a high compared with an intermediate or low SYNTAX score II (34.9% vs 11% vs 3.8%; log-rank P < .001). By adding a SYNTAX score II to standard prognostic factors, we showed a significant improvement of 40.1% (P < .001) for predicting 6-year mortality. The area under the curve of the SYNTAX score II (continuous) yielded 0.79 (95% CI, 0.75-0.82) in predicting 6-year mortality. ConclusionsOur findings show that the admission SYNTAX score II is a powerful marker of short- and long-term mortality, and therefore may be used as a risk stratification tool in patients with multivessel coronary artery disease who are candidates for revascularization.

Impact of Balloon Postdilation on Six-Year Mortality After Transcatheter Aortic Valve Replacement

Balloon postdilation (BPD) is one strategy for decreasing paravalvular leakage, but its effect on long-term mortality remains unclear. The authors sought to clarify whether BPD influences long-term mortality of patients with transcatheter aortic valve replacement (TAVR). Single-center retrospective study. National heart center; single institution. Participants were patients who underwent TAVR in the authors' hospital from January 2014 to December 2016. A balloon-expandable Sapien XT or Sapien3, or self-expandable CoreValve or Evolute R, was implanted according to the decision of the surgeon considering degree of calcification of the aortic valve. No interventions. Multivariate Cox regression analysis and inverse probability weighted estimation were performed using a propensity score to examine whether BPD influenced six-year mortality. Ultimately, 180 patients were analyzed. During the follow-up period, with a median of 1104 (interquartile range: 730-1463) days, 41 patients died and cumulative incidence of mortality at six years was 22.8%. Society of Thoracic Surgeons score (odds ratio [OR]: 2.257, 95% CI: 1.213-4.197, p = 0.010)], BPD (OR: 0.306, 95% CI: 0.098-0.953, p = 0.041), and paravalvular regurgitation of at least moderate-to-mild severity after deploying (OR: 5.407, 95% CI: 1.626-17.978, p = 0.006) were significant factors of mortality. BPD is associated with reduced six-year mortality.

Clinical characteristics of late-life depression predicting mortality

Objective Depression has been associated with increased mortality rates, and modifying mechanisms have not yet been elucidated. We examined whether specific subtypes or characteristics of late-life depression predict mortality. Methods A cohort study including 378 depressed older patients according to DSM-IV criteria and 132 never depressed comparisons. The predictive value of depression subtypes and characteristics on the six-year mortality rate, as well as their interaction with somatic disease burden and antidepressant drug use, were studied by Cox proportional hazard analysis adjusted for demographic and lifestyle characteristics. Results Depressed persons had a higher mortality risk than non-depressed comparisons (HR = 2.95 [95% CI: 1.41–6.16], p = .004), which lost significance after adjustment for age, sex, education, smoking, alcohol, physical activity, number of prescribed medications and somatic comorbidity. Regarding depression subtypes and characteristics, only minor depression was associated with a higher mortality risk when adjusted for confounders (HR = 6.59 [95% CI: 1.79–24.2], p = .005). Conclusions Increased mortality rates of depressed older persons seem best explained by unhealthy lifestyle characteristics and multiple drug prescriptions. The high mortality rate in minor depression, independent of these factors, might point to another, yet unknown, pathway towards mortality for this depression subtype. An explanation might be that minor depression in later life reflects depressive symptoms due to underlying aging-related processes, such as inflammation-based sickness behavior, frailty, and mild cognitive impairment, which have all been associated with increased mortality.

Pacemaker dependency after transcatheter aortic valve implantation: incidence, predictors and long-term outcomes.

The aims of this study were to determine the appropriateness of permanent pacemaker implantation (PPI) after TAVI through an analysis of PM dependency at follow-up, and to assess long-term outcomes of patients undergoing PPI after TAVI. From June 2007 to February 2018, 1,116 consecutive patients without prior PM underwent TAVI in our institution. We assessed the incidence and predictors of PM dependency of patients who underwent PPI within 30 days, and also the six-year outcomes among patients who did not undergo PPI at 30 days. At 30 days, PPI was reported in 145 patients (13.0%). Rates of PM dependency were 35.7%, 35.8% and 33.3% at 1, 6 and 12 months, respectively. Analysing PPI timing, implantation on day 1 was found to be a predictor of PM dependency at six months (OR 20.7 [95% CI: 3.4-126.7]; p=0.001) and 12 months (OR 7.5 [95% CI: 1.4-40.2]; p=0.019). An interaction between PM dependency and the presence of baseline right bundle branch block (RBBB) at six months (pinteraction=0.024) and 12 months (pinteraction=0.028) was reported when PPI was performed on the same day as TAVI. At six years, patients who received a PM at 30 days showed a higher all-cause death rate (KM estimate 41.7% vs 57%; plog-rank=0.034). Among patients receiving PPI after TAVI, PM dependency rates were about 33-36% at one year. Patients with a baseline RBBB undergoing PPI at day 0 or at day 1 when severe CDs persisted for 24 hours after TAVI, irrespective of baseline CDs, had a higher chance of being PM-dependent at follow-ups. Finally, PPI after TAVI was associated with increased six-year mortality.

Six-year mortality in a street-recruited cohort of homeless youth in San Francisco, California.

Objectives. The mortality rate of a street-recruited homeless youth cohort in the United States has not yet been reported. We examined the six-year mortality rate for a cohort of street youth recruited from San Francisco street venues in 2004.Methods. Using data collected from a longitudinal, venue-based sample of street youth 15–24 years of age, we calculated age, race, and gender-adjusted mortality rates.Results. Of a sample of 218 participants, 11 died from enrollment in 2004 to December 31, 2010. The majority of deaths were due to suicide and/or substance abuse. The death rate was 9.6 deaths per hundred thousand person-years. The age, race and gender-adjusted standardized mortality ratio was 10.6 (95% CI [5.3–18.9]). Gender specific SMRs were 16.1 (95% CI [3.3–47.1]) for females and 9.4 (95% CI [4.0–18.4]) for males.Conclusions. Street-recruited homeless youth in San Francisco experience a mortality rate in excess of ten times that of the state’s general youth population. Services and programs, particularly housing, mental health and substance abuse interventions, are urgently needed to prevent premature mortality in this vulnerable population.

The impact of admission renal dysfunction on in-hospital and long-term outcome of patients with ST-elevation myocardial infarction in Beijing

To investigate impact of admission renal dysfunction on in-hospital and long-term outcome of patients with ST-elevation myocardial infarction (STEMI). This was a multicentre, observational, prospective-cohort study. Totally 718 consecutive patients were admitted to 19 hospitals in Beijing within 24 hours of onset of STEMI. Estimation of glomerular filtration rate (eGFR) was calculated according to the abbreviated MDRD equation. The patients were categorized into two groups as renal preservation group (eGFR ≥ 60 ml · min⁻¹ · 1.73 m⁻²) and renal dysfunction group (eGFR < 60 ml · min⁻¹ · 1.73 m⁻²). The association between admission renal dysfunction and in-hospital and six-year outcome was evaluated. A total of 718 patients with STEMI were evaluated. There were 551 men and 167 women with age of (61.0 ± 13.0) years. One hundred and thirty-three patients (18.5%) had renal dysfunction. Patients with renal dysfunction were more often female and older, more patients had hypertension, diabetes and heart failure, and more patients had ≥ Killip II classes on admission. These patients were less likely to present with chest pain. The in-hospital mortality (16.5% vs 2.6%, P < 0.001), major adverse cardiac events (MACE) (60.9% vs 24.4%, P < 0.001), six-year all-cause mortality (35.3% vs 11.4%, P < 0.001), six-year cardiac mortality (15.9% vs 5.7%, P = 0.001) and six-year MACE (52.4% vs 28.0%, P < 0.001) were markedly increased in renal dysfunction group than in renal preservation group. After adjusting for other confounding factors, renal dysfunction was an independent predictor of in-hospital MACE (OR 2.120, 95% CI 1.563-2.878, P = 0.003), six-year all-cause mortality (RR 2.122, 95%CI 1.127-3.996, P = 0.020) and six-year MACE (RR 1.586, 95% CI 1.003-2.530, P = 0.047). The mortality and MACE in STEMI patients with renal dysfunction were higher than in those with preserved renal function. Renal dysfunction evaluated by eGFR on admission is an important independent predictor of short-term and long-term outcome in patients with acute STEMI.

Clinical risk scores and blood biomarkers as predictors of long‐term outcome in patients with community‐acquired pneumonia: a 6‐year prospective follow‐up study

Prediction of long-term outcomes in patients with community-acquired pneumonia (CAP) is incompletely understood. We investigated the value of clinical risk scores [pneumonia severity index (PSI) and CURB-65] (Confusion, Urea, Respiratory rate, Blood Pressure, Age >65years) and blood biomarkers of different physiopathological pathways in predicting long-term survival in a well-characterized cohort of patients with CAP enrolled in an antibiotic stewardship trial. Patients admitted with CAP to six medical centres in Switzerland were prospectively followed for 6years. Cox regression models and area under the receiver operating characteristics curve (AUC) were used to investigate associations between initial risk assessment and all-cause mortality. All-cause mortality during a 6-year follow-up period. Six-year mortality in the present cohort (median age 73years) was 45.1% [95% confidence interval (CI) 41.8-48.3%]. Initial PSI and CURB-65 scores both had excellent long-term prognostic accuracy, with a stepwise increase in mortality per risk class. The hazard ratios (95% CI) of the highest PSI and CURB-65 classes (reference: lowest class) were 38.0 (14.0-103.0) and 7.8 (2.2-14.5), respectively, after 6years. The addition of inflammatory (pro-adrenomedullin) and cardiac (pro-atrial natriuretic peptide) blood biomarkers measured upon hospital admission further improved the prognostic capabilities of the PSI (AUC increase from 0.79 to 0.83; P<0.0001) and the CURB-65 score (AUC increase from 0.73 to 0.80; P<0.001). Risk assessment using clinical scores allowed accurate long-term prognostication, which was further improved by the addition of two inflammatory (pro-adrenomedullin) and cardiac (pro-atrial natriuretic peptide) blood biomarkers. These data provide a rationale for a more risk-adapted, 'personalized' strategy for long-term management of patients with CAP.

Components of Depression and 6-Year Mortality After an Acute Coronary Syndrome

BackgroundPost-myocardial infarct depression includes both somatic depressive symptoms and nonsomatic cognitive symptoms. Their respective relationships to long-term survival are unclear. MethodsDepression was diagnosed by measuring the Beck Depression Inventory-II (BDI-II) on consecutive patients who presented with acute coronary syndrome in 2005. Six-year mortality data were extracted from the National Health Index. This study investigated whether mortality was related to the somatic or cognitive elements of the BDI-II score, controlling for baseline characteristics including the Global Registry of Acute Coronary Events score. The BDI-II, somatic, and cognitive scores were treated as continuous variables. ResultsOf the 277 patients, 52 died over 6 years. Higher BDI-II score did not predict mortality at 6 years (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.98-1.06). In the Cognitive/Affective-Somatic model, somatic depressive symptoms (OR, 1.10; 95% CI, 1.01-1.20) predicted all-cause mortality, but cognitive/affective depressive symptoms (OR, 1.01; 95% CI, 0.96-1.08) did not. This association attenuated after controlling for age and sex (OR, 1.10; 95% CI, 0.99-1.22), and age, sex, and Global Registry of Acute Coronary Events score (OR, 1.09; 95% CI, 0.99-1.21). Results from the Somatic/Affective-Cognitive model did not reach statistical significance. Differences were small and unlikely to be of clinical importance. ConclusionsIn patients with acute coronary syndrome, those who died had a higher baseline BDI-II score, particularly somatic score, although this did not reach statistical significance.

Does admission anaemia still predict mortality six years after myocardial infarction?

Anaemia is present in 12-30% of patients with acute coronary syndromes (ACS). Many studies have shown that admission anaemia is an independent predictor of in-hospital or short-term mortality in patients with ACS. However, there is limited data on the long-term prognostic importance of anaemia in this group of patients. To establish the relation between haemoglobin concentration on admission and six-year all-cause mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated invasively. We retrospectively studied 551 patients with the diagnosis of STEMI referred to the catheterisation laboratory of our hospital and treated with successful primary percutaneous coronary intervention. Patients were divided into two groups according to admission haemoglobin concentration (< 13 g/dL in males and < 12 g/dL in females). A total of 551 patients with STEMI (164 female, 30%) were included in the analysis, mean age was 63 ± 12 years. Anaemia on admission was present in 11% (n = 61) of the patients. Of the entire cohort, renal failure was present in 25% (n = 138), and diabetes in 16% (n = 88). Admission haemoglobin concentration was significantly associated with age (r = -0.2663, p < 0.05), blood pressure (systolic blood pressure [SBP]: r = 0.1940, diastolic blood pressure [DBP]: r = 0.2023, p < 0.05), glucose concentration (r = -0.1218, p < 0.05), white blood cells count (r = 0.1230, p < 0.05), cholesterol concentration (r = 0.1253,p < 0.05), estimated glomerular filtration rate (eGFR; r = 0.1819, p < 0.05), Killip-Kimball class (r = -0.1387, p < 0.05) and TIMI risk score for STEMI (r = -0.2647, p < 0.05). During follow-up, 27% (n = 130) of the patients died. The mortality rate was significantly higher in the patients with admission anaemia (47% vs. 24%, p = 0.0002). The patients with anaemia were older (p = 0.0007), had lower blood pressure (SBP: p = 0.007; DBP: p = 0.01), higher heart rate (p = 0.03), higher glycaemia concentration (p = 0.003), higher C-reactive protein concentration (p = 0.0007) and lower white blood cells count (p = 0.03). Patients with anaemia had more frequently renal failure (eGFR < 60 mL/min/1.73 m²) (p = 0.02) and a significantly higher TIMI risk score for STEMI (p = 0.01). In multivariate analysis, all-cause mortality was associated with: anaemia on admission (OR = 2.29; 95% CI 1.20-4.36; p = 0.011), low ejection fraction (OR = 2.97; 95% CI 1.78-4.96; p < 0.001) and age (OR = 1.65 [per 10 years]; 95% CI 1.34-2.03; p < 0.001). Anaemia on admission remained an independent predictor of six-year mortality. Admission anaemia significantly influences all-cause mortality in patients with STEMI treated invasively ina six-year follow-up and may be used for risk stratification in this population.

Comparison of radical treatment and mortality in patients with nonmetastatic prostate cancer in England and the United States.

46 Background: Prostate-cancer mortality in the U.S. is amongst the lowest globally. Given historical differences in management between England and the U.S., this paper aims to determine if risk-adjusted prostate-cancer mortality is inferior amongst men in England compared to the U.S. Methods: Patients diagnosed with non-metastatic prostate-cancer between 2004 and 2008 were identified using English hospital admission records linked to national cancer registry data, and the American Surveillance, Epidemiology and End Results program. Complete data were available for 222,163 patients. Patients were stratified into low-, intermediate-, and high-risk groups according to disease characteristics. Patient demographics from the two countries were compared using the Chi-square test. Competing-risks survival analyses were used to estimate relative six-year prostate-cancer mortality. Results: In comparison to patients in the U.S., English patients were more likely to present at an older age (70 to 79: England 44.2%, USA 29.3%, p&lt;0.001), with higher clinical tumour stage (cT3-4: England 25.1%, USA 8.6%, p&lt;0.001) and higher Gleason score (GS 8-10: England 20.7%, USA 11.2%, p&lt;0.001). They were also less likely to receive radical therapy, with greatest disparity amongst patients with high-risk disease (England 30%, U.S. 83%, p&lt;0.001). After adjusting for age, ethnicity, year of diagnosis, Gleason score, and tumour stage, English patients were more likely to die of prostate cancer (all risk groups: HR 1.9, 95% CI 1.7-2.0, p&lt;0.001). However, this difference was no longer statistically significant on adjustment for radical therapy (all risk groups: HR 1.0, 95% CI 1.0-1.1, p=0.336). Conclusions: After risk adjustment, prostate-cancer mortality is significantly higher in England compared to the U.S. for men with intermediate- and high-risk disease. This difference appears to be explained by decreased use of radical therapy in England.

Somatic Depression Predicts Six-Year Mortality in Acute Coronary Syndrome (ACS)

Somatic Depression Predicts Six-Year Mortality in Acute Coronary Syndrome (ACS)

Somatic Depression Predicts Six-Year Mortality in Acute Coronary Syndrome

LVCR to exercise and thus OCAD cannot be excluded.We suggest alternate testing e.g. CT coronary angiography. http://dx.doi.org/10.1016/j.hlc.2013.05.114

Six-Year Mortality Rates of Patients in Methadone and Buprenorphine Maintenance Therapy

Six-Year Mortality Rates of Patients in Methadone and Buprenorphine Maintenance Therapy