Clinical impact of perioperative atrial fibrillation on long-term recurrence of malignancy.

Perioperative complications have been reported to be associated with a lower incidence of cancer-free survival. Perioperative atrial fibrillation (POAF) is one of occasionally observed complications in patients with malignancies who undergo noncardiac surgeries. However, the long-term clinical impact of POAF on those with malignancies have remained unknown. This was a prospective, single-center, observational study. Patients who underwent noncardiac surgeries for definitive malignancies between 2014 and 2017 were included. The primary and secondary endpoints were 3-year recurrence of malignancies and cancer death, respectively. The present study included consecutive 752 patients (mean age, 68 ± 11 years; males, 62%), and POAF was observed in 77 patients. The follow-up duration was 1037 (interquartile range, 699-1408) days. The 3-year recurrence of malignancies was observed in 239 (32%) patients (POAF, 32 [42%]; non-POAF, 207 [31%]) and 3-year mortality was 130 patients (17%). Cardiac, noncardiac, and cancer deaths were observed in 4 (0.5%), 126 (17%), and 111 (15%) patients, respectively. Multivariate Cox regression analysis demonstrated that POAF was associated with 3-year recurrence of malignancies (hazard ratio [HR], 1.70; 95% confidence interval [CI], 1.15-2.52). Landmark analysis demonstrated that POAF tended to be correlated with the incidence of 3-year cancer death (HR, 1.79; 95% CI, 0.96-3.31). In conclusion, POAF is associated with the subsequent recurrence of malignancies. The association of arrhythmia with cancer death may be revealed under longer follow-up durations.Clinical Trial Registration: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000018270 . UMIN ID: UMIN000016146.

Feasibility and safety of noncontrast percutaneous coronary intervention in patients with complicated acute coronary syndrome.

OBJECTIVES: This study aimed to examine the feasibility and safety of noncontrast percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). BACKGROUND: Contrast-induced acute kidney injury (CI-AKI) occurs in 10-20% of ACS patients undergoing PCI, resulting in poor short- and long-term prognoses. Reducing the amount of contrast medium can prevent CI-AKI. METHODS: This was a prospective single-center study. In successful noncontrast PCI, contrast medium was not injected from guiding catheter engagement to wire removal in ad-hoc PCI. Coronary angiography after PCI was permitted once. CI-AKI was defined as an increase in the serum creatinine level of ≥0.5 mg/dl or ≥1.25 times the baseline within 72 hr post PCI. Worsening renal function (WRF) was defined as an increase in the serum creatinine level of ≥0.3 mg/dl from baseline after PCI. RESULTS: This study included 106 lesions from 81 patients. Forty-eight (45%) lesions were Type C lesions. Successful noncontrast PCI was performed in 95 (90%) lesions. CI-AKI, coronary perforation, no/slow flow, and periprocedural death were observed in 4 (5%), 0, 9 (11%), and 0 patients, respectively. The follow-up period was 348 (190-492) days. Six-month WRF was observed in 18 individuals (22%). While successful noncontrast PCI was not associated with the incidence of CI-AKI, successful noncontrast PCI was inversely associated with WRF (hazard ratio, 0.28; 95% confidence interval, 0.09-0.90) after adjustment for renal function. CONCLUSIONS: The present study suggests that noncontrast PCI is feasible and can be safely performed in ACS patients with complex lesions.

Clinical characterization of patients with primary aldosteronism plus subclinical Cushing's syndrome.

BACKGROUND: Primary aldosteronism (PA) plus subclinical Cushing's syndrome (SCS), PASCS, has occasionally been reported. We aimed to clinically characterize patients with PASCS who are poorly profiled. METHODS: A population-based, retrospective, single-center, observational study was conducted in 71 patients (age, 58.2 ± 11.2 years; 24 males and 47 females) who developed PA (n = 45), SCS (n = 12), or PASCS (n = 14). The main outcome measures were the proportion of patients with diabetes mellitus (DM), serum potassium concentration, and maximum tumor diameter (MTD) on the computed tomography (CT) scans. RESULTS: The proportion of DM patients was significantly greater in the PASCS group than in the PA group (50.0% vs. 13.9%, p <  0.05), without a significant difference between the PASCS and SCS groups. Serum potassium concentration was significantly lower in the PASCS group than in the SCS group (3.2 ± 0.8 mEq/L vs. 4.0 ± 0.5 mEq/L; p <  0.01), without a significant difference between the PASCS and PA groups. Among the 3 study groups of patients who had a unilateral adrenal tumor, MTD was significantly greater in the PASCS group than in the PA group (2.7 ± 0.1 cm vs. 1.4 ± 0.1 cm; p <  0.001), without a significant difference between the PASCS and SCS groups. CONCLUSIONS: Any reference criteria were not obtained that surely distinguish patients with PASCS from those with PA or SCS. However, clinicians should suspect the presence of concurrent SCS in patients with PA when detecting a relatively large adrenal tumor on the CT scans.

Investigating the risk of bone fractures in elderly patients with type 2 diabetes mellitus: a retrospective study.

BACKGROUND: Elderly patients with type 2 diabetes mellitus (T2DM) experience fractures more frequently than elderly individuals without diabetes. Fractures requiring hospitalization greatly affect quality of life, and although elderly patients with T2DM have several risk factors associated with fractures, only a few studies have evaluated these in detail in the Asian population. We conducted a retrospective study of elderly patients with T2DM for evaluating factors associated with fracture risk. METHODS: We conducted a retrospective study using electronic medical records (EMR) of patients aged ≥65 years with T2DM who were admitted to a public general medical institute in central Tokyo, Japan. We evaluated factors associated with fractures necessitating hospitalization in elderly patients with T2DM characteristics and hypoglycemic agent use. Factors associated with fracture risk were identified using multivariable logistic regression analysis. RESULTS: A total of 2,112 elderly patients (age ≥ 65 years) with T2DM were analyzed. Among them, 69 (3.3%) patients had been hospitalized for fractures. Factors associated with fractures were female sex (OR, 3.46), eGFR < 60 ml / min / 1.73 m2 (OR, 0.55), and thiazolidine use (OR, 4.28). Further, a separate analysis based on sex revealed that the use of thiazolidines was significantly associated with fracture risk in both sexes. CONCLUSIONS: In elderly patients with T2DM, the key factor associated with fractures was the use of thiazolidines in both males and females. In this study, the use of thiazolidines was newly identified as a factor which increased the risk of fractures requiring hospitalization in elderly males. The study findings should be considered when hypoglycemic agents are selected for treating elderly patients with T2DM. Information bias, selection bias, and the effect of concomitant drugs may be the underlying reasons for why eGFR < 60 mL / min / 1.73 m2 reduced the fracture risk. However, details are unknown, and additional investigations are needed.

The study protocol for PREDICT AF RECURRENCE: a PRospEctive cohort stuDy of surveIllanCe for perioperaTive Atrial Fibrillation RECURRENCE in major non-cardiac surgery for malignancy.

BACKGROUND: A previous retrospective cohort study established the relationship between perioperative atrial fibrillation (POAF) and subsequent mortality and stroke. However, the details regarding the cause of death and etiology of stroke remain unclear. METHODS: The prospective cohort study of surveillance for perioperative atrial fibrillation recurrence in major non-cardiac surgery for malignancy (PREDICT AF RECURRENCE) registry is an ongoing prospective cohort study to elucidate the long-term recurrence rate and the clinical impact of new-onset POAF in the setting of head and neck, non-cardiac thoracic, and abdominal surgery for malignancy. In this study, cardiologists collaborate with a surgical team during the perioperative period, carefully observe the electrocardiogram (ECG) monitor, and treat arrhythmia as required. Furthermore, patients who develop new-onset POAF are followed up using a long-term Holter ECG monitor, SPIDER FLASH-t AFib®, to assess POAF recurrence. DISCUSSION: Even if patients with malignancy survive by overcoming the disease, they may die from any preventable cardiovascular diseases. In particular, those with POAF may develop cardiogenic stroke in the future. Because details of the natural history of patients with POAF remain unclear, investigating the need to continue anticoagulation therapy for such patients is necessary. This study will provide essential information on the recurrence rate of POAF and new insights into the prediction and treatment of POAF. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry (UMIN-CTR): UMIN000016146 ; Data of Registration: January 7, 2015.

Clinical impact of non-culprit lesions on 1-year mortality in very elderly patients with acute coronary syndrome.

Preventive percutaneous coronary intervention (PCI) for non-culprit lesions after primary PCI remains controversial in patients with acute coronary syndrome (ACS). We analyzed whether PCI for non-culprit lesions would be associated with a better long-term prognosis in very elderly (≥85 years) patients. This study included 91 consecutive patients with ACS (mean age, 88.2 ± 3.0, 52 % male). We investigated the association of residual lesions with 1-year mortality. Culprit lesions affected the left anterior descending artery (LAD) in 50 patients, the left circumflex artery (LCx) in 29, and the right coronary artery (RCA) in 31. Residual lesions affected LAD in 20 cases, LCx in 22, and RCA in 21 patients. Residual lesions in LAD were associated with a higher 1-year mortality (p = 0.013), whereas residual lesions in LCx or RCA were not (p = 0.547 and 0.473, respectively). A Cox regression model demonstrated that patients with residual lesions in LAD had an increased risk of 1-year mortality compared with those without residual lesions (hazard ratio, 2.39; 95 % confidence interval, 1.16-4.96; p = 0.019). Therefore, the option to not treat residual lesions in LAD of patients with PCI may be associated with a higher 1-year mortality. Further studies are needed to confirm these findings.

Higher Body Mass Index and Increased Prevalence of Paranasal Sinus Disease.

BACKGROUND: We hypothesized that higher body mass index (BMI) was associated with increased prevalence of paranasal sinus disease and examined the hypothesis in Japanese adults. METHODS: This was a cross-sectional study including 1350 Japanese adults aged 40 years or more who participated in a health check-up program focusing on brain diseases and metabolic syndrome. Participants were divided into quartiles of BMI levels. Paranasal sinus disease was confirmed by a head MRI scan. The association between BMI and paranasal sinus disease was examined using logistic regression analysis, which was adjusted for age, sex, waist:hip ratio, hemoglobin A1c, systolic blood pressure, smoking status, alcohol intake, and white blood cell count. RESULTS: Of the 1350 participants, 151 (11.2%) had paranasal sinus disease. In relation to those in the lowest quartile of BMI, the odds ratios of having the disease among those in the 2nd, 3rd, and 4th quartiles of BMI were 1.89 (95% confidence interval [CI], 1.03-3.48), 2.26 (95% CI, 1.20-4.23) and 2.26 (95% CI, 1.14-4.51), respectively. When BMI was analysed as a continuous variable, an increase of one unit in BMI was significantly associated with increased odds of having the disease, with an OR of 1.08 (95% CI, 1.01-1.16). CONCLUSIONS: The present study suggests that patients with higher BMI are more likely to have paranasal sinus disease.

Time Spent Walking and Risk of Diabetes in Japanese Adults: The Japan Public Health Center-Based Prospective Diabetes Study.

BACKGROUND: The association between time spent walking and risk of diabetes was investigated in a Japanese population-based cohort. METHODS: Data from the Japan Public Health Center-based Prospective Diabetes cohort were analyzed. The surveys of diabetes were performed at baseline and at the 5-year follow-up. Time spent walking per day was assessed using a self-reported questionnaire (<30 minutes, 30 minutes to <1 hour, 1 to <2 hours, or ≥2 hours). A cross-sectional analysis was performed among 26 488 adults in the baseline survey. Logistic regression was used to examine the association between time spent walking and the presence of unrecognized diabetes. We then performed a longitudinal analysis that was restricted to 11 101 non-diabetic adults who participated in both the baseline and 5-year surveys. The association between time spent walking and the incidence of diabetes during the 5 years was examined. RESULTS: In the cross-sectional analysis, 1058 participants had unrecognized diabetes. Those with time spent walking of <30 minutes per day had increased odds of having diabetes in relation to those with time spent walking of ≥2 hours (adjusted odds ratio [OR] 1.23; 95% CI, 1.02-1.48). In the longitudinal analysis, 612 participants developed diabetes during the 5 years of follow-up. However, a significant association between time spent walking and the incidence of diabetes was not observed. CONCLUSIONS: Increased risk of diabetes was implied in those with time spent walking of <30 minutes per day, although the longitudinal analysis failed to show a significant result.

Association between diabetes and increased prevalence of paranasal sinus disease: a cross-sectional study in Japanese adults.

BACKGROUND: The association between diabetes and paranasal sinus disease has not been thoroughly investigated. METHODS: We cross-sectionally investigated the association between diabetes and the presence of paranasal sinus disease, which was confirmed by a head MRI scan in 1350 adults who underwent a health screening program focusing on brain diseases and metabolic syndrome. Logistic regression, which was adjusted for age, sex, body mass index, waist-to-hip ratio, hypertension, smoking status, alcohol intake, and white blood cell count, was performed to calculate the odds ratio (OR) of having paranasal sinus disease among adults with diabetes in relation to those without. The dose-response relationship between hemoglobin A1c (HbA1c) levels and the presence of paranasal sinus disease was also investigated. RESULTS: Of the 1350 participants (mean age, 61.6 ± 10.0 years; 71.6% men), 220 diabetes cases were identified. Paranasal sinus disease was diagnosed in 151 adults. The adjusted OR of having paranasal sinus disease was 1.74 (95% confidence interval [CI], 1.12-2.71) in those with diabetes. The odds of having paranasal sinus disease increased with HbA1c levels. Compared to those with HbA1c of ≤5.4%, those with HbA1c of 5.5%-6.4%, 6.5%-7.9%, and ≥8.0% were more likely to have paranasal sinus disease, with adjusted ORs of 1.32 (95% CI, 0.88-1.98), 1.63 (95% CI, 0.86-3.09) and 2.71 (95% CI, 1.12-6.61), respectively (P for trend = 0.019). CONCLUSIONS: Diabetes may be significantly associated with higher prevalence of paranasal sinus disease in Japanese adults. We should keep this increased risk in mind when a diabetic patient is suspected of having paranasal sinus disease.

J waves in accidental hypothermia.

BACKGROUND: The J wave is an ECG marker of ventricular fibrillation. However, the prevalence and clinical implications of J waves in hypothermic patients remain unclear. METHODS AND RESULTS: We evaluated the clinical characteristics and ECGs of patients who were admitted for accidental hypothermia (<35.0°C). J waves were defined as notches or slurs in the terminal part of the QRS complex with an amplitude ≥0.1mV. We analyzed the prevalence of J waves and the relationship between body temperature (BT) and J wave amplitude. We also examined the augmentation of J waves following variable R-R intervals in patients with atrial fibrillation. Furthermore, we assessed the incidence of ventricular arrhythmias. A total of 60 hypothermic patients were recruited (mean age, 64±9 years; 97% male). The mean BT was 31.3°C (range, 29.4-33.5°C). J waves, which disappeared after rewarming, were observed in 30 patients (50%), with a higher frequency in patients with lower BT. Higher amplitude of J waves was associated with lower BT (P<0.001). Of the 8 patients with J waves and atrial fibrillation, 4 exhibited an augmentation of J waves following a short R-R interval. Only 1 patient with J waves developed ventricular tachycardia during rewarming. CONCLUSIONS: The prevalence of J waves and their amplitude increased with the severity of hypothermia. The temporal development of J waves might not be associated with fatal arrhythmic events.

Association of glycemic status with impaired lung function among recipients of a health screening program: a cross-sectional study in Japanese adults.

BACKGROUND: The dose-response relationship between glycemic status and lung function has not been thoroughly investigated. We hypothesized that there are continuous and inverse associations between glycemic measures and lung function tests and examined the hypothesis in Japanese adults. METHODS: We cross-sectionally investigated associations of hemoglobin A1c (HbA1c) and fasting plasma glucose (FPG) with forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in 3161 adults who participated in a health screening from 2008 to 2011. The study participants included both diabetic and non-diabetic adults. Multiple linear regression analyses were performed to examine the associations. RESULTS: Inverse associations were observed in both sexes, which were attenuated in women after adjustment for multiple variables. A 1% absolute increase in HbA1c was associated with a -52-mL (95% confidence interval [CI] -111 to 8 mL) difference in FVC and a -25-mL (95% CI -75 to 25 mL) difference in FEV1 in women, and a -128-mL (95% CI -163 to -94 mL) difference in FVC and a -73-mL (95% CI -101 to -44 mL) difference in FEV1 in men. A 10-mg/dL increase in FPG was associated with a -11-mL (95% CI -29 to 8 mL) difference in FVC and a -8-mL (95% CI -24 to 7 mL) difference in FEV1 in women, and a -32-mL (95% CI -44 to -21 mL) difference in FVC and a -19-mL (95% CI -28 to -9 mL) difference in FEV1 in men. CONCLUSIONS: Inverse associations between glycemic measures and lung function were observed. Men seem more susceptible to the alteration in FVC and FEV1 than women.

Descriptive epidemiology of diabetes prevalence and HbA1c distributions based on a self-reported questionnaire and a health checkup in the JPHC diabetes study.

BACKGROUND: The present study examined the prevalence of diabetes in Japan during the late 1990s and early 2000s using the Japan Public Health Center-based Prospective Diabetes cohort. We also investigated the distributions of HbA1c values in noncompliant diabetic participants in the cohort. METHODS: A total of 28 183 registered inhabitants aged 46-75 years from 10 public health center areas were included in the initial survey. The 5-year follow-up survey included 20 129 participants. The prevalence of diabetes was estimated using both a self-reported questionnaire and laboratory measurements. Among the participants who reported the presence of diabetes on the questionnaire (self-reported diabetes), the distributions of HbA1c values were described according to their treatment status. RESULTS: The age-standardized prevalence of diabetes in 55- to 74-year-old adults was 8.2% at the initial survey and 10.6% at the 5-year follow-up. At the initial survey, among participants with self-reported diabetes, the mean HbA1c values in the participants who had never and who had previously received diabetes treatment were 7.01% (standard deviation [SD] 1.56%) and 6.56% (SD 1.46%), respectively. Approximately 15% of the participants who had self-reported diabetes but had never received diabetes treatment had an HbA1c ≥ 8.4%. CONCLUSIONS: The prevalence of diabetes increased in the JPHC cohort between the late 1990s and early 2000s. A certain proportion of participants who were aware of their diabetes but were not currently receiving treatment had poor diabetic control. Efforts to promote continuous medical attendance for diabetes care may be necessary.

Clinical impact of noncontrast percutaneous coronary intervention in patients with acute coronary syndrome.

PURPOSE: Contrast-induced acute kidney injury (CI-AKI) is one of the common serious complications of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). This study aimed to assess the significance of noncontrast strategy in the setting of ACS. METHODS: CI-AKI was defined as an increase in serum creatinine of ?0.5 mg/dL or ?1.25 times from the baseline. One-year worsening renal function (WRF) was defined as an increase of ?0.3mg/dL in serum creatinine from the baseline after PCI. RESULTS: Of 250 ACS patients, 81 were treated with noncontrast PCI. The average doses of contrast medium in the noncontrast and conventional groups were 17 (9?22) ml and 150 (120?200) ml, respectively. CI-AKI was observed in 4 patients (5%) in the noncontrast group and 29 patients (17%) in the conventional group. Noncontrast PCI was associated with a lower incidence of CI-AKI (adjusted odds ratio, 0.26;95% confidence interval [CI], 0.08?0.82). The bootstrap method and inverse probability weighting led to similar results. CI-AKI was associated with a higher incidence of 1-year WRF (adjusted hazard ratio, 2.30;95% CI, 1.12?4.69), while noncontrast PCI was not. CONCLUSIONS: Noncontrast PCI was associated with the lower incidence of CI-AKI in ACS patients. J. Med. Invest. 69 : 57-64, February, 2022.

Psychological and Situational Factors Affecting Dropout from Regular Visits in Diabetes Practice: The Japan Diabetes Outcome Intervention Trial-2 Large Scale Trial 004 (J-DOIT2-LT004).

Introduction: This study explored the psychological and situational factors affecting dropout from regular visits to diabetes care using data obtained from the Japan Diabetes Outcome Intervention Trial 2 (J-DOIT2) Large-scale Trial (LT). Methods: A total of 2,031 patients with type 2 diabetes who participated in the J-DOIT2-LT were included in the analysis. Responses to a baseline questionnaire with 17 items asking about the experience of dropout from regular visits in diabetes care and its reasons were analyzed using principal component analysis, and factors related to dropout were extracted. Using Cox regression analysis, the association of these factors with the incidence of dropout was investigated. Results: The mean age of the 2,031 patients was 56.4 ± 5.9 years and 742 (36.5%) were women. They were followed for a median of 392 days, and 125 patients dropped out from regular visits during the follow-up period. In the principal component analysis of the questionnaire, there were four latent factors with eigenvalues of >1.0, which were labeled as "negative perceptions for regular visits," "social pressure," "lack of perceived necessity," and "environmental obstacles" based on the retained items. The Cox regression analysis demonstrated that patients with high scores of "lack of perceived necessity" and "environmental obstacles" had a significantly increased risk of dropout from regular visits. Conclusions: The present study revealed psychological and situational factors related to dropout, which may be useful for detecting patients at high risk of dropout. Effective measures focusing on such patients to prevent dropouts should be investigated in future studies (The trial registration number: UMIN000002186, registered at the University Hospital Medical Information Network-Clinical Trials Registry).

Cross-sectional associations between the types/amounts of beverages consumed and the glycemia status: The Japan Public Health Center-based Prospective Diabetes study.

Background: The associations between the types/amounts of beverages consumed in daily life and measures of the glycemia status were investigated in a Japanese population-based cohort. Methods: Data from the baseline survey of the Japan Public Health Center-based Prospective Diabetes cohort were used. A cross-sectional analysis was performed in 3852 men and 6003 women who were evaluated under the fasting condition. The daily consumptions of coffee, green tea, oolong tea, black tea, soft drinks, fruit juices, or plain water were assessed using a self-reported questionnaire. Multivariable-adjusted linear regression analyses were performed using measures of the glycemia status (fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) ) as dependent variables and the types/amounts of beverages consumed as the independent variables, to calculate the differences according to the types/amounts of beverages consumed. Results: In the multivariable-adjusted models, coffee consumption of ≥240 mL/day was significantly associated with a change of the FPG level by -1.9 mg/dL in men (p = 0.013) and -1.4 mg/dL in women (p = 0.015), as compared to coffee consumption of 0 mL/day. No significant association of the FPG level was observed with any of the other types/amounts of beverages consumed. On the other hand, significant associations were found between the HbA1c levels and consumption of several types of beverages. Conclusions: High coffee consumption was associated with lower FPG levels in this Japanese population. Some unexpected associations of the HbA1c levels with the consumption of some types of beverages were observed, which need to be further investigated.

Polypharmacy and oral antidiabetic treatment for type 2 diabetes characterised by drug class and patient characteristics: A Japanese database analysis.

Polypharmacy (PP) occurs in patients with type 2 diabetes (T2DM) owing to multimorbidity. We evaluated concomitant PP and medication adherence in T2DM 3 years after initiation of administration of a hypoglycaemic agent using a nationwide claim-based database in Japan. Factors associated with medication PP and imperfect adherence were identified using multivariable logistic regression. PP was defined as using ≥6 medications. Patients with proportion of days covered (PDC) of <80% were defined as having poor medication adherence. A total of 884 patients were analysed. Multivariate analysis revealed that age, total number of consultations and body mass index (BMI) are factors that influence PP. Factors associated with PDC < 80% were 2-3, 4-5 and ≥ 6 medications compared with 1 medication, male sex, <17 consultations and age 50-59 and ≥ 60 years compared with <40 years. In conclusion, older age, high total number of consultations and BMI ≥ 25 kg/m2 are risk factors for PP. PP influenced good medication adherence at the end of the observation period.

Determination of factors affecting medication adherence in type 2 diabetes mellitus patients using a nationwide claim-based database in Japan.

BACKGROUND: The extent of medication adherence in patients with type 2 diabetes mellitus (T2DM) several years after starting treatment with hypoglycemic agents remains unknown. Most previous work on medication adherence targeting this group of patients has been undertaken across a single year or is questionnaire based. This study aimed to determine medication adherence status and factors affecting adherence 3 years after initiation of hypoglycemic agents, using a nationwide medical claim-based database in Japan. METHODS: This retrospective study was conducted on data from 884 subjects with T2DM to better understand medication adherence, the effects of polypharmacy, and other factors. We also investigated the effects of medication nonadherence on hemoglobin A1c levels. Proportion of days covered was defined as the number of days for which a hypoglycemic agent was prescribed and in the patient's possession to the number of days in the observation period. A proportion of days covered ≥0.8 were considered adherent, and those with a value <0.8 as nonadherence. Polypharmacy was defined as taking ≥5 medications. RESULTS: Of the 884 patients investigated, 440 were considered adherent during the study period. Significant factors related to adherence included number of medications (3 or 4, or ≥5), male sex, age 50-<60 years, and total number of visits ≥17. Medication adherence was also a factor related to patients with hemoglobin A1c values < 7.0% at the end of the observation period. CONCLUSIONS: We surveyed medication adherence for 3 years with post medication initiation, and found that subjects aged 50-<60 years, those with ≥3 concomitant medications, and those with a total number of visits ≥17 were more likely to be adherent and persistent, and more likely to continue their hypoglycemic agents. A high degree of medication adherence was found to have a positive influence on hemoglobin A1c levels.

Urinary cast is a useful predictor of acute kidney injury in acute heart failure.

Acute kidney injury (AKI) is associated with poor prognosis among patients with acute heart failure (AHF). Early documentation of impaired kidney function through simple examination may provide risk reduction in such patients. The present study aims to reveal an association between cellular casts and hospital-acquired AKI in AHF. This study included patients with AHF who underwent urinalysis, including urinary sediment analysis within 24 hours post admission. AKI was defined as an increase of ≥0.3 mg/dL within 48 hours or ≥1.5 times in serum creatinine level in contrast to baseline creatinine level. In this study, 114 patients with AHF (age, 75 ± 14 years; male, 59.7%) were included. Of them, 40 (35%) developed hospital-acquired AKI. Cellular casts were detected in 30 patients (26%) prior to AKI development and related to hospital-acquired AKI in the multivariate logistic regression analysis (odds ratio, 2.80; 95% confidence interval, 1.04-7.49; P = 0.041). In conclusion, cellular casts are observed occasionally in patients with AHF and potentially useful markers for development of AKI during hospitalization.

Perioperative Atrial Fibrillation in Noncardiac Surgeries for Malignancies and One-Year Recurrence.

BACKGROUND: Perioperative atrial fibrillation (POAF) in noncardiac surgeries is common. However, it is unclear whether such atrial fibrillation (AF) recurs in the long term. METHODS: This study was a prospective, single-center, observational study that included patients who underwent noncardiac surgeries for malignancies. Patients were followed up for 1 year to evaluate the incidence of AF, ischemic stroke, and mortality. An event-triggered recorder was used in patients with POAF. The incidences were compared according to the presence of POAF. RESULTS: Of 752 consecutive patients, 77 (10.2%) developed POAF and wore an event recorder for 19 (12-30) days. AF and ischemic stroke at 1 year were observed in 24 patients (31.1%) and 2 patients (2.6%) with POAF and 4 patients (0.6%) and 3 patients (0.4%) without POAF, respectively. Of the 24 patients with POAF and AF recurrence, 22 (92%) were asymptomatic. Anticoagulation was prescribed in 67 patients (87%) with POAF. Multivariate Cox regression analysis demonstrated that a higher AF recurrence rate in patients with POAF was associated with hypertension (hazard ratio, 2.79; 95% confidence interval, 1.06-7.38) and serum creatinine level (hazard ratio for 20 µmol/L increase, 2.32; 95% confidence interval, 1.16-4.62). CONCLUSIONS: AF recurs in approximately 30% of patients with POAF with malignancy in the subsequent year; most recurrences are asymptomatic.

Incidence and complications of perioperative atrial fibrillation after non-cardiac surgery for malignancy.

BACKGROUND: Perioperative atrial fibrillation (POAF) is one of the common arrhythmias in the setting of non-cardiac surgeries for malignancy. As POAF may cause subsequent adverse events, it is important to confirm its characteristics and risk factors. MATERIALS AND METHODS: The prospective cohort study of surveillance for perioperative atrial fibrillation recurrence (PREDICT AF RECURRENCE) is an ongoing prospective, single-center, observational study that aims to illustrate the clinical impact of POAF in major non-cardiac surgery for malignancy. Patients who planned to undergo non-cardiac surgery for definitive/suspected malignancy were registered. Those with a history of AF and atrial flutter were excluded. Any 30-day complications included acute myocardial infarction, congestive heart failure, bleeding, thrombosis, any infection, and acute kidney injury. The primary endpoint was an incidence of POAF. RESULTS: The present study included 799 patients (age, 68 ± 11; male, 62%). Of these, 80 patients (10.0%) developed POAF. Notably, 66 patients (83%) had no symptoms. Any 30-day complications occurred in 180 patients (23%) (with POAF: 34 (43%); without POAF: 146 (20%); p < 0.001). POAF in 17 patients (50%) was preceded by the development of complications. No patient developed cardiogenic shock and/or acute heart failure. The association between 30-day complications and POAF development were analyzed using the multivariate adjusted model (odds ratio: 2.84; 95% confidence interval: 1.74-4.62; p < 0.001). CONCLUSION: Ten percent of patients who underwent non-cardiac surgery for malignancy developed POAF, which was strongly associated with perioperative complications. As a majority were asymptomatic, careful observation using electrocardiography monitoring is important to avoid oversights. CLINICAL TRIAL REGISTRATION: UMIN ID: UMIN000016146.