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Antithrombotic treatment in patients with heart failure and associated atrial fibrillation and vascular disease: a nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature104350
Source
J Am Coll Cardiol. 2014 Jun 24;63(24):2689-98
Publication Type
Article
Date
Jun-24-2014
Author
Morten Lamberts
Gregory Y H Lip
Martin H Ruwald
Morten Lock Hansen
Cengiz Özcan
Søren L Kristensen
Lars Køber
Christian Torp-Pedersen
Gunnar H Gislason
Author Affiliation
Department of Cardiology, Gentofte University Hospital, Hellerup, Copenhagen, Denmark. Electronic address: mortenlamberts@gmail.com.
Source
J Am Coll Cardiol. 2014 Jun 24;63(24):2689-98
Date
Jun-24-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Atrial Fibrillation - diagnosis - drug therapy - epidemiology
Cohort Studies
Denmark - epidemiology
Female
Fibrinolytic Agents - therapeutic use
Follow-Up Studies
Heart Failure - diagnosis - drug therapy - epidemiology
Hospitalization - trends
Humans
Male
Middle Aged
Registries
Retrospective Studies
Treatment Outcome
Vascular Diseases - diagnosis - drug therapy - epidemiology
Abstract
The aim of this study was to investigate the impact of atrial fibrillation (AF) and antithrombotic treatment on the prognosis in patients with heart failure (HF) as well as vascular disease.
HF, vascular disease, and AF are pathophysiologically related, and understanding antithrombotic treatment for these conditions is crucial.
In hospitalized patients with HF and coexisting vascular disease (coronary artery disease or peripheral arterial disease) followed from 1997 to 2009, AF status was categorized as prevalent AF, incident AF, or no AF. Risk of thromboembolism (TE), myocardial infarction (MI), and serious bleeding was assessed by Cox regression models (hazard ratio [HR] with 95% confidence interval [CI]) with antithrombotic therapy and AF as time-dependent variables.
A total of 37,464 patients were included (age, 74.5 ± 10.7 years; 36.3% females) with a mean follow-up of 3 years during which 20.7% were categorized as prevalent AF and 17.2% as incident AF. Compared with vitamin K antagonist (VKA) in prevalent AF, VKA plus antiplatelet was not associated with a decreased risk of TE (HR: 0.91; 95% CI: 0.73 to 1.12) or MI (HR: 1.11; 95% CI: 0.96 to 1.28), whereas bleeding risk was significantly increased (HR: 1.31; 95% CI: 1.09 to 1.57). Corresponding estimates for incident AF were HRs of 0.77 (95% CI: 0.56 to 1.06), 1.07 (95% CI: 0.89 to 1.28), and 2.71 (95% CI: 1.33 to 2.21) for TE, MI, and bleeding, respectively. In no AF patients, no statistical differences were seen between antithrombotic therapies in TE or MI risk, whereas bleeding risk was significantly increased for VKA with and without single-antiplatelet therapy.
In AF patients with coexisting HF and vascular disease, adding single-antiplatelet therapy to VKA therapy is not associated with additional benefit in thromboembolic or coronary risk, but notably increased bleeding risk.
Notes
Comment In: J Am Coll Cardiol. 2014 Jun 24;63(24):2699-70124794117
PubMed ID
24794118 View in PubMed
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International geographic variation in event rates in trials of heart failure with preserved and reduced ejection fraction.

https://arctichealth.org/en/permalink/ahliterature261225
Source
Circulation. 2015 Jan 6;131(1):43-53
Publication Type
Article
Date
Jan-6-2015
Author
Søren L Kristensen
Lars Køber
Pardeep S Jhund
Scott D Solomon
John Kjekshus
Robert S McKelvie
Michael R Zile
Christopher B Granger
John Wikstrand
Michel Komajda
Peter E Carson
Marc A Pfeffer
Karl Swedberg
Hans Wedel
Salim Yusuf
John J V McMurray
Source
Circulation. 2015 Jan 6;131(1):43-53
Date
Jan-6-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Angiotensin II Type 1 Receptor Blockers - therapeutic use
Benzimidazoles - therapeutic use
Biphenyl Compounds - therapeutic use
Canada - epidemiology
Europe - epidemiology
Female
Fluorobenzenes - therapeutic use
Geography
Heart Failure - drug therapy - epidemiology - physiopathology
Hospitalization - statistics & numerical data
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Pyrimidines - therapeutic use
Risk factors
Russia - epidemiology
Stroke Volume - physiology
Sulfonamides - therapeutic use
Tetrazoles - therapeutic use
Treatment Outcome
United States - epidemiology
Abstract
International geographic differences in outcomes may exist for clinical trials of heart failure and reduced ejection fraction (HF-REF), but there are few data for those with preserved ejection fraction (HF-PEF).
We analyzed outcomes by international geographic region in the Irbesartan in Heart Failure with Preserved systolic function trial (I-Preserve), the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM)-Preserved trial, the CHARM-Alternative and CHARM-Added HF-REF trials, and the Controlled Rosuvastatin Multinational Trial in HF-REF (CORONA). Crude rates of heart failure hospitalization varied by geographic region, and more so for HF-PEF than for HF-REF. Rates in patients with HF-PEF were highest in the United States/Canada (HF hospitalization rate 7.6 per 100 patient-years in I-Preserve; 8.8 in CHARM-Preserved), intermediate in Western Europe (4.8/100 and 4.7/100), and lowest in Eastern Europe/Russia (3.3/100 and 2.8/100). The difference between the United States/Canada versus Eastern Europe/Russia persisted after adjustment for key prognostic variables: adjusted hazard ratios 1.34 (95% confidence interval, 1.01-1.74; P=0.04) in I-Preserve and 1.85 (95% confidence interval, 1.17-2.91; P=0.01) in CHARM-Preserved. In HF-REF, rates of HF hospitalization were slightly lower in Western Europe compared with other regions. For both HF-REF and HF-PEF, there were few regional differences in rates of all-cause or cardiovascular mortality.
The differences in event rates observed suggest there is international geographic variation in 1 or more of the definition and diagnosis of HF-PEF, the risk profile of patients enrolled, and the threshold for hospitalization, which has implications for the conduct of future global trials.
Notes
Comment In: Circulation. 2015 Jan 6;131(1):7-1025406307
PubMed ID
25406306 View in PubMed
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Return to the Workforce After First Hospitalization for Heart Failure: A Danish Nationwide Cohort Study.

https://arctichealth.org/en/permalink/ahliterature282113
Source
Circulation. 2016 Oct 04;134(14):999-1009
Publication Type
Article
Date
Oct-04-2016
Author
Rasmus Rørth
Chih Wong
Kristian Kragholm
Emil L Fosbøl
Ulrik M Mogensen
Morten Lamberts
Mark C Petrie
Pardeep S Jhund
Thomas A Gerds
Christian Torp-Pedersen
Gunnar H Gislason
John J V McMurray
Lars Køber
Søren L Kristensen
Source
Circulation. 2016 Oct 04;134(14):999-1009
Date
Oct-04-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Cohort Studies
Comorbidity
Denmark
Female
Heart Failure - diagnosis - physiopathology
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Prognosis
Pulmonary Disease, Chronic Obstructive - complications - diagnosis - physiopathology
Registries
Risk factors
Time Factors
Young Adult
Abstract
Return to work is important financially, as a marker of functional status and for self-esteem in patients developing chronic illness. We examined return to work after first heart failure (HF) hospitalization.
By individual-level linkage of nationwide Danish registries, we identified 21?455 patients of working age (18-60 years) with a first HF hospitalization in the period from 1997 to 2012. Of these patients, 11?880 (55%) were in the workforce before HF hospitalization and comprised the study population. We applied logistic regression to estimate odds ratios for associations between age, sex, length of hospital stay, level of education, income, comorbidity, and return to work.
One year after first HF hospitalization, 8040 (67.7%) returned to the workforce, 2981 (25.1%) did not, 805 (6.7%) died, and 54 (0.5%) emigrated. Predictors of return to work included younger age (18-30 versus 51-60 years; odds ratio [OR], 3.12; 95% confidence interval [CI], 2.42-4.03), male sex (OR, 1.22; 95% CI, 1.12-1.34), and level of education (long-higher versus basic school; OR, 2.06; 95% CI, 1.63-2.60). Conversely, hospital stay >7 days (OR, 0.56; 95% CI, 0.51-0.62) and comorbidity including history of stroke (OR, 0.55; 95% CI, 0.45-0.69), chronic kidney disease (OR, 0.46; 95% CI, 0.36-0.59), chronic obstructive pulmonary disease (OR, 0.62; 95% CI, 0.52-0.75), diabetes mellitus (OR 0.76; 95% CI, 0.68-0.85), and cancer (OR, 0.49; 95% CI, 0.40-0.61) were all significantly associated with lower chance of return to work.
Patients in the workforce before HF hospitalization had low mortality but high risk of detachment from the workforce 1 year later. Young age, male sex, and a higher level of education were predictors of return to work.
PubMed ID
27507406 View in PubMed
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Return to the workforce following infective endocarditis-A nationwide cohort study.

https://arctichealth.org/en/permalink/ahliterature287600
Source
Am Heart J. 2018 Jan;195:130-138
Publication Type
Article
Date
Jan-2018
Author
Jawad H Butt
Kristian Kragholm
Michael Dalager-Pedersen
Rasmus Rørth
Søren L Kristensen
Mavish S Chaudry
Nana Valeur
Lauge Østergaard
Christian Torp-Pedersen
Gunnar H Gislason
Lars Køber
Emil L Fosbøl
Source
Am Heart J. 2018 Jan;195:130-138
Date
Jan-2018
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Denmark - epidemiology
Endocarditis, Bacterial - epidemiology - rehabilitation
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Population Surveillance
Return to Work - statistics & numerical data
Risk factors
Sick Leave - trends
Social Class
Young Adult
Abstract
The ability to return to work after infective endocarditis (IE) holds important socioeconomic consequences for both patients and society, yet data on this issue are sparse. We examined return to the workforce and associated factors in IE patients of working age.
Using Danish nationwide registries, we identified 1,065 patients aged 18-60 years with a first-time diagnosis of IE (1996-2013) who were part of the workforce prior to admission and alive at discharge.
One year after discharge, 765 (71.8%) patients had returned to the workforce, 130 (12.2%) were on paid sick leave, 76 (7.1%) received disability pension, 23 (2.2%) were on early retirement, 65 (6.1%) had died, and 6 (0.6%) had emigrated. Factors associated with return to the workforce were identified using multivariable logistic regression. Younger age (18-40 vs 56-60 years; odds ratio, 2.85; 95% CI, 1.71-4.76) and higher level of education (higher educational level vs basic school; 5.47, 2.05-14.6) and income (highest quartile vs lowest; 3.17, 1.85-5.46) were associated with return to the workforce. Longer length of hospital stay (>90 vs 14-30 days; 0.16, 0.07-0.38); stroke during IE admission (0.38, 0.21-0.71); and a history of chronic kidney disease (0.29, 0.11-0.75), chronic obstructive pulmonary disease (0.31, 0.13-0.71), and malignancy (0.39, 0.22-0.69) were associated with a lower likelihood of returning to the workforce.
Seven of 10 patients who were part of the workforce prior to IE and alive at discharge were part of the workforce 1 year later. Younger age, higher socioeconomic status, and absence of major comorbidities were associated with return to the workforce.
PubMed ID
29224640 View in PubMed
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