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1.
BMC Public Health ; 20(1): 157, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32007100

RESUMEN

BACKGROUND: South Africa's maternal mortality ratio remains high although it has substantially declined in the past few years. Numerous studies undertaken in South Africa on maternal mortality have not paid much attention to how the causes are distributed in different socio-demographic groups. This study assesses and analyses the causes of maternal mortality according to sociodemographic factors in South Africa. METHODS: The causes of maternal deaths were assessed with respect to age, province, place of death, occupation, education and marital status. Data were obtained from the vital registration database of Statistics South Africa. About 14,892 maternal deaths of women from 9 to 55 years of age were analysed using frequency tables, cross-tabulations and logistic regression. Maternal mortality ratio (MMR), by year, age group, and province for the years 2007-2015 was calculated. RESULTS: The 2007-2015 MMR was 139.3 deaths per 100,000 live births (10,687,687 total live births). The year 2009 had the highest MMR during this period. Specific province MMR for three triennia (2007-2009; 2010-2012; 2013-2015) shows that the Free State province had the highest MMR (297.9/100000 live births; 214.6/100000 live births; 159/100000 live births) throughout this period. MMR increased with age. Although the contribution of the direct causes of death (10603) was more than double the contribution of indirect causes (4289) maternal mortality showed a steady decline during this period. CONCLUSIONS: The study shows evidence of variations in the causes of death among different socio-demographic subgroups. These variations indicate that more attention has to be given to the role played by socio-demographic factors in maternal mortality.


Asunto(s)
Causas de Muerte/tendencias , Muerte Materna/estadística & datos numéricos , Muerte Materna/tendencias , Mortalidad Materna/tendencias , Adolescente , Adulto , Niño , Femenino , Predicción , Humanos , Persona de Mediana Edad , Embarazo , Factores Socioeconómicos , Sudáfrica/epidemiología , Adulto Joven
2.
Am Heart J ; 222: 26-29, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32004797

RESUMEN

Atrial arrhythmias commonly occur in patients with cardiac amyloidosis (CA), but there is limited data on safety or efficacy of cardioversion (DCCV) for management of these rhythms in CA. We identified 25 patients with CA (20 with transthyretin (TTR) and 5 with light-chain (AL) amyloidosis) at Duke University who underwent DCCV for atrial arrhythmias and documented procedural success, complications, and long-term morbidity and mortality. While DCCV successfully restored sinus rhythm in 96% of patients, 36% of patients experienced immediate procedural complications (primarily bradycardia and hypotension), 80% had recurrence of atrial arrhythmias at 1 year, and 52% died at 3 years, highlighting short-term safety concerns, long-term inefficacy, and poor prognosis associated with symptomatic atrial arrhythmias requiring DCCV in CA.


Asunto(s)
Amiloidosis/complicaciones , Fibrilación Atrial/terapia , Aleteo Atrial/terapia , Cardiomiopatías/complicaciones , Cardioversión Eléctrica/métodos , Anciano , Amiloidosis/diagnóstico , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Aleteo Atrial/epidemiología , Aleteo Atrial/etiología , Biopsia , Cardiomiopatías/diagnóstico , Causas de Muerte/tendencias , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Cinemagnética/métodos , Masculino , Morbilidad/tendencias , Miocardio/patología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Estados Unidos/epidemiología
3.
Am Heart J ; 222: 208-219, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32105987

RESUMEN

BACKGROUND: Experimental evidence suggests that sedentary time (ST) may contribute to cardiovascular disease by eliciting detrimental hemodynamic changes in the lower limbs. However, little is known about objectively measured ST and lower extremity peripheral artery disease (PAD). METHODS: We included 7,609 Hispanic/Latinos (ages 45-74) from the Hispanic Community Health Study/Study of Latinos. PAD was measured using the ankle brachial index (≤0.9). ST was measured using accelerometry. We used multivariable logistic regression to assess associations of quartiles of ST and PAD, and then used the same logistic models with restricted cubic splines to investigate continuous nonlinear associations of ST and PAD. Models were sequentially adjusted for traditional PAD risk factors, leg pain, and moderate- to vigorous-intensity physical activity (MVPA). RESULTS: Median ST was 12.2 h/d, and 5.4% of individuals had PAD. In fully adjusted restricted cubic splines models accounting for traditional PAD risk factors, leg pain, and MVPA, ST had a significant overall (P = .048) and nonlinear (P = .024) association with PAD. A threshold effect was seen such that time spent above median ST was associated with higher odds of PAD. That is, compared to median ST, 1, 2, and 3 hours above median ST were associated with a PAD odds ratio of 1.16 (95% CI = 1.02-1.31), 1.44 (1.06-1.94), and 1.80 (1.11-2.90), respectively. CONCLUSIONS: Among Hispanic/Latino adults, ST was associated with higher odds of PAD, independent of leg pain, MVPA, and traditional PAD risk factors. Notably, we observed a threshold effect such that these associations were only observed at the highest levels of ST.


Asunto(s)
Ejercicio Físico/fisiología , Hispanoamericanos , Extremidad Inferior/irrigación sanguínea , Enfermedad Arterial Periférica/etnología , Salud Pública , Conducta Sedentaria/etnología , Adolescente , Adulto , Anciano , Índice Tobillo Braquial , Causas de Muerte/tendencias , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/fisiopatología , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Ultrasonografía Doppler , Estados Unidos/epidemiología , Adulto Joven
4.
BMJ ; 368: m131, 2020 02 12.
Artículo en Inglés | MEDLINE | ID: mdl-32051121

RESUMEN

OBJECTIVE: To compare established associations between risk factors and mortality in UK Biobank, a study with an exceptionally low rate of response to its baseline survey, against those from representative studies that have conventional response rates. DESIGN: Prospective cohort study alongside individual participant meta-analysis of other cohort studies. SETTING: United Kingdom. PARTICIPANTS: Analytical sample of 499 701 people (response rate 5.5%) in analyses in UK Biobank; pooled data from the Health Surveys for England (HSE) and the Scottish Health Surveys (SHS), including 18 studies and 89 895 people (mean response rate 68%). Both study populations were linked to the same nationwide mortality registries, and the baseline age range was aligned at 40-69 years. MAIN OUTCOME MEASURE: Death from cardiovascular disease, selected malignancies, and suicide. To quantify the difference between hazard ratios in the two studies, a ratio of the hazard ratios was used with HSE-SHS as the referent. RESULTS: Risk factor levels and mortality rates were typically more favourable in UK Biobank participants relative to the HSE-SHS consortium. For the associations between risk factors and mortality endpoints, however, close agreement was seen between studies. Based on 14 288 deaths during an average of 7.0 years of follow-up in UK Biobank and 7861 deaths over 10 years of mortality surveillance in HSE-SHS, for cardiovascular disease mortality, for instance, the age and sex adjusted hazard ratio for ever having smoked cigarettes (versus never) was 2.04 (95% confidence interval 1.87 to 2.24) in UK Biobank and 1.99 (1.78 to 2.23) in HSE-SHS, yielding a ratio of hazard ratios close to unity (1.02, 0.88 to 1.19). The overall pattern of agreement between studies was essentially unchanged when results were compared separately by sex and when baseline years and censoring dates were aligned. CONCLUSION: Despite a very low response rate, risk factor associations in the UK Biobank seem to be generalisable.


Asunto(s)
Bancos de Muestras Biológicas , Causas de Muerte/tendencias , Encuestas Epidemiológicas , Humanos , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Reino Unido/epidemiología
5.
West Afr J Med ; 37(1): 74-78, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32030716

RESUMEN

PURPOSE: Identification of health problems of women of reproductive age, using a reliable mortality data, is essential in evading preventable female deaths. This study aimed at investigating mortality profile of women of reproductive age group in Nigeria. MATERIALS AND METHODS: This is a descriptive, retrospective study involving women of reproductive age group of 15-49 years that died at DELSUTH from 1st January 2016 to 31st December 2018. The age, date of death and cause of death were retrieved from the hospital records and subsequently analyzed using SPSS version 21. RESULTS: One hundred and eighty-seven eligible deaths were encountered in this study, constituting 17.5% of all deaths in the hospital. Twenty four (12.8%) cases were of maternal etiology while 163 (87.2%) were of non-maternal causes. Non-communicable disease, communicable disease and external injuries accounted for 100 (53.5%), 44 (23.5%) and 19 (10.2%) deaths among the non-maternal causes. The mean age and the peak age group are 34.4 years and the 4th decade respectively. The leading specified non-maternal causes of death (in descending order) are AIDS/TB, cerebrovascular accidents (CVA), breast cancer, road traffic accident (RTA), diabetes, perioperative death and sepsis while the leading maternal causes of death are abortion, postpartum hemorrhage, eclampsia and puerperal sepsis. CONCLUSION: Most deaths affecting WRAG are preventable, with non-maternal causes in excess of maternal causes. There is need for holistic life-long interventional policies and strategies that will address the health need of these women, using evidence-based research findings.


Asunto(s)
Mortalidad Hospitalaria , Hospitales/estadística & datos numéricos , Mortalidad Materna , Aborto Inducido/mortalidad , Adolescente , Adulto , Neoplasias de la Mama/mortalidad , Causas de Muerte/tendencias , Eclampsia/mortalidad , Femenino , Infecciones por VIH/mortalidad , Humanos , Mortalidad Materna/tendencias , Persona de Mediana Edad , Nigeria/epidemiología , Complicaciones del Trabajo de Parto/mortalidad , Hemorragia Posparto/mortalidad , Embarazo , Complicaciones del Embarazo/mortalidad , Infección Puerperal/mortalidad , Estudios Retrospectivos , Sepsis/mortalidad , Accidente Cerebrovascular , Tuberculosis/mortalidad , Adulto Joven
6.
Diabetes Res Clin Pract ; 160: 108003, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31911247

RESUMEN

AIMS: Although diabetes mellitus at the end of life is associated with complex care, its end-of-life prevalence is uncertain. Our aim is to estimate diabetes prevalence in the end-of-life population, to evaluate which medical register has the largest added value to cause-of-death data in detecting diabetes cases, and to assess the extent to which reporting of diabetes as a cause of death is associated with disease severity. METHODS: Our study population consisted of deaths in the Netherlands (2015-2016) included in Nivel Primary Care Database (Nivel-PCD; N = 18,162). The proportion of deaths with diabetes (Type 1 or 2) within the last two years of life was calculated using individually linked cause-of-death, general practice, medication, and hospital discharge data. Severity status of diabetes was defined with dispensed medicines. RESULTS: According to all data sources combined, 28.7% of the study population had diabetes at the end of life. The estimated end-of-life prevalence of diabetes was 7.7% using multiple cause-of-death data only. Addition of general practice data increased this estimate the most (19.7%-points). Of the cases added by primary care data, 76.3% had a severe or intermediate status. CONCLUSIONS: More than one fourth of the Dutch end-of-life population has diabetes. Cause-of-death data are insufficient to monitor this prevalence, even of severe cases of diabetes, but could be enriched particularly with general practice data.


Asunto(s)
Causas de Muerte/tendencias , Diabetes Mellitus/epidemiología , Cuidado Terminal/métodos , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Atención Primaria de Salud , Sistema de Registros
7.
N Z Med J ; 133(1508): 65-71, 2020 01 17.
Artículo en Inglés | MEDLINE | ID: mdl-31945043

RESUMEN

AIM: Sudden unexpected death in epilepsy (SUDEP) is well recognised and widely reported but remains poorly understood. SUDEP in young adults is 27 times more common than sudden death in control populations. The incidence of SUDEP in New Zealand is not known but up to 40 people with epilepsy may die from SUDEP every year. A review of coroner's reports of SUDEP was undertaken to learn more about SUDEP in New Zealand. METHOD: Coroner's reports of all cases of possible SUDEP in New Zealand from 2007-2016 (n=190) were obtained and post-mortem and toxicology results were reviewed. Cases were categorised using published criteria. RESULTS: We obtained reports of 190 cases from the coroner's office. Of these 190 cases, we determined that 123 were definite SUDEP, 40 were definite SUDEP plus, three were probable SUDEP, seven were possible SUDEP and 17 were probably not SUDEP. The number of cases per year varied from 11-26 (2013). Cases were aged 1.5-67 years, with 63% aged 15-45 (mean 37 years). Sixty-one percent were male. Eighty-seven percent of the deaths occurred at home, with 74% found dead in their bed or bedroom. The majority were not employed, with only 33% working or retired at the time of death; 15% were children or students. Information regarding work status was not available for 11%. Toxicology results were available for 155 cases; antiepileptic drug (AED) use was detected in 67% of these cases, with a single AED detected in 44%, two AEDs in 21%, and three AEDs in 3% of samples taken at autopsy. Approximately half who took an AED were taking either sodium valproate or carbamazepine. CONCLUSION: This study suggests that people with epilepsy who die from SUDEP in New Zealand are young and are often compliant with their medication. We plan to establish a nationwide SUDEP registry using the EpiNet database to determine the incidence of SUDEP in New Zealand, and to track changes in SUDEP rates. We are also planning to take part in an international case-control study of SUDEP in the hope that we might learn more about risk factors that predispose people with epilepsy to SUDEP, and factors that might reduce the risk.


Asunto(s)
Muerte Súbita/epidemiología , Epilepsia/mortalidad , Muerte Súbita e Inesperada en la Epilepsia/epidemiología , Adolescente , Adulto , Anciano , Anticonvulsivantes/efectos adversos , Anticonvulsivantes/uso terapéutico , Autopsia/estadística & datos numéricos , Causas de Muerte/tendencias , Niño , Preescolar , Médicos Forenses/estadística & datos numéricos , Epilepsia/tratamiento farmacológico , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
8.
Rev Esp Cardiol (Engl Ed) ; 73(1): 14-20, 2020 Jan.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31160265

RESUMEN

INTRODUCTION AND OBJECTIVES: To compare the long-term results of direct oral anticoagulants (DOAC) vs vitamin K antagonists (VKA) in real-world-patients with nonvalvular atrial fibrillation (NVAF) in a nationwide, prospective study. METHODS: The FANTASIIA registry prospectively included outpatients with AF anticoagulated with DOAC or VKA (per protocol, proportion of VKA and DOAC 4:1), consecutively recruited from June 2013 to October 2014 in Spain. The incidence of major events was analyzed and compared according to the anticoagulant treatment received. RESULTS: A total of 2178 patients were included in the study (mean age 73.8±9.4 years), and 43.8% were women. Of these, 533 (24.5%) received DOAC and 1645 (75.5%) VKA. After a median follow up of 32.4 months, patients receiving DOAC vs those receiving VKA had lower rates of stroke-0.40 (95%CI, 0.17-0.97) vs 1.07 (95%CI,0.79-1.46) patients/y, P=.032-, severe bleedings-2.13 (95%CI, 1.45-3.13) vs 3.28 (95%CI, 2.75-3.93) patients/y; P = .044-, cardiovascular death-1.20 (95%CI, 0.72-1.99) vs 2.45 (95%CI, 2.00-3.00) patients/y; P = .009-, and all-cause death-3.77 (95%CI, 2.83-5.01) vs 5.54 (95%CI, 4.83-6.34) patients/y; P = .016-. In a modified Cox regression model by the Andersen-Gill method for multiple events, hazard ratios for patients receiving DOAC were: 0.42 (0.16-1.07) for stroke; 0.47 (0.20-1.16) for total embolisms; 0.76 (0.50-1.15) for severe bleedings; 0.67 (0.39-1.18) for cardiovascular death; 0.86 (0.62-1.19) for all-cause death, and 0.82 (0.64-1.05) for the combined event consisting of stroke, embolism, severe bleeding, and all-cause death. CONCLUSIONS: Compared with VKA, DOAC is associated with a trend to a lower incidence of all major events, including death, in patients with NVAF in Spain.


Asunto(s)
Anticoagulantes/administración & dosificación , Fibrilación Atrial/tratamiento farmacológico , Accidente Cerebrovascular/prevención & control , Vitamina K/antagonistas & inhibidores , Administración Oral , Anciano , Fibrilación Atrial/complicaciones , Causas de Muerte/tendencias , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Pacientes Ambulatorios , Pronóstico , Estudios Prospectivos , España/epidemiología , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Tasa de Supervivencia/tendencias , Factores de Tiempo
9.
Rev Esp Cardiol (Engl Ed) ; 73(1): 35-42, 2020 Jan.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31122784

RESUMEN

INTRODUCTION AND OBJECTIVES: This study sought to analyze the association of early coronary angiography with all-cause mortality and cardiovascular mortality in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) using a large contemporary cohort of patients with NSTEACS from 2 Spanish tertiary hospitals. METHODS: This retrospective observational study included 5673 consecutive NSTEACS patients from 2 Spanish hospitals between 2005 and 2016. We performed propensity score matching to obtain a well-balanced subset of patients with the same probability of undergoing an early strategy, resulting in 3780 patients. Survival analyses were performed by Cox regression models once proportional risk test were verified. RESULTS: Among the study participants, only 2087 patients (40.9%) underwent early invasive coronary angiography. The median follow-up was 59.0 months [interquartile range, 25.0-80.0 months]. All-cause mortality was 19.0%, cardiovascular mortality was 12.8%, and 51.1% patients experienced at least 1 major cardiovascular adverse event in the follow-up. After propensity score matching, the early strategy was associated with significantly lower mortality (hazard ratio: 0.79; 95% confidence interval 0.62-0.98) in high-risk NSTEACS patients. The darly strategy showed a nonsignificant inverse tendency in patients with GRACE score <140. CONCLUSIONS: In high-risk (GRACE score≥ 140) NSTEACS patients in a contemporary real-world registry, early coronary angiography (first 24hours after hospital admission) may be associated with reduced all-cause mortality and cardiovascular mortality at long-term follow-up.


Asunto(s)
Infarto del Miocardio sin Elevación del ST/cirugía , Intervención Coronaria Percutánea/métodos , Puntaje de Propensión , Sistema de Registros , Causas de Muerte/tendencias , Angiografía Coronaria , Electrocardiografía , Estudios de Seguimiento , Humanos , Infarto del Miocardio sin Elevación del ST/diagnóstico , Infarto del Miocardio sin Elevación del ST/mortalidad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , España/epidemiología , Tasa de Supervivencia/tendencias , Factores de Tiempo
10.
Am J Cardiol ; 125(2): 205-209, 2020 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-31847957

RESUMEN

We examined the association between poor physical activity (PA) and subclinical myocardial injury (SC-MI), and how concomitant exposure to poor PA and SC-MI modifies their association with cardiovascular disease (CVD) mortality. This analysis included 6,044 participants free of CVD from the NHANES-III survey. Leisure time PA was defined as: ideal (3 to 5.99 METs and ≥5 times/week or any PA with ≥6METs and ≥3times/week), intermediate (any activity other than ideal), or poor (no activity at all). SC-MI was defined as an electrocardiographic cardiac infarction/injury score ≥10 units. CVD mortality was ascertained from the National Death Index. In multivariable logistic regression analysis, poor PA (odds ratio [OR] [95% confidence interval, CI]: 1.30 [1.10 to 1.54]) and intermediate PA (OR [95%CI]: 1.19 [1.02 to 1.38]), compared with ideal PA, were associated with an increased odds of SC-MI. During a median follow-up of 14 years, 589 CVD deaths occurred. In multivariable Cox-proportional hazard analysis, the presence (vs absence) of SC-MI was associated with a 33% increased risk of CVD mortality whereas poor (vs ideal) PA was associated with a 67% increased risk of CVD mortality (HR [95%CI]: 1.33 [1.11 to 1.58] and 1.67 [1.37 to 2.05], respectively). Additionally, the concomitant presence of both poor PA and SC-MI were associated with a higher risk of CVD mortality (HR [95%CI]: 2.25[1.68 to 3.00]) compared with ideal PA and the absence of SC-MI. In conclusion, poor PA is associated with an increased risk of SC-MI and their concomitant presence is associated with a marked increase in CVD mortality, underscoring the potential role of PA in preventing clinical and subclinical CVD outcomes.


Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Electrocardiografía , Ejercicio Físico/fisiología , Infarto del Miocardio/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Causas de Muerte/tendencias , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/fisiopatología , Encuestas Nutricionales , Factores de Riesgo , Tasa de Supervivencia/tendencias , Estados Unidos/epidemiología
11.
Am J Cardiol ; 125(1): 1-10, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31685213

RESUMEN

The benefit-risk ratio of a pharmacoinvasive strategy (PI) in patients ≥70 years of age with ST-segment elevation myocardial infarction (STEMI) remains uncertain resulting in its limited use in this population. This study compared efficacy and safety of PI with primary percutaneous coronary intervention (pPCI). Data from 2,841 patients (mean age: 78.1 ± 5.6 years, female: 36.1%) included in a prospective multicenter registry, and who underwent either PI (n = 269) or pPCI (n = 2,572), were analyzed. The primary end point was in-hospital major adverse cardiovascular events (MACE) defined as the composite of all-cause mortality, nonfatal MI, stroke, and definite stent thrombosis. Secondary end points included all-cause death, major bleeding, net adverse clinical events, and the development of in-hospital Killip class III or IV heart failure. Propensity-score matching and conditional logistic regression were used to adjust for confounders. Within the matched cohort, rates of MACE was not statistically different between the PI (n = 247) and pPCI (n = 958) groups, (11.3% vs 9.0%, respectively, odds ratio 1.25, 95% confidence interval 0.81 to 1.94; p = 0.31). Secondary end points were comparable between groups at the exception of a lower rate of development of Killip class III or IV heart failure after PI. The rate of intracranial hemorrhage was significantly higher in the PI group (2.3% vs 0.0%, p = 0.03). In conclusion, the present study demonstrated no difference regarding in-hospital MACE following PI or pPCI in STEMI patients ≥70 years of age. An adequately-powered randomized trial is needed to precisely define the role of PI in this high-risk subgroup.


Asunto(s)
Intervención Coronaria Percutánea/normas , Guías de Práctica Clínica como Asunto , Sistema de Registros , Infarto del Miocardio con Elevación del ST/terapia , Terapia Trombolítica/normas , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Femenino , Estudios de Seguimiento , Francia/epidemiología , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Intervención Coronaria Percutánea/métodos , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/mortalidad , Tasa de Supervivencia/tendencias , Terapia Trombolítica/métodos , Tiempo de Tratamiento
12.
Am J Cardiol ; 125(1): 40-47, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31694775

RESUMEN

There is little data regarding the risks and benefits of bariatric surgery in patients with coronary artery disease (CAD). We aimed to assess the short- and long-term cardiovascular outcomes of patients with CAD undergoing bariatric surgery. Patients with a history of CAD were identified from a dedicated database with prospectively collected outcomes, comprising all 6795 patients who underwent bariatric surgery between January 1992 and October 2017. Patients were matched with patients who did not have CAD before the bariatric surgery procedure. The primary endpoints were mortality (cardiac and noncardiac) and major adverse cardiocerebral events (MACCE), including all-cause death, myocardial infarction, stroke, and myocardial revascularization at 30 days after bariatric surgery and throughout follow-up. After propensity score matching, 249 patients with chronic CAD were matched with 249 patients without CAD. Throughout follow-up (7.4 years; interquartile range 4.1 to 11.5, maximum 22 years), mortality (mainly cardiac mortality) remained significantly higher in the CAD compared with the non-CAD group (18% vs 10%, hazard ratio [HR] 1.70, 95% confidence interval [CI]: 1.03 to 2.79, p = 0.037). At 30 days, MACCE rate was significantly higher in the CAD compared with the non-CAD group (3.6% vs 0.4%, p = 0.011), essentially driven by non-ST elevation myocardial infarctions. After 30 days, MACCE rates remained significantly higher in the CAD group (30% vs 14%, HR 2.18, 95% CI: 1.45-3.28, p = 0.0002). In conclusion, patients with severe obesity and CAD referred to bariatric surgery were at a higher risk of early and late MACCE compared with non-CAD severely obese patients. Further study is required to define how this cardiovascular risk compares with nonoperated patients.


Asunto(s)
Cirugía Bariátrica , Enfermedad de la Arteria Coronaria/complicaciones , Obesidad/cirugía , Complicaciones Posoperatorias/epidemiología , Puntaje de Propensión , Medición de Riesgo/métodos , Adulto , Causas de Muerte/tendencias , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Pronóstico , Quebec/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia/tendencias , Factores de Tiempo
13.
Am J Cardiol ; 125(1): 127-134, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31699360

RESUMEN

Anecdotal cases of reversible methamphetamine-associated cardiomyopathy (rMAC) have been reported, but not well understood. This study sought to determine the clinical characteristics, outcomes and predictors of reversibility among patients with rMAC as compared with patients with persistent MAC (pMAC). We retrospectively studied adult MAC patients with left ventricular ejection fraction (LVEF) ≤40% at a single center between 2004 and 2018. rMAC was defined as increase in LVEF by ≥20 points or to ≥50%. Those with persistent LVEF ≤40% constituted the pMAC group. 357 MAC cases were identified: 250 patients had pMAC and 107 had rMAC. After a median follow-up of 45 months (interquartile range 27 to 70), LVEF increased by 28.3 ± 6.9% in rMAC (p <0.001), whereas it was unchanged in pMAC (Δ: -0.5 ± 8.7%, p = 0.350). Heart failure hospitalizations and New York Heart Association Class III/IV heart failure were both significantly reduced for rMAC than the pMAC group. All-cause mortality was 21.6% overall, 28% in pMAC and 6.5% in the rMAC group (p <0.001). Kaplan-Meier survival curves demonstrated significantly higher cumulative survival for rMAC (Log Rank p <0.001). Multivariable logistic regression identified MA cessation (odds ratio/OR: 4.23, 95% confidence interval/CI: 2.47 to 7.38, p <0.001) and baseline right ventricular end systolic area (OR: 0.92, 95% CI: 0.87 to 0.97, p = 0.001) as strongly predictive of MAC reversal. In conclusion, MAC reversal is not uncommon and is associated with significant clinical improvement including reduced mortality. It can be facilitated by MA cessation when the cardiac chambers, especially the right ventricle, are not severely dilated.


Asunto(s)
Trastornos Relacionados con Anfetaminas/diagnóstico , Cardiomiopatías/inducido químicamente , Ventrículos Cardíacos/diagnóstico por imagen , Metanfetamina/efectos adversos , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología , Trastornos Relacionados con Anfetaminas/mortalidad , Trastornos Relacionados con Anfetaminas/fisiopatología , California/epidemiología , Cardiomiopatías/diagnóstico , Cardiomiopatías/fisiopatología , Causas de Muerte/tendencias , Dopaminérgicos/efectos adversos , Ecocardiografía , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia/tendencias
14.
Am J Cardiol ; 125(1): 11-18, 2020 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31732135

RESUMEN

Although older adults are the fastest-growing age group among cardiovascular patients, nonagenarians with ST-segment elevation myocardial infarction (STEMI) are under-represented in clinical trials. The aims of this study are to analyze the clinical presentation and outcomes of nonagenarian patients presenting with STEMI and to compare in-hospital and 1-year clinical outcomes between those treated with optimal medical treatment alone and those receiving primary percutaneous coronary intervention (pPCI). We included all consecutive nonagenarians presenting with STEMI admitted in 2 academic centers between 2006 and 2018. There were no exclusion criteria. All-cause mortality was assessed in-hospital and at 1-year follow-up. In total, 167 patients (mean age 91.9 ± 0.17 years; 60% females) were included. Emergent catheterization was performed in 60% of our patients, and pPCI was performed in 50% (n = 83). Overall mortality was 22% in-hospital and 41% at 1-year follow-up. The pPCI group had lower mortality than the medical treatment group: 12% versus 32% in-hospital (p <0.01) and 26% versus 45% at 1-year follow-up (p <0.01), respectively. Multivariable analysis identified 4 independent predictors of all-cause mortality at 1 year: mechanical complications (adjusted odds ratio [OR] 9.25, p <0.01), Killip class III/IV (adjusted OR 4.22, p <0.01), serum creatinine at admission (mg/dl; adjusted OR 1.8, p <0.01), and pPCI (adjusted OR 0.52; p <0.05). In conclusion, STEMI in nonagenarians is becoming increasingly common. pPCI may be the preferred strategy in this high-risk cohort when a high grade of disability is not present. Hemodynamic compromise, the presence of complications related to myocardial infarction, renal impairment, and early revascularization may be related to prognosis in these patients.


Asunto(s)
Intervención Coronaria Percutánea/métodos , Medición de Riesgo/métodos , Infarto del Miocardio con Elevación del ST/mortalidad , Terapia Trombolítica/métodos , Factores de Edad , Anciano de 80 o más Años , Causas de Muerte/tendencias , Femenino , Estudios de Seguimiento , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Oportunidad Relativa , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/terapia , España/epidemiología , Tasa de Supervivencia/tendencias
15.
Public Health Rep ; 135(1): 150-160, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31804898

RESUMEN

OBJECTIVES: Male mortality fell substantially during the past century, and major causes of death changed. Building on our recent analysis of female mortality trends in the United States, we examined all-cause and cause-specific mortality trends at each decade from 1900 to 2010 among US males. METHODS: We conducted a descriptive study of age-adjusted death rates (AADRs) for 11 categories of disease and injury stratified by race (white, nonwhite, and, when available, black), the excess of male mortality over female mortality ([male AADR - female AADR]/female AADR), and potential causes of persistent excess of male mortality. We used national mortality data for each decade. RESULTS: From 1900 to 2010, the all-cause AADR declined 66.4% among white males and 74.5% among nonwhite males. Five major causes of death in 1900 were pneumonia and influenza, heart disease, stroke, tuberculosis, and unintentional nonmotor vehicle injuries; in 2010, infectious conditions were replaced by cancers and chronic lower respiratory diseases. The all-cause excess of male mortality rose from 9.1% in 1900 to 65.5% in 1980 among white males and a peak of 63.7% in 1990 among nonwhite males, subsequently falling among all groups. CONCLUSION: During the last century, AADRs among males declined more slowly than among females. Although the gap diminished in recent decades, exploration of social and behavioral factors may inform interventions that could further reduce death rates among males.


Asunto(s)
Causas de Muerte/tendencias , Mortalidad/historia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Enfermedades Transmisibles/mortalidad , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Mortalidad/etnología , Mortalidad/tendencias , Enfermedades no Transmisibles/mortalidad , Estados Unidos/epidemiología , Adulto Joven
16.
Rev Med Chil ; 147(6): 727-732, 2019 Jun.
Artículo en Español | MEDLINE | ID: mdl-31859825

RESUMEN

BACKGROUND: With the aim to inform end of life public policies, the place of death in Chile, its trends and associated factors were analysed. MATERIALS AND METHODS: A cross sectional using publically available death database from 1990 to 2014 was conducted. The proportion of hospital deaths was selected as the main outcome. A logistic regression was used to assess the association between place of death, age, and main diagnosis at death. Also, a Prais-Winsten regression and a Chi2 test were used to assess a time series and regional analysis, respectively. RESULTS: 2,063,615 deaths were analysed. Overall, deaths 898,871 (43.6%) occurred at hospital. Those who died over 85 years (OR 2,52 IC95% 2.49-2.55) and those who died from cancer (OR 2.43 IC95% 2.42-2.45) had higher risk for dying outside de hospital. For the general population and those who die form cancer, there is no evidence for an increase or decrease trend in the proportion of hospital deaths over time (p = 0,75 and p = 0.68, respectively). However, there is an increase of the proportion of hospital deaths in those who died over 85 years (p < 0.001,27% in 1990 to 32% in 2014). Also, there are geographic differences between country regions (p < 0.001) (Eg. Magallanes 52.9%). CONCLUSIONS: The proportion of hospital deaths has been stable over time in the general population and has increased in those over 85 years.


Asunto(s)
Mortalidad Hospitalaria/tendencias , Mortalidad/tendencias , Adulto , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Chile/epidemiología , Estudios Transversales , Certificado de Defunción , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Neoplasias/mortalidad , Probabilidad , Política Pública , Análisis Espacio-Temporal , Cuidado Terminal , Factores de Tiempo
17.
BMC Public Health ; 19(1): 1440, 2019 Nov 01.
Artículo en Inglés | MEDLINE | ID: mdl-31675932

RESUMEN

BACKGROUND: San Francisco has implemented several programs addressing the needs of two large vulnerable populations: people living with HIV and those who are homeless. Assessment of these programs on health outcomes is paramount for reducing preventable deaths. METHODS: Individuals diagnosed with HIV/AIDS and reported to the San Francisco Department of Public Health HIV surveillance registry, ages 13 years or older, who resided in San Francisco at the time of diagnosis, and who died between January 1, 2002, and December 31, 2016 were included in this longitudinal study. The primary independent variable was housing status, dichotomized as ever homeless since diagnosed with HIV, and the dependent variables were disease-specific causes of death, as noted on the death certificate. The Cochran-Armitage test measured changes in the mortality rates over time and unadjusted and adjusted Poisson regression models measured prevalence ratios (PR) and 95% confidence intervals (CI) for causes of death. RESULTS: A total of 4158 deceased individuals were included in the analyses: the majority were male (87%), ages 40-59 years old at the time of death (64%), non-Hispanic White (60%), men who have sex with men (54%), had an AIDS diagnosis prior to death (87%), and San Francisco residents at the time of death (63%). Compared to those who were housed, those who were homeless were more likely to be younger at time of death, African American, have a history of injecting drugs, female or transgender, and were living below the poverty level (all p values < 0.0001). Among decedents who were SF residents at the time of death, there were declines in the proportion of deaths due to AIDS-defining conditions (p < 0.05) and increases in accidents, cardiomyopathy, heart disease, ischemic disease, non-AIDS cancers, and drug overdoses (p < 0.05). After adjustment, deaths due to mental disorders (aPR = 1.63, 95% CI 1.24, 2.14) were more likely and deaths due to non-AIDS cancers (aPR = 0.63, 95% CI 0.44, 0.89) were less likely among those experiencing homelessness. CONCLUSIONS: Additional efforts are needed to improve mental health services to homeless people with HIV and prevent mental-health related mortality.


Asunto(s)
Causas de Muerte/tendencias , Infecciones por VIH/diagnóstico , Personas sin Hogar/estadística & datos numéricos , Vivienda/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Infecciones por VIH/mortalidad , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , San Francisco/epidemiología , Adulto Joven
18.
Eur J Epidemiol ; 34(12): 1131-1142, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31729683

RESUMEN

Socioeconomic inequalities in mortality are a challenge for public health around the world, but appear to be resistant to policy-making. We aimed to identify European countries which have been more successful than others in narrowing inequalities in mortality, and the factors associated with narrowing inequalities. We collected and harmonised mortality data by educational level in 15 European countries over the last 25 years, and quantified changes in inequalities in mortality using a range of measures capturing different perspectives on inequality (e.g., 'relative' and 'absolute' inequalities, inequalities in 'attainment' and 'shortfall'). We determined which causes of death contributed to narrowing of inequalities, and conducted country- and period-fixed effects analyses to assess which country-level factors were associated with narrowing of inequalities in mortality. Mortality among the low educated has declined rapidly in all European countries, and a narrowing of absolute, but not relative inequalities was seen in many countries. Best performers were Austria, Italy (Turin) and Switzerland among men, and Spain (Barcelona), England and Wales, and Austria among women. Ischemic heart disease, smoking-related causes (men) and amenable causes often contributed to narrowing inequalities. Trends in income inequality, level of democracy and smoking were associated with widening inequalities, but rising health care expenditure was associated with narrowing inequalities. Trends in inequalities in mortality have not been as unfavourable as often claimed. Our results suggest that health care expansion has counteracted the inequalities widening effect of other influences.


Asunto(s)
Causas de Muerte/tendencias , Gastos en Salud/tendencias , Disparidades en el Estado de Salud , Disparidades en Atención de Salud/tendencias , Mortalidad/tendencias , Clase Social , Escolaridad , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Sistema de Registros , Distribución por Sexo , Factores Sexuales , Factores Socioeconómicos
19.
Sleep Health ; 5(6): 630-638, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31678177

RESUMEN

OBJECTIVES: To reveal sleep health phenotypes in older adults and examine their associations with time to 5-year all-cause and cardiovascular mortality. DESIGN: Prospective longitudinal cohorts. SETTING: The Study of Osteoporotic Fractures and Outcomes of Sleep Disorders in Older Men Study. PARTICIPANTS: N = 1722 men and women aged ≥65 years matched 1:1 on sociodemographic and clinical measures. MEASUREMENTS: Self-reported habitual sleep health characteristics (satisfaction, daytime sleepiness, timing, efficiency, and duration) measured at an initial visit and longitudinal follow-up for mortality. RESULTS: Latent class analysis revealed 3 sleep health phenotypes: (1) heightened sleep propensity (HSP; medium to long duration, high sleepiness, high efficiency/satisfaction; n = 322), (2) average sleep (AS; medium duration, average efficiency, high satisfaction, low sleepiness; n = 1,109), and (3) insomnia with short sleep (ISS; short to medium duration, low efficiency/satisfaction, moderate sleepiness; n = 291). Phenotype predicted time to all-cause mortality (χ2 = 9.4, P = .01), with HSP conferring greater risk than AS (hazard ratio [95% confidence interval] = 1.48 [1.15-1.92]) or ISS (1.52 [1.07-2.17]), despite ISS reporting the poorest mental and physical health. Although sex did not formally moderate the relationship between phenotype and mortality, subgroup analyses indicated that these findings were driven primarily by women. Phenotype did not predict cardiovascular mortality. CONCLUSIONS: These analyses support the utility of examining multidimensional sleep health profiles by suggesting that the combination of long sleep, high efficiency/satisfaction, and daytime sleepiness-previously identified as independent risk factors-may be components of a single high-risk sleep phenotype, HSP. Further investigation of sex differences and the mechanisms underlying mortality risk associated with HSP is warranted.


Asunto(s)
Sueño , Anciano , Enfermedades Cardiovasculares/mortalidad , Causas de Muerte/tendencias , Femenino , Humanos , Estudios Longitudinales , Masculino , Fenotipo , Estudios Prospectivos , Factores de Riesgo , Autoinforme
20.
J Stroke Cerebrovasc Dis ; 28(12): 104431, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31624036

RESUMEN

BACKGROUND AND AIM: Romanian national level stroke mortality data is relatively scarce. The current study investigated stroke mortality rates and trends in Romania. METHODS: All individual deaths registered in Romania during 1994-2017 were analyzed using an anonymized database, based on death certificates. Stroke crude mortality rates (CMR) and age-standardized mortality rates (ASMR) were calculated and expressed per 100,000 persons-year. RESULTS: Between 1994 and 2017, 6,281,873 persons died in Romania, stroke being registered as the underlying cause of death in 959,319 cases. The overall stroke CMR was 188.2 (199.3 for women and 176.5 for men). The CMR for hemorrhagic stroke (HEMS) was 32.4 and for ischemic stroke (ISCS) 10.9. There was a significant decrease in stroke ASMR from 344.4 (95% confidence interval [CI] 343.4-345.4) in 1994 to 192.1 (95% CI 191.5-192.7) in 2017, with an annual percent change (APC) of 2.53% per year (95% CI 2.50-2.55, P < .001). Although compared with men, women had higher CMRs, when those rates were age-standardized men had higher ASMR as compared with women. The decline in HEMS ASMR had an APC of 4.65% per year (95% CI 4.59-4.70, P < .001). ISCS ASMR showed an initial increase in ASMR during 1994-2005, with APC 6.39% per year (95% CI 6.09-6.70, P < .001), followed by a significant decrease until 2017, with APC 2.83% per year (95% CI 2.59-3.07, P < .001). CONCLUSION: There was a significant reduction in stroke ASMR during 1994-2017. The decline was slow until 2002 and became steeper after that, with significant differences in gender analysis.


Asunto(s)
Accidente Cerebrovascular/mortalidad , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Causas de Muerte/tendencias , Femenino , Humanos , Esperanza de Vida , Masculino , Persona de Mediana Edad , Pronóstico , Sistema de Registros , Medición de Riesgo , Factores de Riesgo , Rumanía/epidemiología , Distribución por Sexo , Accidente Cerebrovascular/diagnóstico , Factores de Tiempo
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