bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6360Prognostic value of polypharmacy in patients with heart failure
Authors: Fujita R , Takabayashi K , Iwatsu K , Matsumura K , Ikeda T , Kitaguchi S , Nohara R 
Published: October 2019

Abstract

Background
Polypharmacy creates an increased patient's burden by drug-drug interactions and poor adherence. However, there are very few studies available evaluating the association of polypharmacy with hospital readmission in patients with heart failure (HF).

Purpose
The aim of this study was to investigate the impact of polypharmacy on hospital readmission for HF.

Methods
We enrolled 1253 patients who were hospitalized with acute heart failure (AHF) or acute exacerbation of chronic heart failure in the Kitakawachi Clinical Background and Outcome of Heart Failure Registry (KICKOFF Registry) from April 2015 to July 2018 (age 78.1±11.5 years, male 51.4%). Our Registry is a prospective multicenter community-based cohort study of HF patients in Japan. The inclusion criteria for the registry was a diagnosis of HF during hospitalization according to the Framingham criteria, and there were no exclusion criteria. From data at discharge, we collected data on clinical characteristics, medication schedule, and social backgrounds. We defined polypharmacy as the use of seven or more medications. The primary end point was HF rehospitalization within 1 year after discharge. Cox proportional hazards regression analysis was used to describe the association between polypharmacy and 1-year HF rehospitalization, controlling for potential confounding factors.

Results
In this study, the prevalence of polypharmacy was 59.7% of all patients. Patients with polypharmacy were more likely to have comorbidities such as hypertension, dyslipidemia, diabetes, chronic kidney disease, coronary artery disease and dementia. They also had lower EF (50.9±0.64 vs 53.6±0.80, p<0.01), compared to patients without polypharmacy. There was no significant difference in age, gender and BMI, compared to patients without polypharmacy. During the follow-up period, a total of 278 patients (24.9%) were readmitted for HF. In Kaplan-Meier analyses, hospital readmission for HF during 1-year follow-up was significantly higher in patients with polypharmacy (p<0.01) (figure). After adjusting for gender, age, EF, and the other co-morbidities, polypharmacy was independently associated with higher risk of rehospitalization for HF (hazard ratio 1.28, 95% confidence interval, 1.07–1.52, p<0.01).

Conclusion
Polypharmacy is an independent predictor of hospital readmission for HF. Our study suggests the need for developing an effective strategy to choose the appropriate drugs in patients with HF.

Acknowledgement/Funding
Nakajima Steel Pipe
P6371Network characteristics of a hypertension referral system in western kenya
Authors: Thakkar A , Valente T , Andesia J , Njuguna B , Miheso J , Mercer T , Mwangi E , Pastakia S D , Pillsbury M M , Pathak S , Kamano J , Naanyu V , Vedanthan R , Bloomfield G S , Akwanalo C 
Published: October 2019

Abstract

Introduction
The Strengthening Referral Networks for Management of Hypertension Across the Health System (STRENGTHS) trial is creating and testing interventions to improve the effectiveness of referral networks for patients with hypertension in Western Kenya.

Purpose
Network analysis of facility-based healthcare providers was used to understand the existing network of referrals. The ultimate goal was to identify both structural gaps and opportunities for implementation of the planned intervention.

Methods
A network survey was administered to providers who deliver care to patients with hypertension asking individuals to nominate a) individuals to whom, and b) facilities to which they refer patients, both up and down the health system. We analyzed survey data using centrality measures of in-degree and out-degree (number of links each provider received and sent, respectively), as well as fitting a core-periphery (CP) model. A higher CP indicates a strong referral network, while a lower CP indicates a relatively weaker network.

Results
Data were collected from 130 providers across 39 sites within 7 geographically separate network clusters. Each cluster consists of a mix of primary, secondary, and/or tertiary facilities. Compared to a perfect CP referral network model (Correlation Score [CP] = 1.00) and a random referral network model (CP = 0.200), the provider referral networks within each cluster showed a weak tendency for CP structure. There was a large range in CP from 0.334 to 0.639. In contrast, cluster-level facility networks showed a strong tendency for CP structure, with a CP range of 0.857 to 0.949.
Core Periphery Correlation Scores [CP] Network Cluster 1 Cluster 2 Cluster 3 Cluster 4 Cluster 5 Cluster 6 Cluster 7 Provider Referrals 0.433 0.424 0.334 0.639 0.535 0.448 0.407 Facility Referrals 0.949 0.894 0.871 0.949 0.949 0.904 0.857 Each cluster represents a geographically separate referral network. A random referral network would reveal a CP score of 0.200; while a perfect referral network would give a CP of 1.00.
Referral Network Models

Conclusions
The current health system across Western Kenya does not demonstrate a strong network of referrals between providers for patients with hypertension. While facility-to-facility referrals are more in-line with a perfect referral model, there are gaps in communication between the specific providers. These results highlight the need for STRENGTHS to design and test interventions that strengthen provider referral patterns in order to improve blood pressure control and reduce cardiovascular risk.

Acknowledgement/Funding
National Institutes of Health: National Heart Lung and Blood Institute, Doris Duke Charitable Foundation:International Clinical Research Fellowship
P6384Thrombotic-hemorrhagic balance evaluation in STEMI patients with or without associated cardiac arrest: an observational study
Authors: Picard F , Diefenbronn M , Laghlam D , Llitjos J F , Sokoloff A , Varenne O , Dumas F , Cariou A 
Published: October 2019

Abstract

Background
Data is scarce on hemorrhagic and thrombotic complications in patients with ST-elevation myocardial infarction (STEMI) associated with out-of-hospital cardiac arrest (OHCA).

Purpose
We sought to evaluate the difference in the thrombotic-hemorrhagic balance in STEMI patients with or without associated cardiac arrest.

Methods
This is a monocentric, retrospective study conducted from January 2012 to December 2017. Over the study period, all consecutive patients who were treated for STEMI with our without OHCA were included. Baseline characteristics, treatments, haemorrhagic and thrombotic events were compared between STEMI patients associated or not with OHCA. Univariate and multivariate analysis were performed to identify predictors of 30-day mortality, occurrence of major bleeding, defined by BARC score ≥3 and early stent thrombosis.

Results
A total of 549 patients treated for STEMI and 146 patients for STEMI associated with OHCA were included. The incidence of stent thrombosis and major bleeding after coronary angioplasty in patients treated for STEMI was significantly higher when associated with OHCA (2.7% vs. 12.3%, p=0.04 and 3.3% vs. 19.2%, p<0.001, respectively). Independent predictors of major bleeding in OHCA patients were effective anticoagulation (HR=3.11, 95% CI [1.22–7.98], p=0.02) and the use of glycoprotein IIb/IIIa inhibitors (HR=4.16, 95% CI [1.61–10.79], p=0.003). Independent predictors of mortality in STEMI associated with OHCA were age (HR=1.05, 95% CI [1.02–1.09], p=0.004) and stent thrombosis (HR=5.62, 95% CI [1.61–19.65], p=0.007, with a protective effect of new anti-P2Y12 treatments (HR=0.20, 95% CI [0.08–0.46], p<0.001).
Clinical outcomes at 30 days follow-up

Conclusion
Patients treated for STEMI associated with OHCA are at higher-risk of stent thrombosis and bleeding than those who did not experience cardiac arrest. The use of effective anticoagulation and glycoprotein IIb/IIIa inhibitors contributes to increase bleeding complications. In this subset of patients, prospective studies are needed to better evaluate thrombotic and haemorrhagic balance.
P6391Major acute cardiovascular events in patients with inflammatory bowel disease
Authors: Gill G , Fernandez S , Soud M , Mete M , Malhotra N , Garcia-Garcia H M 
Published: October 2019

Abstract

Introduction
Traditional risk factors for coronary heart disease have been reported in around 85% patients who present with myocardial infarction. More recently, inflammation and immune mediated diseases have been associated with ischemic heart disease.
Inflammatory Bowel Disease (IBD) is an immune mediated disorder which comprises of ulcerative colitis and Crohn's disease. Estimated prevalence of IBD in the United States in 2004 was 1.4 million people. These patients have an overall increased risk of thrombotic complications with microvascular thrombosis hypothesized to contribute in disease pathogenesis.
Results from a recent meta-analysis were consistent with increased risk of ischemic heart disease among IBD patients, with risk greater in females and younger patients, although heterogeneity was considerable in overall data. Also, in a recent study, IBD was found to be associated with an increased risk of acute myocardial infarction and heart failure despite lower prevalence of coronary risk factors in IBD patients.
IBD pathogenesis involves sustained activation of immune responses with upregulation of cytokines including but not limited to IL-1 beta, IL-6 and TNF-alpha. Upregulation of these cytokines has also been reported in coronary atherosclerosis.
Based on above information, we explored incidence of MACE (Major Adverse Cardiac Event) in this patient population from our health system data-base.

Methods
Propensity scores were estimated for all 15,292 (0.4%) patients with inflammatory bowel disease from a total patient pool of 3,917,894 patients in our health system to assemble a 1:1 matched cohort balanced for age, gender, race and known cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus and smoking (current and former). ICD-9 and ICD-10 codes were used to identify cardiovascular risk factors and outcomes.

Results
Matched patients (n=30,584) had a mean age of 51 years, with 58% of all being women, and 63% Caucasian. During the median follow up of 4.4 years all-cause mortality was observed in 1.7% and 1.2% of patients from IBD and non-IBD groups respectively (hazard ratio {HR}, 1.31; 95% confidence interval {CI}, 1.08–1.58; p=0.005). Combined outcome for myocardial infarction or all-cause mortality was noted in 4.1% and 3.4% from IBD and non-IBD groups respectively (HR, 1.16; 95% CI, 1.03–1.30; p=0.014) while HRs for cardiovascular mortality, myocardial infarction and unstable angina independently were 1.04 (0.74–1.47; p=0.833), 1.05 (0.89–1.23; p=0.591) and 1.10 (0.83–1.46; p=0.524) respectively.

Conclusion
Inflammatory bowel disease did not show association with myocardial infarction, cardiovascular mortality or unstable angina when matched for known cardiovascular risk factors, but was associated with increased all-cause mortality and combined end-point of all-cause mortality or myocardial infarction.
P6430Does positive family history for premature coronary artery disease increase the cardiovascular risk among elderly?
Authors: Traub Kormann D , Cerci R , Zapparoli M , Antonio Fruet Bettini L , Henrique Ramos Prado P , Vitola J , Morita Fernandes Da Silva M 
Published: October 2019

Abstract

Background
Family history (FH) for premature coronary artery disease (CAD) increases the risk of coronary artery disease and appears to be independently associated with high coronary artery calcium scores (CAC). However, it is uncertain if the positive FH predict high CAC among elderly individuals, as it does among younger individuals.

Objective
We investigated whether the association between family history (FH) for premature coronary artery disease and coronary calcium scores differs according to age.

Methods
We evaluated individuals referred to 128-slice multi-detector computed tomography to measure CAC scores at a single center from 2011 to 2017. Individuals with known CAD or typical angina were excluded. Positive FH was defined as first-degree relatives with early onset CAD (men ≤55 years, women ≤65 years). High CAC scores were defined as above 100 Agatston or higher than the 75th percentile for age and sex. The participants were divided in two age categories: “Younger age” for men ≤55 years old or women ≤65 years old, and “Older age” otherwise.

Results
We evaluated 3187 individuals ageing from 18 to 92 years, 54% (n=1721) being categorized as “Younger age”. Overall, participants with positive FH (n=759) were younger (56±12 vs 60±13) and more frequently women (54% vs 48%) than those with negative FH. Positive FH was independently associated with high CAC, after adjustment for age, sex, body mass index, smoking status, hypertension, diabetes mellitus, dyslipidemia and sedentary lifestyle. This association was similar between individuals at “Younger age” [Odds Ratio 1.46 (95% Confidence Interval 1.15 - 1.86)] and individuals at “Older Age” [OR 1.65 (95% IC 1.23 - 2.20), p for interaction = 0.79, Figure]

Conclusion
Positive FH for premature CAD was associated with higher CAC scores, independently of other cardiovascular risk factors, and this association was similar between younger and older individuals.
P6469Predictive value of currently available echocardiographic work-up algorithm for previous and updated pulmonary hypertension definitions
Authors: Tanyeri S , Akbal O Y , Keskin B , Hakgor A , Karagoz A , Tokgoz H C , Kulahcioglu S , Erdogan E , Tanboga I H , Dogan C , Acar R D , Ozdemir N , Kaymaz C 
Published: October 2019

Abstract

Background and aim
In this study we evaluated the predictive value of currently available European Society of Cardiology 2015 Pulmonary Hypertension (PH) Guidelines two-step echocardiographic (Echo) work-up algorithm for two PH definitions as invasively evaluated pulmonary arterial mean pressures (PAMP) ≥25 mmHg and >20 mmHg.

Methods
Study group comprised the retrospectively evaluated 1299 patients (pts) (53.1±18.8 years, female 807, 62.1%) who underwent right heart catheterisation (RHC) with different indications between 2006 and 2018. Echo data obtained from same day and pre-RHC evaluation were available in all pts. Chemla method was used for Doppler estimation of PAMP from tricuspid regurgitant jet. For two PH definitions as PAMP ≥25 mmHg (definition-A) and PAMP >20 mmHg (definition-B) predictive value of the ESC Echo algorithm was tested with two logistic regression models based on only PAMP-Echo (Model-1) and PAMP-Echo and Echo findings supportive for PH (Model-2).

Results
RHC revealed that criteria for PH definitions A and B were met in 891 (68.6%) and 1051 (80.9%) of overall pts. Pre-RHC Echo findings supportive for PH were noted in 529 (40.7%) of pts. Because pulmonary regurgitant velocity data were imprecise, other 6 supportive Echo findings were utilised. The % of the supportive Echo measures were as follows; 1 (11%), 2 (10%),3 (8.1%), 4 (7.2%), 5 (2.5%) and 6 (1.8%). In Model-1, for definitions A and B, odds ratio (OR) of PAMP-Echo were (1.07; 0.99–1.19, p=0.058, LRX2:139, c: 0.72) and (1.05; 0.98–1.12, p=0.102, LRX2:129, c: 0.71), respectively.
In Model-2, for definition-A, OR of PAMP-Echo and number of supportive findings were (1.05; 0.98–1.12, p=0.162) and (1.58; 1.42–1.75, p<0.001) (LRX2:217, c: 0.77), respectively. Using the same model for definition-B, OR of PAMP-Echo and number of supportive findings were (1.04; 0.97–1.11, p=0.264) and (1.56; 1.40–1.73, p<0.001),(LRX2:203, c: 0.76), respectively. Receiver operating curve (ROC) analysis yielded that PAMP-Echo >39.8 mmHg had a sensitivity of 80% and a specificity of 54% for definition-A, and a sensitivity of 81% and a specificity of 52% for definition-B, respectively. Regardless of the definition tresholds for PH on RHC, number of supportive Echo findings were responsible for nearly 70% of the overall variance in the PH diagnosis.

Conclusions
Irrespective of the RHC definition criteria as PAMP ≥25 mmHg or >20 mmHg, number of supportive Echo findings but not PAMP-Echo only approach seems to be reliable in the diagnostic work-up for PH.
P6534Prognostic implication of serum cystatin C and creatinine-based glomerular filtration rate ratio in coronary disease patients receiving PCI: a surrogate of low muscle mass and a predictor of mortality
Authors: Rhee T.-M , Park K W , Kim C.-H , Kang J , Han J.-K , Yang H.-M , Kang H.-J , Koo B.-K , Kim H.-S 
Published: October 2019

Abstract

Background
Low muscle mass results in impaired exercise capacity and is related with poor prognosis in chronic diseases. Although the ratio of serum creatinine (Scr) to cystatin C (Scys) is known as a surrogate marker of body muscle mass, the value of this marker is unclear in the patients with coronary artery disease (CAD).

Purpose
We assessed the clinical significance of two markers representing body muscle mass, the ratio of Scr to Scys (Scr/Scys), and ratio of estimated glomerular filtration rate by Scys to Scr (eGFRcys/eGFRcr).

Methods
We analyzed patients enrolled in a single tertiary center prospective percutaneous coronary intervention (PCI) registry that had Scr and Scys levels simultaneously measured before PCI. Optimal cut-off values of Scr/Scys and eGFRcys/eGFRcr, and their prognostic impact on 3-year mortality after PCI were analyzed. Subgroup analysis according to various demographics and risk factors was performed.

Results
A total of 1,928 patients who underwent PCI for significant CAD were analyzed (age 65.2±9.9 years, 70.8% men). Both Scr/Scys and eGFRcys/eGFRcr showed strong correlation with estimated proportion of muscle mass. Cut-off values of Scr/Scys discriminating 3-year death were 1.0 for men and 0.8 for women, while those of eGFRcys/eGFRcr were 1.1 for men and 1.0 for women. Both Scr/Scys- and eGFRcys/eGFRcr-based low muscle mass groups showed significantly higher risk of death, after adjusting for 7 selected covariates including age. The additional discriminative power of low muscle mass group on the predictive model was greater in the group determined by eGFRcys/eGFRcr than Scr/Scys. Low eGFRcys/eGFRcr values showed additional prognostic impact especially in patients older than 65 years, non-obese, men, chronic kidney disease, and current smokers.

Conclusions
Low muscle mass was an independent prognostic indicator in the patients who underwent coronary stenting. eGFRcys/eGFRcr was identified as a useful surrogate of muscle mass, which may be used to detect vulnerable patients with low muscle mass at high risk for future events.

Acknowledgement/Funding
None
P6535Atrial fibrillation and its impact in hospitalised cancer patients
Authors: Malik A H , Siddiqui N , Shetty S , Godara A , Khan Z , El Accaoui R 
Published: October 2019

Abstract

Background
Atrial fibrillation (AF) is associated with increased morbidity and mortality. However, its impact on outcomes of cancer patients is largely unknown. We sought to determine the prevalence and effect of AF on in-hospital outcomes of patients admitted with AF in the United States.

Methods
We obtained and analyzed data from Nationwide Inpatient Sample (NIS 2002- 2014). The study population included all adults (>18 years old) with the discharge diagnosis of cancer and the associated secondary diagnosis of AF. The associations of AF with in-hospital complications, procedures, discharge outcomes, and mortality, were analyzed after adjusting for potential confounders using logistic regression analyses.

Results
During the study period, 12,410,290 patients were admitted with cancer; of which, 1,013,735 (8.2%) had AF. Patients with AF were likely to be male (51.1% vs 42.7%), white (86.3% vs 73.6%), and had significantly higher rates comorbidities including hypertension (59.6% vs 44.6%), diabetes (20.9% vs 15.8%), heart failure (23.8% vs 4.5%), and stroke (1.3% vs 0.7%). Similarly, in-hospital complications (including infections, venous thromboembolism, gastrointestinal bleeding, myocardial infarction) and hospital procedures (including cardiac catheterization, intubation, blood transfusion, percutaneous coronary intervention) were found at a significantly higher rate in cancer patients with AF compared to without AF (p-value for all <0.0001). After adjusting for all confounding factors, cancer patients in the AF group had higher odds of in-hospital death (odds ratio, 1.26; 95% confidence interval, 1.23–1.28; P<0.0001). The presence of AF conferred on average three days of extra inpatient stay in patients with cancer. Mortality in the cancer patients admitted with a concomitant diagnosis of AF has gradually increased from 7.2% to 9.7% over the 13-year study period.
Table 1. Multivariate model showing Atrial fibrillation as an independent risk factor of inpatient mortality in cancer patients Unadjusted univariate model Multivariate model adjusted for age, sex, race and potential confounders* Odds ratio (95% confidence interval P-value Odds ratio (95% confidence interval P-value Discharged alive Reference Reference In-hospital mortality 2.08 (2.07, 2.10) <0.0001 1.26 (1.23, 1.28) <0.0001 *Confounders adjusted for include all clinical comorbidities and in-hospital complications and procedures.

Conclusions
In patients with cancer, AF confers significant in-hospital burden by increasing the hospital stay by 3 days. AF is also associated with significantly higher rates of in-hospital procedures and complications in cancer patients and is an independent risk factor of in-hospital mortality.

Acknowledgement/Funding
None
P6546Canadian Registry of Electronic Device Outcomes (CREDO): remote monitoring outcomes in the abbott battery performance alert, a multicentre cohort
Authors: Davis S , Thibault B , Mangat I , Coutu B , Bennett M , Philippon F , Sandhu R , Sterns L , Essebad V , Nery P , Wells G , Yee R , Exner D , Krahn A , Parkash R 
Published: October 2019

Abstract

Background
Cardiac implantable electronic devices have been known to have lead and device malfunctions leading to advisories. Increased use of remote monitoring of devices has been suggested to allow the identification of abnormal device performance and allow early intervention. We sought to describe the outcomes of patients with and without remote monitoring of in devices in the Abbott Premature Battery Depletion advisory with data from a Canadian registry

Methods
Patients with an Abbott device subject to the Battery Performance Alert Advisory from nine ICD implanting centres in Canada were included in the registry. The use of remote monitoring was identified from baseline and followup data in the registry. The primary outcome was detection of premature battery depletion and all cause mortality.

Results
2679 patents were identified with a device subject to the advisory. Devices were implanted between 2010 and 2017. 1716 patients (64%) had remote monitoring at baseline with this increasing to 83.7% at followup at 12 months. Premature battery depletion occurred in 43 patients (1.6%). Discovery of premature battery depletion was detected by remote monitoring in 70% of patients. There were 492 deaths during the follow up. Mortality was higher in those without a remote monitor compared to those with a remote monitor at follow-up and remote monitor at baseline and follow-up (11.3%, 2.6% versus 6.1% respectively; p=0.0186). There were no deaths attributed to premature battery depletion

Conclusion
The use of remote monitoring in patients with ICD and CRT under advisory reliably detected device failure and was associated with a reduction in all-cause mortality.