Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 10.190
Filtrar
1.
Acta Biomed ; 92(3): e2021204, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34212905

RESUMO

Cardiovascular diseases (CVDs)  have been the most common cause of death worldwide for decades. Until recently the most affected patients were middle-aged and elderly, predominantly men, with more frequent ST elevation myocardial infarction  (STEMI) caused by obstructive coronary artery disease (CAD). However, in the last two decades we have noticed an increased incidence of ischemia with non-obstructive coronary arteries (INOCA), which includes myocardial infarction with non-obstructive coronary arteries (MINOCA) and non-myocardial infarction syndromes, such as microvascular and vasospastic angina, conditions that have been particularly pronounced in women and young adults - the population we considered low-risky till than. Therefore, it has become apparent that for this group of patients conventional methods of assessing the risk of future cardiovascular (CV) events are no longer specific and sensitive enough. Heart failure with preserved ejection fraction (HFpEF) is another disease, the incidence of which has been rising rapidly during last two decades, and predominantly affects elderly population. Although the etiology and pathophysiology of INOCA and HFpEF are complex and not fully understood, there is no doubt that the underlying cause of both conditions is endothelial dysfunction (ED) which further promotes the development of left ventricular diastolic dysfunction (LVDD). Plasma biomarkers of ED, as well as natriuretic peptides (NPs), have been intensively investigated recently, and some of them have great potential for early detection and better assessment of CV risk in the future.


Assuntos
Doença da Artéria Coronariana , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Idoso , Doença da Artéria Coronariana/etiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Disfunção Ventricular Esquerda/etiologia
2.
Georgian Med News ; (314): 107-110, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34248037

RESUMO

Anemia and iron deficiency (ID) are important and common comorbidities that often coexist in patients with heart failure (HF). Both conditions, together or independently, are associated with poor clinical status and worse outcomes. The aim of our research was to study prevalence and clinical impact of ID and anemia in HF patients attending cardiology department of our hospital. We studied 133 patients with HF who have been admitted to hospital since September 2019: 78 (58.6%) patient had ID, 55 (42.4%) with HF and without ID were included in the control group. Patient baseline assessment included a standardized HF history regarding HF etiology (classified as ischemic or non-ischemic) and co-morbidities. All patients underwent a standardized clinical evaluation, including physical examination, determination of NYHA class. Blood samples were drawn for the assessment of a full blood count and clinical chemistry, including iron and serum ferritin and kidney function (creatinine). Assessment of exercise capacity was performed by a 6-min walk test. ID was present in 78(58.6%) patients. 70(52.6%) patients from 133 presented with anemia. Most patients in both groups are men, patients with ID were elderly, in both groups, most patients had arterial hypertension, more patients with ID had diabetes mellitus, HF etiology was predominantly ischemic in both groups, most patients were with NYHA class III, patients with ID had significantly low LVEF. No differences were recorded for body weight, diastolic blood pressure, platelets, eGFR or serum creatinine, no such differences were found regarding hypertension and chronic obstructive pulmonary disease. There was a highly significant association between hemoglobin and serum ferritin in patients with ID, but in patients without ID, this association was only of borderline significance. The presence of anemia, ID, or both was associated with significantly higher NYHA class. We found that gender, NYHA class, LVEF, the presence of anemia, eGFR all predicted lower exercise capacity.


Assuntos
Anemia Ferropriva , Anemia , Insuficiência Cardíaca , Idoso , Anemia/complicações , Anemia/epidemiologia , Anemia Ferropriva/complicações , Anemia Ferropriva/epidemiologia , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Hospitais , Humanos , Masculino , Prevalência
3.
FP Essent ; 506: 11-19, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34264588

RESUMO

The incidence and prevalence of heart failure (HF) in the United States are high, with an estimated 6.2 million cases, and these numbers are expected to increase. Age is a nonmodifiable risk factor for HF development. Hypertension, diabetes, and ischemic heart disease are modifiable risk factors that can be addressed to reduce the morbidity and mortality associated with HF. Improvements in understanding of the pathophysiology of HF have led to changes in terminology. Terms such as congestive heart failure, systolic heart failure, and diastolic heart failure should no longer be used. Currently, the ejection fraction (EF) is used to classify left-sided HF. Patients with classic HF symptoms and an EF of 50% or greater have HF with a preserved EF (HFpEF). Patients with an EF of 40% or less have HF with a reduced EF (HFrEF). Priorities in HFpEF management are symptom management and control of comorbid conditions. This includes avoidance of fluid overload, blood pressure control optimization, and atrial fibrillation management. The diagnosis of HFpEF is associated with a 22% to 65% 5-year mortality rate, with 51% to 60% of deaths due to cardiovascular causes.


Assuntos
Fibrilação Atrial , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Prognóstico , Volume Sistólico , Estados Unidos/epidemiologia
4.
FP Essent ; 506: 20-26, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34264589

RESUMO

Heart failure (HF) with reduced ejection fraction (HFrEF) is becoming more prevalent as the US population ages. Although the clinical presentation of HFrEF is remarkably similar to that of HF with preserved ejection fraction (HFpEF), the primary etiology may be different. In particular, cardiac ischemia is a common cause of HFrEF and should be considered in any patient with new-onset HFrEF. Although there is some overlap in the management strategies for HFpEF and HFrEF, there are some key distinctions. It is vital to ensure that all patients with HFrEF are adhering to goal-directed management and therapy within 6 months of diagnosis to reduce morbidity and mortality. Some patients with HFrEF will benefit from device therapy with an implantable cardioverter-defibrillator and/or cardiac resynchronization therapy. Referral to a cardiology subspecialist is recommended for select patients with HFrEF.


Assuntos
Terapia de Ressincronização Cardíaca , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Prognóstico , Volume Sistólico
7.
Medicine (Baltimore) ; 100(25): e26502, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-34160467

RESUMO

ABSTRACT: Reflux esophagitis (RE) is a subset of gastroesophageal reflux disease (GERD) with endoscopic evidence of esophageal inflammation, which has been linked to an increased incidence of atrial fibrillation (AF). However, data on the effect of RE on patient outcomes is limited. We sought to examine the potential association of RE with outcomes of patients with AF in a nationwide study.The National Inpatient Sample (NIS) database was queried to identify hospitalized adult patients with AF and RE between 2010 and 2014. Primary outcomes included inpatient mortality, length of stay (LOS), and total hospital charges. AF related complications such as acute stroke, transient ischemic attack (TIA) and acute heart failure were assessed as secondary outcomes. Propensity score matching and multivariate regression analysis were used.Six lakh sixty seven thousands five hundred twenty patients were admitted for primary diagnosis of AF out of which 5396 had a secondary diagnosis of RE. In the AF with RE cohort, the average age was 73.6 years, 41.5% were male, and 79.9% were Caucasian. There was a greater prevalence of concomitant dyslipidemia, chronic liver disease and chronic pulmonary disease (P < .01) when compared to the AF without RE cohort. Patients with AF and RE also had higher incidence of acute strokes and TIAs (P < .05), longer LOS (P < .001), and higher hospital charges (P < .05) with no difference in acute heart failure (P = .08), hospital mortality (P = .12), or CHA2DS2-VASc score (P = .67).In hospitalized patients with AF, RE was associated with a higher rate of acute stroke and TIAs, longer LOS, and greater hospital charges.


Assuntos
Fibrilação Atrial/complicações , Esofagite Péptica/epidemiologia , Insuficiência Cardíaca/epidemiologia , Ataque Isquêmico Transitório/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/mortalidade , Fibrilação Atrial/terapia , Comorbidade , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Insuficiência Cardíaca/etiologia , Mortalidade Hospitalar , Humanos , Incidência , Ataque Isquêmico Transitório/etiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Estados Unidos/epidemiologia , Adulto Jovem
8.
Open Heart ; 8(1)2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1259016

RESUMO

AIMS: In response to the COVID-19 pandemic, the UK was placed under strict lockdown measures on 23 March 2020. The aim of this study was to quantify the effects on physical activity (PA) levels using data from the prospective Triage-HF Plus Evaluation study. METHODS: This study represents a cohort of adult patients with implanted cardiac devices capable of measuring activity by embedded accelerometery via a remote monitoring platform. Activity data were available for the 4 weeks pre-implementation and post implementation of 'stay at home' lockdown measures in the form of 'minutes active per day' (min/day). RESULTS: Data were analysed for 311 patients (77.2% men, mean age 68.8, frailty 55.9%. 92.2% established heart failure (HF) diagnosis, of these 51.2% New York Heart Association II), with comorbidities representative of a real-world cohort.Post-lockdown, a significant reduction in median PA equating to 20.8 active min/day was seen. The reduction was uniform with a slightly more pronounced drop in PA for women, but no statistically significant difference with respect to age, body mass index, frailty or device type. Activity dropped in the immediate 2-week period post-lockdown, but steadily returned thereafter. Median activity week 4 weeks post-lockdown remained significantly lower than 4 weeks pre-lockdown (p≤0.001). CONCLUSIONS: In a population of predominantly HF patients with cardiac devices, activity reduced by approximately 20 min active per day in the immediate aftermath of strict COVID-19 lockdown measures. TRIAL REGISTRATION NUMBER: NCT04177199.


Assuntos
Acelerometria , COVID-19 , Controle de Doenças Transmissíveis , Insuficiência Cardíaca , Monitorização Fisiológica , Distanciamento Físico , Telemedicina , Acelerometria/instrumentação , Acelerometria/métodos , Acelerometria/estatística & dados numéricos , Atividades Cotidianas , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Exercício Físico , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Monitorização Fisiológica/estatística & dados numéricos , SARS-CoV-2 , Telemedicina/instrumentação , Telemedicina/métodos , Telemedicina/estatística & dados numéricos , Reino Unido/epidemiologia , Dispositivos Eletrônicos Vestíveis
9.
Arch Cardiovasc Dis ; 114(5): 415-425, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34099379

RESUMO

BACKGROUND: Although cardiovascular comorbidities seem to be strongly associated with worse outcomes in patients with coronavirus disease 2019 (COVID-19), data regarding patients with preexisting heart failure are limited. AIMS: To investigate the incidence, characteristics and clinical outcomes of patients with COVID-19 with a history of heart failure with preserved or reduced ejection fraction. METHODS: We performed an observational multicentre study including all patients hospitalized for COVID-19 across 24 centres in France from 26 February to 20 April 2020. The primary endpoint was a composite of in-hospital death or need for orotracheal intubation. RESULTS: Overall, 2809 patients (mean age 66.4±16.9years) were included. Three hundred and seventeen patients (11.2%) had a history of heart failure; among them, 49.2% had heart failure with reduced ejection fraction and 50.8% had heart failure with preserved ejection fraction. COVID-19 severity at admission, defined by a quick sequential organ failure assessment score>1, was similar in patients with versus without a history of heart failure. Before and after adjustment for age, male sex, cardiovascular comorbidities and quick sequential organ failure assessment score, history of heart failure was associated with the primary endpoint (hazard ratio [HR]: 1.41, 95% confidence interval [CI]: 1.06-1.90; P=0.02). This result seemed to be mainly driven by a history of heart failure with preserved ejection fraction (HR: 1.61, 95% CI: 1.13-2.27; P=0.01) rather than heart failure with reduced ejection fraction (HR: 1.19, 95% CI: 0.79-1.81; P=0.41). CONCLUSIONS: History of heart failure in patients with COVID-19 was associated with a higher risk of in-hospital death or orotracheal intubation. These findings suggest that patients with a history of heart failure, particularly heart failure with preserved ejection fraction, should be considered at high risk of clinical deterioration.


Assuntos
COVID-19/epidemiologia , Insuficiência Cardíaca/epidemiologia , Sistema de Registros/estatística & dados numéricos , SARS-CoV-2 , Idoso , COVID-19/sangue , Comorbidade , Fatores de Confusão Epidemiológicos , Feminino , França/epidemiologia , Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/fisiopatologia , Mortalidade Hospitalar , Humanos , Incidência , Intubação Intratraqueal/estatística & dados numéricos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Utilização de Procedimentos e Técnicas , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico , Resultado do Tratamento
10.
Open Heart ; 8(1)2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34088789

RESUMO

AIMS: In response to the COVID-19 pandemic, the UK was placed under strict lockdown measures on 23 March 2020. The aim of this study was to quantify the effects on physical activity (PA) levels using data from the prospective Triage-HF Plus Evaluation study. METHODS: This study represents a cohort of adult patients with implanted cardiac devices capable of measuring activity by embedded accelerometery via a remote monitoring platform. Activity data were available for the 4 weeks pre-implementation and post implementation of 'stay at home' lockdown measures in the form of 'minutes active per day' (min/day). RESULTS: Data were analysed for 311 patients (77.2% men, mean age 68.8, frailty 55.9%. 92.2% established heart failure (HF) diagnosis, of these 51.2% New York Heart Association II), with comorbidities representative of a real-world cohort.Post-lockdown, a significant reduction in median PA equating to 20.8 active min/day was seen. The reduction was uniform with a slightly more pronounced drop in PA for women, but no statistically significant difference with respect to age, body mass index, frailty or device type. Activity dropped in the immediate 2-week period post-lockdown, but steadily returned thereafter. Median activity week 4 weeks post-lockdown remained significantly lower than 4 weeks pre-lockdown (p≤0.001). CONCLUSIONS: In a population of predominantly HF patients with cardiac devices, activity reduced by approximately 20 min active per day in the immediate aftermath of strict COVID-19 lockdown measures. TRIAL REGISTRATION NUMBER: NCT04177199.


Assuntos
Acelerometria , COVID-19 , Controle de Doenças Transmissíveis , Insuficiência Cardíaca , Monitorização Fisiológica , Distanciamento Físico , Telemedicina , Acelerometria/instrumentação , Acelerometria/métodos , Acelerometria/estatística & dados numéricos , Atividades Cotidianas , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/estatística & dados numéricos , Exercício Físico , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Monitorização Fisiológica/estatística & dados numéricos , SARS-CoV-2 , Telemedicina/instrumentação , Telemedicina/métodos , Telemedicina/estatística & dados numéricos , Reino Unido/epidemiologia , Dispositivos Eletrônicos Vestíveis
11.
Artigo em Inglês | MEDLINE | ID: mdl-34066464

RESUMO

Background: Early detection of heart failure is the basis for better medical treatment and prognosis. Over the last decades, both prevalence and incidence rates of heart failure have increased worldwide, resulting in a significant global public health issue. However, an early diagnosis is not an easy task because symptoms of heart failure are usually non-specific. Therefore, this study aims to develop a risk prediction model for incident heart failure through a machine learning-based predictive model. Although African Americans have a higher risk of incident heart failure among all populations, few studies have developed a heart failure risk prediction model for African Americans. Methods: This research implemented the Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression, support vector machine, random forest, and Extreme Gradient Boosting (XGBoost) to establish the Jackson Heart Study's predictive model. In the analysis of real data, missing data are problematic when building a predictive model. Here, we evaluate predictors' inclusion with various missing rates and different missing imputation strategies to discover the optimal analytics. Results: According to hundreds of models that we examined, the best predictive model was the XGBoost that included variables with a missing rate of less than 30 percent, and we imputed missing values by non-parametric random forest imputation. The optimal XGBoost machine demonstrated an Area Under Curve (AUC) of 0.8409 to predict heart failure for the Jackson Heart Study. Conclusion: This research identifies variations of diabetes medication as the most crucial risk factor for heart failure compared to the complete cases approach that failed to discover this phenomenon.


Assuntos
Insuficiência Cardíaca , Aprendizado de Máquina , Área Sob a Curva , Insuficiência Cardíaca/epidemiologia , Humanos , Modelos Logísticos , Máquina de Vetores de Suporte
12.
Kardiol Pol ; 79(5): 493-502, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34125921

RESUMO

With the aging of the population and improvement of life expectancy of patients with heart disease, there is an increase in non-cardiovascular (CV) comorbidities affecting chronic heart failure (HF) patients. The increased prevalence of different CV and non-CV comorbidities is a rising problem in the management of patients with HF, mostly because these comorbidities may lead to poor prognosis, increase of hospitalizations and mortality rate. Recently, important data from multicenter randomized studies point to diabetes mellitus or iron deficiency as new pharmacological targets, and this highlights the need of broad expertise for the 21st-century cardiologist. The management of HF should take into account non-CV comorbidities. In this review, we discuss novel aspects of non-CV comorbidities in HF patients and emphasize the impact on prognosis.


Assuntos
Diabetes Mellitus , Insuficiência Cardíaca , Doença Crônica , Comorbidade , Diabetes Mellitus/epidemiologia , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Estudos Multicêntricos como Assunto , Prognóstico
13.
BMJ Open ; 11(6): e047356, 2021 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127492

RESUMO

OBJECTIVES: Using free-text clinical notes and reports from hospitalised patients, determine the performance of natural language processing (NLP) ascertainment of Framingham heart failure (HF) criteria and phenotype. STUDY DESIGN: A retrospective observational study design of patients hospitalised in 2015 from four hospitals participating in the Atherosclerosis Risk in Communities (ARIC) study was used to determine NLP performance in the ascertainment of Framingham HF criteria and phenotype. SETTING: Four ARIC study hospitals, each representing an ARIC study region in the USA. PARTICIPANTS: A stratified random sample of hospitalisations identified using a broad range of International Classification of Disease, ninth revision, diagnostic codes indicative of an HF event and occurring during 2015 was drawn for this study. A randomly selected set of 394 hospitalisations was used as the derivation dataset and 406 hospitalisations was used as the validation dataset. INTERVENTION: Use of NLP on free-text clinical notes and reports to ascertain Framingham HF criteria and phenotype. PRIMARY AND SECONDARY OUTCOME MEASURES: NLP performance as measured by sensitivity, specificity, positive-predictive value (PPV) and agreement in ascertainment of Framingham HF criteria and phenotype. Manual medical record review by trained ARIC abstractors was used as the reference standard. RESULTS: Overall, performance of NLP ascertainment of Framingham HF phenotype in the validation dataset was good, with 78.8%, 81.7%, 84.4% and 80.0% for sensitivity, specificity, PPV and agreement, respectively. CONCLUSIONS: By decreasing the need for manual chart review, our results on the use of NLP to ascertain Framingham HF phenotype from free-text electronic health record data suggest that validated NLP technology holds the potential for significantly improving the feasibility and efficiency of conducting large-scale epidemiologic surveillance of HF prevalence and incidence.


Assuntos
Aterosclerose , Insuficiência Cardíaca , Algoritmos , Aterosclerose/epidemiologia , Registros Eletrônicos de Saúde , Insuficiência Cardíaca/epidemiologia , Humanos , Pacientes Internados , Processamento de Linguagem Natural , Fenótipo
14.
Medicine (Baltimore) ; 100(19): e25891, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106645

RESUMO

BACKGROUND: : Published studies investigating enteral nutrition's effect on serum inflammatory factors and the cardiac function of malnourished elderly patients with heart failure (HF) are of poor quality, with small sample sizes, and involve a homogeneous population. Therefore, in order to provide new medical evidence for clinical treatment, we undertook a systematic review and meta-analysis to assess the relationship between enteral nutrition and serum levels of inflammatory factors and cardiac function in elderly patients with HF. METHODS: : The protocol was written following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement guidelines. Electronic databases including Web of Science, Embase, PubMed, Wanfang, Data, Scopus, Science Direct, Cochrane Library will be searched in April 2021 by 2 independent reviewers. The primary outcome is body mass index, triceps skin fold thickness, upper arm muscle circumference, serum total protein, albumin, and hemoglobin's change in index; secondary outcomes include left ventricular ejection fraction, B-type natriuretic peptide, interleukin-6, C-reactive protein, and tumor necrosis factor-α. The risk of bias assessment of the included studies was performed by 2 authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions (version 5.1.0). We will perform meta-analysis using Review Manager Software. RESULTS: : The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings. CONCLUSION: : Its findings will provide helpful evidence for the application of enteral nutrition in elderly patients with HF. OSF REGISTRATION NUMBER: 10.17605/OSF.IO/RTYBP.


Assuntos
Nutrição Enteral/métodos , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Mediadores da Inflamação/sangue , Desnutrição/dietoterapia , Desnutrição/epidemiologia , Índice de Massa Corporal , Pesos e Medidas Corporais , Testes de Função Cardíaca , Humanos , Desnutrição/sangue , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa
15.
BMC Public Health ; 21(1): 1183, 2021 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-34154554

RESUMO

BACKGROUND: To date, little is known about cardiovascular disease risks among older adults with non-valvular atrial fibrillation by their association with diabetes and osteoarthritis status, based on longitudinal data with substantial amounts of non-white individuals. The objective of this study was to examine the risks for three cardiovascular diseases: stroke, acute myocardial infarction (AMI), and heart failure (HF), by diabetes and osteoarthritis status among older adults with non-valvular atrial fibrillation in Hawaii. METHODS: We conducted a retrospective observational cohort study for older adults (65 years and older) with non-valvular atrial fibrillation using the Hawaii Medicare data 2009-2017. Their risks for the three cardiovascular diseases by diabetes and osteoarthritis status (diabetes, osteoarthritis, diabetes and osteoarthritis, and without diabetes and osteoarthritis) were examined by multivariable Cox proportional hazard regression models. RESULTS: The analysis included 19,588 beneficiaries followed up for a maximum of 3288 days (diabetes: n = 4659, osteoarthritis: n = 1978, diabetes and osteoarthritis: n = 1230, without diabetes and osteoarthritis: n = 11,721).  Among them, those diagnosed with the cardiovascular diseases were identified (stroke: diabetes n = 837, osteoarthritis n = 315, diabetes and osteoarthritis n = 184, without diabetes and osteoarthritis n = 1630)(AMI: diabetes n = 438, osteoarthritis n = 128, diabetes and osteoarthritis n = 118, without diabetes and osteoarthritis n = 603)(HF: diabetes n = 2254, osteoarthritis n = 764, diabetes and osteoarthritis n = 581, without diabetes and osteoarthritis n = 4272). After adjusting for age, sex, race/ethnicity, and other potential confounders, those with diabetes and osteoarthritis had higher risks for HF (hazard ratio: 1.21 95% confidence interval: 1.10-1.33) than those without diabetes and osteoarthritis. They also had higher risks than those with osteoarthritis for HF. Those with diabetes had higher risks for all three cardiovascular diseases than the other three groups. CONCLUSIONS: Variation in cardiovascular disease risks for older adults with non-valvular atrial fibrillation in Hawaii exists with diabetes and osteoarthritis status.


Assuntos
Fibrilação Atrial , Diabetes Mellitus , Insuficiência Cardíaca , Infarto do Miocárdio , Osteoartrite , Acidente Vascular Cerebral , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Diabetes Mellitus/epidemiologia , Hawaii/epidemiologia , Insuficiência Cardíaca/epidemiologia , Humanos , Medicare , Infarto do Miocárdio/epidemiologia , Osteoartrite/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Estados Unidos
16.
Stud Health Technol Inform ; 281: 243-247, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042742

RESUMO

Heart failure (HF) is a grave problem in the clinical and public health sectors. The aim of this study is to develop a phenotyping algorithm to identify patients with HF by using the medical information database network (MID-NET) in Japan. METHODS: From April 1 to December 31, 2013, clinical data of patients with HF were obtained from MID-NET. A phenotyping algorithm was developed with machine learning by using disease names, examinations, and medications. Two doctors validated the cases by manually reviewing the medical records according to the Japanese HF guidelines. The algorithm was also validated with different cohorts from an inpatient database of the Department of Cardiovascular Medicine at Tohoku University Hospital. RESULTS: The algorithm, which initially had low precision, was improved by incorporating the value of B-type natriuretic peptide and the combination of medications related to HF. Finally, the algorithm on a different cohort was verified with higher precision (35.0% → 87.8%). CONCLUSIONS: Proper algorithms can be used to identify patients with HF.


Assuntos
Registros Eletrônicos de Saúde , Insuficiência Cardíaca , Algoritmos , Eletrônica , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Humanos , Japão/epidemiologia , Peptídeo Natriurético Encefálico
17.
J Clin Hypertens (Greenwich) ; 23(6): 1252-1259, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33939257

RESUMO

People living with HIV (PLWH) have a two-fold higher risk of cardiovascular diseases (CVDs) compared with HIV-negative populations. Although 70% of the global HIV population reside in Africa, data on CVD outcomes among PLWH are scarce. We seek to evaluate factors associated with incidence of stroke and heart failure in a prospective cohort of Ghanaian PLWH. We followed up a cohort of PLWH on antiretroviral therapy for 12 months to assess rates of clinically adjudicated stroke, and heart failure. We calculated incidence rates of events/1000 person-years and fitted Cox proportional hazards regression models to identify factors associated with incident stroke and heart failure as a combined outcome measure and as separate outcome measures. Among 255 participants, the mean age was 46 years and 211 (82.7%) were female. The participants contributed 245 years of follow-up data with mean follow-up duration of 11.5 months. There were three incident strokes giving an incidence rate of 12.24 per 1000 person-years (95% CI: 3.13-33.33) and two heart failure events with an incidence rate of 8.16 (95%CI: 1.37-26.97) per 1000 py. The combined event rate was 20.41 (95% CI: 7.48-45.24) per 1000 py. Being hypertensive was associated with aHR of 8.61 (1.32-56.04) of the combined outcome while each 100 cells/mm3 rise in CD4 count was associated with aHR of 0.56 (0.35-0.88). Carotid bulb intimal media thickness was independently associated with stroke occurrence with aHR of 12.23 (1.28-117.07). People living with HIV on long-term cART in this Ghanaian sample have high rates of clinically adjudicated cardiovascular diseases driven by uncontrolled hypertension and persisting immunosuppression. Integration of CVD care into routine HIV management may help alleviate this untoward confluence of rising CVDs among PLWH.


Assuntos
Infecções por HIV , Insuficiência Cardíaca , Hipertensão , Acidente Vascular Cerebral , Feminino , Gana/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Insuficiência Cardíaca/epidemiologia , Humanos , Incidência , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia
18.
Hypertension ; 77(6): 2014-2022, 2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1221676

RESUMO

Presence of heart failure is associated with a poor prognosis in patients with coronavirus disease 2019 (COVID-19). The aim of the present study was to examine whether first-phase ejection fraction (EF1), the ejection fraction measured in early systole up to the time of peak aortic velocity, a sensitive measure of preclinical heart failure, is associated with survival in patients hospitalized with COVID-19. A retrospective outcome study was performed in patients hospitalized with COVID-19 who underwent echocardiography (n=380) at the West Branch of the Union Hospital, Wuhan, China and in patients admitted to King's Health Partners in South London, United Kingdom. Association of EF1 with survival was performed using Cox proportional hazards regression. EF1 was compared in patients with COVID-19 and in historical controls with similar comorbidities (n=266) who had undergone echocardiography before the COVID-19 pandemic. In patients with COVID-19, EF1 was a strong predictor of survival in each patient group (Wuhan and London). In the combined group, EF1 was a stronger predictor of survival than other clinical, laboratory, and echocardiographic characteristics including age, comorbidities, and biochemical markers. A cutoff value of 25% for EF1 gave a hazard ratio of 5.23 ([95% CI, 2.85-9.60]; P<0.001) unadjusted and 4.83 ([95% CI, 2.35-9.95], P<0.001) when adjusted for demographics, comorbidities, hs-cTnI (high-sensitive cardiac troponin), and CRP (C-reactive protein). EF1 was similar in patients with and without COVID-19 (23.2±7.3 versus 22.0±7.6%, P=0.092, adjusted for prevalence of risk factors and comorbidities). Impaired EF1 is strongly associated with mortality in COVID-19 and probably reflects preexisting, preclinical heart failure.


Assuntos
COVID-19 , Ecocardiografia , Insuficiência Cardíaca , Volume Sistólico , Adulto , Idoso , COVID-19/mortalidade , COVID-19/fisiopatologia , COVID-19/terapia , China/epidemiologia , Comorbidade , Ecocardiografia/métodos , Ecocardiografia/estatística & dados numéricos , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/fisiopatologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Valor Preditivo dos Testes , Prevalência , Prognóstico , SARS-CoV-2/isolamento & purificação , Análise de Sobrevida , Reino Unido/epidemiologia
20.
BMC Geriatr ; 21(1): 288, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933023

RESUMO

CONTEXT: A growing number of elderly patients hospitalized for Acute Heart Failure (AHF) are being managed in cardiogeriatrics departments, but their characteristics and prognosis are poorly known. This study aimed to investigate the profile and outcome (rehospitalization at 90 days) of patients hospitalized for AHF in cardiogeriatrics departments in the Val-de-Marne area in the suburbs of Paris, and to compare them to AHF patients hospitalized in cardiology departments in the same area. METHODS: Observational study, ICREX-94, conducted in seven cardiology departments in France and three specific cardiogeriatrics departments in Val-de-Marne. RESULTS: A total of 308 patients were hospitalized for AHF between October 2017 and January 2019. During the 90 days following discharge, 29.6% patients were readmitted to the hospital. Compared with patients hospitalized in cardiology departments, patients in cardiogeriatrics departments were older (p < 0.001), less independent (living more often alone or in an institution) (p < 0.001), more often depressed (p < 0.001), had more often major neurocognitive disorder (p < 0.001), had a higher Human Development Index (HDI, p < 0.001), and were less often diagnosed with amyloidosis (p < 0.001). There was no difference in outcome whether patients were discharged from cardiology or cardiogeriatrics departments. The most frequent precipitating factors underlying AHF decompensation between the first and second hospitalization were arrhythmia and infection. CONCLUSION: AHF patients discharged from cardiogeriatrics departments, compared to cardiology departments, showed clinical differences but had the same prognosis regarding AHF rehospitalization at 90 days.


Assuntos
Insuficiência Cardíaca , Doença Aguda , Idoso , França/epidemiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Hospitalização , Humanos , Alta do Paciente , Prognóstico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...