scholarly journals Hospital volume and outcomes for acute pulmonary embolism: multinational population based cohort study

BMJ ◽  
2019 ◽  
pp. l4416 ◽  
Author(s):  
David Jiménez ◽  
Behnood Bikdeli ◽  
Andrés Quezada ◽  
Alfonso Muriel ◽  
José Luis Lobo ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Odds Ratio ◽  
Hospital Volume ◽  
Acute Pulmonary Embolism ◽  
Adjusted Odds Ratio ◽  
High Volume ◽  
Population Based ◽  
Symptomatic Pulmonary Embolism ◽  
Pulmonary Embolisms ◽  
Related Mortality

AbstractObjectivesTo evaluate the association between experience in the management of acute pulmonary embolism, reflected by hospital case volume, and mortality.DesignMultinational population based cohort study using data from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry between 1 January 2001 and 31 August 2018.Setting353 hospitals in 16 countries.Participants39 257 consecutive patients with confirmed diagnosis of acute symptomatic pulmonary embolism.Main outcome measurePulmonary embolism related mortality within 30 days after diagnosis of the condition.ResultsPatients with acute symptomatic pulmonary embolism admitted to high volume hospitals (>40 pulmonary embolisms per year) had a higher burden of comorbidities. A significant inverse association was seen between annual hospital volume and pulmonary embolism related mortality. Admission to hospitals in the highest quarter (that is, >40 pulmonary embolisms per year) was associated with a 44% reduction in the adjusted odds of pulmonary embolism related mortality at 30 days compared with admission to hospitals in the lowest quarter (<15 pulmonary embolisms per year; adjusted risk 1.3% v 2.3%; adjusted odds ratio 0.56 (95% confidence interval 0.33 to 0.95); P=0.03). Results were consistent in all sensitivity analyses. All cause mortality at 30 days was not significantly reduced between the two quarters (adjusted odds ratio 0.78 (0.50 to 1.22); P=0.28). Survivors showed little change in the odds of recurrent venous thromboembolism (odds ratio 0.76 (0.49 to 1.19)) or major bleeding (1.07 (0.77 to 1.47)) between the low and high volume hospitals.ConclusionsIn patients with acute symptomatic pulmonary embolism, admission to high volume hospitals was associated with significant reductions in adjusted pulmonary embolism related mortality at 30 days. These findings could have implications for management strategies.

scholarly journals Computed Tomography Pulmonary Perfusion for Prediction of Short-Term Clinical Outcome in Acute Pulmonary Embolism

TH Open ◽  
2021 ◽  
Vol 05 (01) ◽  
pp. e66-e72
Author(s):  
Lisette F. van Dam ◽  
Lucia J. M. Kroft ◽  
Menno V. Huisman ◽  
Maarten K. Ninaber ◽  
Frederikus A. Klok
Keyword(s):  
Computed Tomography ◽  
Pulmonary Embolism ◽  
Predictive Value ◽  
Acute Pulmonary Embolism ◽  
Clinical Presentation ◽  
Reperfusion Therapy ◽  
Pulmonary Perfusion ◽  
Short Term ◽  
Acute Pe ◽  
Related Mortality

Abstract Background Computed tomography pulmonary angiography (CTPA) is the imaging modality of choice for the diagnosis of acute pulmonary embolism (PE). With computed tomography pulmonary perfusion (CTPP) additional information on lung perfusion can be assessed, but its value in PE risk stratification is unknown. We aimed to evaluate the correlation between CTPP-assessed perfusion defect score (PDS) and clinical presentation and its predictive value for adverse short-term outcome of acute PE. Patients and Methods This was an exploratory, observational study in 100 hemodynamically stable patients with CTPA-confirmed acute PE in whom CTPP was performed as part of routine clinical practice. We calculated the difference between the mean PDS in patients with versus without chest pain, dyspnea, and hemoptysis and 7-day adverse outcome. Multivariable logistic regression analysis and likelihood-ratio test were used to assess the added predictive value of PDS to CTPA parameters of right ventricle dysfunction and total thrombus load, for intensive care unit admission, reperfusion therapy and PE-related death. Results We found no correlation between PDS and clinical symptoms. PDS was correlated to reperfusion therapy (n = 4 with 16% higher PDS, 95% confidence interval [CI]: 3.5–28%) and PE-related mortality (n = 2 with 22% higher PDS, 95% CI: 4.9–38). Moreover, PDS had an added predictive value to CTPA assessment for PE-related mortality (from Chi-square 14 to 19, p = 0.02). Conclusion CTPP-assessed PDS was not correlated to clinical presentation of acute PE. However, PDS was correlated to reperfusion therapy and PE-related mortality and had an added predictive value to CTPA-reading for PE-related mortality; this added value needs to be demonstrated in larger studies.

Self-Reported Vision Impairment and Frailty among Older People with Low Cognitive Performance in Central Africa: EPIDEMCA Population-Based Study

2021 ◽  
pp. 1-7
Author(s):  
Antoine Gbessemehlan ◽  
Gilles Kehoua ◽  
Catherine Helmer ◽  
Cécile Delcourt ◽  
Achille Tchalla ◽  
...  
Keyword(s):  
Older People ◽  
Cognitive Performance ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Central Africa ◽  
Population Based ◽  
Vision Impairment ◽  
Sub Saharan Africa ◽  
Population Based Study ◽  
The Impact

<b><i>Introduction:</i></b> Very little is known about the impact of vision impairment (VI) on physical health in late-life in sub-Saharan Africa populations, whereas many older people experience it. We investigated the association between self-reported VI and frailty in Central African older people with low cognitive performance. <b><i>Methods:</i></b> It was cross-sectional analysis of data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) population-based study. After screening for cognitive impairment, older people with low cognitive performance were selected. Frailty was assessed using the Study of Osteoporotic Fracture index. Participants who met one of the 3 parameters assessed (unintentional weight loss, inability to do 5 chair stands, and low energy level) were considered as pre-frail, and those who met 2 or more parameters were considered as frail. VI was self-reported. Associations were investigated using multinomial logistic regression models. <b><i>Results:</i></b> Out of 2,002 older people enrolled in EPIDEMCA, 775 (38.7%) had low cognitive performance on the screening test. Of them, 514 participants (sex ratio: 0.25) had available data on VI and frailty and were included in the analyses. In total, 360 (70%) self-reported VI. Prevalence of frailty was estimated at 64.9% [95% confidence interval: 60.9%–69.1%] and 23.7% [95% CI: 20.1%–27.4%] for pre-frailty. After full adjustment, self-reported VI was associated with frailty (adjusted odds ratio = 2.2; 95% CI: 1.1–4.3) but not with pre-frailty (adjusted odds ratio = 1.8; 95% CI: 0.9–3.7). <b><i>Conclusion:</i></b> In Central African older people with low cognitive performance, those who self-reported VI were more likely to experience frailty. Our findings suggest that greater attention should be devoted to VI among this vulnerable population in order to identify early frailty onset and provide adequate care management.

Abstract 14499: Impact of Pre-existing and New Incident Atrial Fibrillation on Outcomes of Patients With Acute Pulmonary Embolism: Findings From an International Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Behnood Bikdeli ◽  
David Jimenez ◽  
Jorg Del Toro ◽  
Gregory Piazza ◽  
Augussina Rivas ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Acute Pulmonary Embolism ◽  
Adverse Outcomes ◽  
Risk Of Mortality ◽  
Patient Groups ◽  
The Impact ◽  
Related Mortality

Background: Atrial fibrillation (AF) may occur prior to or early in the course of acute pulmonary embolism (PE). The impact of AF on outcomes of patients with PE remains uncertain. Methods: Using the data from a large prospective multicenter registry of patients with objectively-confirmed PE (04/2014 to 01/2020), we identified three patient groups: 1) those with pre-existing AF 2) patients with newly identified AF within 2 days from the index PE (incident AF) and 3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, in unadjusted and multivariable adjusted models considering those without AF as referent. Results: Among 16,497 patients with PE, 792 had pre-existing AF. Compared with those without AF, patients with pre-existing AF, had increased odds of 90-day all-cause (Odds ratio [OR]: 2.81 (95% confidence interval [CI]: 2.33-3.38) and PE-related mortality (OR: 2.38, 95% CI: 1.37-4.14). After multivariable adjustment, pre-existing AF significantly increased the odds of all-cause mortality (OR: 1.91, 95% CI: 1.57-2.32) but not PE-related mortality (OR: 1.50; 95% CI: 0.85-2.66). Pre-existing AF was associated with increased hazard for ischemic stroke at 1-year follow-up (hazard ratio [HR]: 5.48; 95% CI: 3.10-9.69). Among 16,497 patients with PE, 445 developed incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR: 2.28; 95% CI: 1.75-2.97) and PE-related (OR: 3.64; 95% CI: 2.01-6.59) mortality. Findings were similar in multivariable analyses and at 1-year follow-up (Figure). No patients with incident AF developed ischemic stroke. Conclusion: In patients with acute symptomatic PE, both pre-existing AF and incident AF predict an adverse clinical course, although the type of adverse outcomes may be different depending on the timing of AF onset.

Responses to the Physical Activity Guidelines and Dissemination Strategies for Behavior Change in a Representative Sample of US Adults

2021 ◽  
pp. 1-10
Author(s):  
Malorie Polster ◽  
Erin E. Dooley ◽  
Kate Olscamp ◽  
Katrina L. Piercy ◽  
April Oh
Keyword(s):  
Physical Activity ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Information Source ◽  
Population Based ◽  
Multiple Sources ◽  
Physical Activity Guidelines ◽  
Logistic Regressions ◽  
National Trends

Background: Dissemination of the Physical Activity Guidelines for Americans (Guidelines) is needed, but how individuals respond to the Guidelines is not well understood. This surveillance study describes US adults’ reported responses to and information sources for hearing about the Guidelines and explores relationships between how respondents heard about the Guidelines and their reported response(s). Methods: Data were analyzed from the population-based 2019 Health Information National Trends Survey 5 Cycle 3. Population-weighted proportions of response were calculated. Among those who had heard about the Guidelines, binary logistic regressions examined associations between the reported response(s) and the information source and number of sources reported. Results: The analytical sample included 5047 adults. Nearly 65% of US adults reported hearing about the Guidelines, and 29% reported a behavioral response (eg, increased physical activity). Hearing about the Guidelines through health professionals (adjusted odds ratio = 2.30, 95% confidence interval, 1.45–3.65) or social media (adjusted odds ratio = 1.89, 95% confidence interval, 1.20–2.96) (vs other sources) was associated with reporting increasing physical activity. Hearing from multiple sources (vs one source) was associated with reporting increasing physical activity (adjusted odds ratio = 1.97, 95% confidence interval, 1.18–3.31). Conclusion: Findings suggest dissemination of the Guidelines across multiple channels may promote greater changes in physical activity.

scholarly journals Does it matter what a hospital is “high volume” for? Specificity of hospital volume-outcome associations for surgical procedures: analysis of administrative data

BMJ ◽  
2004 ◽  
Vol 328 (7442) ◽  
pp. 737-740 ◽  
Author(s):  
David R Urbach ◽  
Nancy N Baxter
Keyword(s):  
Odds Ratio ◽  
Surgical Procedure ◽  
Hospital Volume ◽  
Colorectal Resection ◽  
Lung Resection ◽  
Secondary Data ◽  
High Volume ◽  
The Other ◽  
Inverse Association ◽  
Volume Outcome

AbstractObjective To determine whether the improved outcome of a surgical procedure in high volume hospitals is specific to the volume of the same procedure.Design and setting Analysis of secondary data in Ontario, Canada.Participants Patients having an oesophagectomy, colorectal resection for cancer, pancreaticoduodenectomy, major lung resection for cancer, or repair of an unruptured abdominal aortic aneurysm between 1994 and 1999.Main outcome measures Odds ratio for death within 30 days of surgery in relation to the hospital volume of the same surgical procedure and the hospital volume of the other four procedures. Estimates were adjusted for age, sex, and comorbidity and accounted for hospital level clustering.Results With the exception of colorectal resection, 30 day mortality seemed to be inversely related not only to the hospital volume of the same procedure but also to the hospital volume of most of the other procedures. In some cases the effect of the volume of a different procedure was stronger than the effect of the volume of the same procedure. For example, the association of mortality from pancreaticoduodenectomy with hospital volume of lung resection (odds ratio for death in hospitals with a high volume of lung resection compared with low volume 0.36, 95% confidence interval 0.23 to 0.57) was much stronger than the association of mortality from pancreaticoduodenectomy with hospital volume of pancreaticoduodenectomy (0.76, 0.44 to 1.32).Conclusion The inverse association between high volume of procedure and risk of operative death is not specific to the volume of the procedure being studied.

scholarly journals Religiousness, social support and the use of antidepressants among the elderly: a population-based study

2018 ◽  
Vol 23 (3) ◽  
pp. 963-971 ◽  
Author(s):  
Adriano Roberto Tarifa Vicente ◽  
Érico Castro-Costa ◽  
Josélia de Oliveira Araújo Firmo ◽  
Maria Fernanda Lima-Costa ◽  
Antônio Ignácio de Loyola Filho
Keyword(s):  
Social Support ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Depressive Disorders ◽  
The Elderly ◽  
Population Based ◽  
Community Dwelling ◽  
Population Based Study

Abstract The purpose of the study was to investigate whether religiousness and social support were associated with the use of antidepressants among community-dwelling elders. The research involved 1,606 older adults who make up the cohort of Bambuí Project, a study on ageing and health. The dependent variable was the use of antidepressants in the last 90 days, and the exposures of interest were social support and religiousness. Logistic regression was used to test the associations and to estimate crude and adjusted Odds Ratio and their 95% confidence intervals. The chances of use of antidepressants were significantly lower among older people with higher level of religiosity (OR = 0.45; 95% CI: 0.29 to 0.70), but none of the descriptors social support was associated with the event. In this population, it is possible that religion occupies a prominent role in the arsenal of health problems coping strategies, especially mental. Health professionals attending this particular segment of the population (elderly people with depressive disorders) should consider religiousness of patients when the proposed guidelines and treatment in coping with their mental suffering.

scholarly journals Bisphenol A and Metabolic Syndrome: Results from NHANES

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Srinivas Teppala ◽  
Suresh Madhavan ◽  
Anoop Shankar
Keyword(s):  
Metabolic Syndrome ◽  
Bisphenol A ◽  
Odds Ratio ◽  
Alcohol Intake ◽  
Adjusted Odds Ratio ◽  
Population Based ◽  
Health And Nutrition ◽  
Direct Association ◽  
Race Ethnicity ◽  
Traditional Risk Factors

Background. Bisphenol A (BPA) is detected in the urine of>95% of US adults. Recent evidence from population-based studies suggests that BPA is associated with individual components for metabolic syndrome (MetS). However, no previous study has examined the direct association between BPA and MetS.Methods. We examined 2,104 participants from the National Health and Nutrition Examination Survey 2003–2008. The main outcome was the presence of MetS (n=741).Results. Increasing levels of urinary BPA were positively associated with MetS, independent of confounders such as age, gender, race/ethnicity, smoking, alcohol intake, physical activity, and urinary creatinine. Compared to tertile 1 (referent), the multivariable adjusted odds ratio (95% confidence interval) of MetS in tertile 3 was 1.51 (1.07–2.12);P-trend was 0.02.Conclusions. Urinary BPA levels are positively associated with MetS, in a representative sample of US adults and independent of traditional risk factors for MetS. Future, prospective studies are needed to confirm our findings.

Medical conditions increasing the risk of chronic thromboembolic pulmonary hypertension

2005 ◽  
Vol 93 (03) ◽  
pp. 512-516 ◽  
Author(s):  
Diana Bonderman ◽  
Johannes Jakowitsch ◽  
Christopher Adlbrecht ◽  
Michael Schemper ◽  
Paul Kyrle ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Odds Ratio ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Medical Conditions ◽  
Symptomatic Pulmonary Embolism ◽  
Increased Risk ◽  
Lung Scan ◽  
Thromboembolic Pulmonary Hypertension ◽  
Inflammatory Bowel

SummaryChronic thromboembolic pulmonary hypertension (CTEPH) is characterized by organized thromboemboli that obstruct the pulmonary vascular bed. Although CTEPH is a serious complication of acute symptomatic pulmonary embolism in 4% of cases, signs, symptoms and classical risk factors for venous thromboembolism are lacking. The aim of the present study was to identify medical conditions conferring an increased risk of CTEPH. We performed a case-control-study comparing 109 consecutive CTEPH patients to 187 patients with acute pulmonary embolism that was confirmed by a high probability lung scan. Splenectomy (odds ratio=13, 95% CI 2.7–127), ventriculoatrial (VA-) shunt for the treatment of hydrocephalus (odds ratio=13, 95% CI 2.5–129) and chronic inflammatory disorders, such as osteomyelitis and inflammatory bowel disease (IBD, odds ratio=67, 95% CI 7.9–8832) were associated with an increased risk of CTEPH.

scholarly journals Clinical importance of the distribution of pulmonary artery embolism in acute pulmonary embolism

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110047
Author(s):  
Yunqiang Nie ◽  
Li Sun ◽  
Wei Long ◽  
Xin LV ◽  
Cuiyun Li ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Mixed Type ◽  
Acute Pulmonary Embolism ◽  
Disease Duration ◽  
Clinical Importance ◽  
Artery Embolism ◽  
Pulmonary Embolisms ◽  
Pulmonary Artery Embolism

Objective To explore the clinical importance of the distribution of pulmonary artery embolism in acute pulmonary embolism (APE). Methods Sixty-four patients with APE were classified into mixed-type and distal-type pulmonary embolism groups. Their right ventricular systolic pressure (RVSP) and disease duration were recorded, and the diameter of their right ventricles was measured by ultrasound. The computed tomography angiographic clot load was determined as a Mastora score. Results Patients with distal-type pulmonary embolisms had significantly lower RVSPs (44.92 ± 17.04 vs 55.69 ± 17.66 mmHg), and significantly smaller right ventricular diameters (21.08 ± 3.06 vs 23.37 ± 3.48 mm) than those with mixed-type pulmonary embolisms. Additionally, disease duration was significantly longer in patients with distal-type pulmonary embolisms (14.33 ± 11.57 vs 8.10 ± 7.10 days), and they had significantly lower Mastora scores (20.91% ± 18.92% vs 43.96% ± 18.30%) than patients with mixed-type pulmonary embolisms. After treatment, RVSPs decreased significantly in patients with both distal-type and mixed-type pulmonary embolisms. Right ventricle diameters also decreased significantly in patients with mixed-type pulmonary embolisms after treatment. Conclusion Patients with mixed-type pulmonary embolisms are significantly more susceptible to pulmonary hypertension, enlarged right ventricular diameters, and shorter durations of disease than those with distal-type pulmonary embolisms. The distribution of pulmonary artery embolism in APE can provide a clinical reference.

scholarly journals Management appropriateness and outcomes of patients with acute pulmonary embolism

2018 ◽  
Vol 51 (5) ◽  
pp. 1800445 ◽  
Author(s):  
David Jiménez ◽  
Behnood Bikdeli ◽  
Deisy Barrios ◽  
Raquel Morillo ◽  
Rosa Nieto ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Major Bleeding ◽  
Acute Pulmonary Embolism ◽  
External Validation ◽  
Vena Cava ◽  
Vena Cava Filters ◽  
All Cause Mortality ◽  
The Impact ◽  
Related Mortality

The impact of adherence to published guidelines on the outcomes of patients with acute pulmonary embolism (PE) has not been well defined by previous studies.In this prospective cohort study of patients admitted to a respiratory department (n=2096), we evaluated whether patients with PE had better outcomes if they were acutely managed according to international guidelines. Outcomes consisted of all-cause mortality, PE-related mortality, recurrent venous thromboembolism (VTE) and major bleeding events during the first month of follow-up after diagnosis.Overall, 408 patients (19% (95% CI 18–21%)) did not receive guideline-adherent PE management. Patients receiving non-adherent management were significantly more likely to experience all-cause mortality (adjusted odds ratio (OR) 2.39 (95% CI 1.57–3.61) or PE-related mortality (adjusted OR 5.02 (95% CI 2.42–10.42); p<0.001) during follow-up. Non-adherent management was also a significant independent predictor of recurrent VTE (OR 2.19 (95% CI 1.11–4.32); p=0.03) and major bleeding (OR 2.65 (95% CI 1.66–4.24); p<0.001). An external validation cohort of 34 380 patients with PE from the RIETE registry confirmed these findings.PE management that does not adhere to guidelines for indications related to anticoagulation, thrombolytics and inferior vena cava filters is associated with worse patient outcomes.

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