scholarly journals Use of the CHA2DS2-VASc Score for Risk Stratification of Hospital Admissions Among Patients With Cardiovascular Diseases Receiving a Fourth-Generation Synchronous Telehealth Program: Retrospective Cohort Study

10.2196/12790 ◽  
2019 ◽  
Vol 21 (1) ◽  
pp. e12790
Author(s):  
Jen-Kuang Lee ◽  
Chi-Sheng Hung ◽  
Ching-Chang Huang ◽  
Ying-Hsien Chen ◽  
Pao-Yu Chuang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cardiovascular Diseases ◽  
Risk Stratification ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Fourth Generation

scholarly journals Use of the CHA2DS2-VASc Score for Risk Stratification of Hospital Admissions Among Patients With Cardiovascular Diseases Receiving a Fourth-Generation Synchronous Telehealth Program: Retrospective Cohort Study (Preprint)

2018 ◽  
Author(s):  
Jen-Kuang Lee ◽  
Chi-Sheng Hung ◽  
Ching-Chang Huang ◽  
Ying-Hsien Chen ◽  
Pao-Yu Chuang ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Cardiovascular Diseases ◽  
Clinical Outcomes ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Lipid Lowering ◽  
Fourth Generation ◽  
Control Group ◽  
Significant Prognostic Factor

BACKGROUND Telehealth programs are generally diverse in approaching patients, from traditional telephone calling and texting message and to the latest fourth-generation synchronous program. The predefined outcomes are also different, including hypertension control, lipid lowering, cardiovascular outcomes, and mortality. In previous studies, the telehealth program showed both positive and negative results, providing mixed and confusing clinical outcomes. A comprehensive and integrated approach is needed to determine which patients benefit from the program in order to improve clinical outcomes. OBJECTIVE The CHA2DS2-VASc (congestive heart failure, hypertension, age >75 years [doubled], type 2 diabetes mellitus, previous stroke, transient ischemic attack or thromboembolism [doubled], vascular disease, age of 65-75 years, and sex) score has been widely used for the prediction of stroke in patients with atrial fibrillation. This study investigated the CHA2DS2-VASc score to stratify patients with cardiovascular diseases receiving a fourth-generation synchronous telehealth program. METHODS This was a retrospective cohort study. We recruited patients with cardiovascular disease who received the fourth-generation synchronous telehealth program at the National Taiwan University Hospital between October 2012 and June 2015. We enrolled 431 patients who had joined a telehealth program and compared them to 1549 control patients. Risk of cardiovascular hospitalization was estimated with Kaplan-Meier curves. The CHA2DS2-VASc score was used as the composite parameter to stratify the severity of patients’ conditions. The association between baseline characteristics and clinical outcomes was assessed via the Cox proportional hazard model. RESULTS The mean follow-up duration was 886.1 (SD 531.0) days in patients receiving the fourth-generation synchronous telehealth program and 707.1 (SD 431.4) days in the control group (P<.001). The telehealth group had more comorbidities at baseline than the control group. Higher CHA2DS2-VASc scores (≥4) were associated with a lower estimated rate of remaining free from cardiovascular hospitalization (46.5% vs 54.8%, log-rank P=.003). Patients with CHA2DS2-VASc scores ≥4 receiving the telehealth program were less likely to be admitted for cardiovascular disease than patients not receiving the program. (61.5% vs 41.8%, log-rank P=.01). The telehealth program remained a significant prognostic factor after multivariable Cox analysis in patients with CHA2DS2-VASc scores ≥4 (hazard ratio=0.36 [CI 0.22-0.62], P<.001) CONCLUSIONS A higher CHA2DS2-VASc score was associated with a higher risk of cardiovascular admissions. Patients accepting the fourth-generation telehealth program with CHA2DS2-VASc scores ≥4 benefit most by remaining free from cardiovascular hospitalization.

scholarly journals Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044196
Author(s):  
Madalene Earp ◽  
Pin Cai ◽  
Andrew Fong ◽  
Kelly Blacklaws ◽  
Truong-Minh Pham ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Heart Disease ◽  
Chronic Disease ◽  
Acute Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Admissions ◽  
Specialist Palliative Care ◽  
Icu Admission

ObjectiveFor eight chronic diseases, evaluate the association of specialist palliative care (PC) exposure and timing with hospital-based acute care in the last 30 days of life.DesignRetrospective cohort study using administrative data.SettingAlberta, Canada between 2007 and 2016.Participants47 169 adults deceased from: (1) cancer, (2) heart disease, (3) dementia, (4) stroke, (5) chronic lower respiratory disease (chronic obstructive pulmonary disease (COPD)), (6) liver disease, (7) neurodegenerative disease and (8) renovascular disease.Main outcome measuresThe proportion of decedents who experienced high hospital-based acute care in the last 30 days of life, indicated by ≥two emergency department (ED) visit, ≥two hospital admissions,≥14 days of hospitalisation, any intensive care unit (ICU) admission, or death in hospital. Relative risk (RR) and risk difference (RD) of hospital-based acute care given early specialist PC exposure (≥90 days before death), adjusted for patient characteristics.ResultsIn an analysis of all decedents, early specialist PC exposure was associated with a 32% reduction in risk of any hospital-based acute care as compared with those with no PC exposure (RR 0.69, 95% CI 0.66 to 0.71; RD 0.16, 95% CI 0.15 to 0.17). The association was strongest in cancer-specific analyses (RR 0.53, 95% CI 0.50 to 0.55; RD 0.31, 95% CI 0.29 to 0.33) and renal disease-specific analyses (RR 0.60, 95% CI 0.43 to 0.84; RD 0.22, 95% CI 0.11 to 0.34), but a~25% risk reduction was observed for each of heart disease, COPD, neurodegenerative diseases and stroke. Early specialist PC exposure was associated with reducing risk of four out of five individual indicators of high hospital-based acute care in the last 30 days of life, including ≥two ED visit,≥two hospital admission, any ICU admission and death in hospital.ConclusionsEarly specialist PC exposure reduced the risk of hospital-based acute care in the last 30 days of life for all chronic disease groups except dementia.

Diabetes, Drug Treatment and Mortality in COVID-19: A Multinational Retrospective Cohort Study

2021 ◽  
Author(s):  
Jennifer E. Nyland ◽  
Nazia T. Raja-Khan ◽  
Kerstin Bettermann ◽  
Philippe A. Haouzi ◽  
Douglas L. Leslie ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Randomized Clinical Trials ◽  
Hospital Admissions ◽  
Inflammatory Responses ◽  
Research Network ◽  
Respiratory Complications ◽  
Dipeptidyl Peptidase 4 ◽  
Increased Risk

Patients with type 2 diabetes mellitus (T2DM) are at increased risk of severe COVID-19 outcomes possibly due to dysregulated inflammatory responses. Glucose-regulating medications such as glucagon-like peptide-1 receptor (GLP-1R) agonists, dipeptidyl peptidase-4 (DPP-4) inhibitors, and pioglitazone are known to have anti-inflammatory effects that may improve outcomes in patients with SARS-CoV-2 infection. In a multinational retrospective cohort study, we used the TriNetX COVID-19 Research Network of 56 large healthcare organizations to examine these medications in relation to the incidence of hospital admissions, respiratory complications, and mortality within 28 days following a COVID-19 diagnosis. After matching for age, sex, race, ethnicity, body mass index, and significant comorbidities, use of GLP-1R agonists and/or pioglitazone was associated with significant reductions in hospital admissions (GLP-1R: 15.7% vs 23.5%; RR, 0.67 [95% CI, 0.57-0.79]; <i>P</i> <.001; pioglitazone: 20.0% vs 28.2%; RR, 0.71 [95% CI, 0.54-0.93]; <i>P</i> =.01). Use of GLP-1R agonists was also associated with reductions in respiratory complications (15.3% vs 24.9%; RR, 0.62 [95% CI, 0.52-0.73]; <i>P</i> <.001) and incidence of mortality (1.9% vs 3.3%; RR, 0.58 [95% CI, 0.35-0.97]; <i>P</i> =.04). Use of DPP-4 inhibitors was associated with a reduction in respiratory complications (24.0% vs 29.2%; RR, 0.82 [95% CI, 0.74-0.90]; <i>P</i> <.001), and continued use of DPP-4 inhibitors after hospitalization was associated with a decrease in mortality compared with those who discontinued use (9% vs 19%; RR, 0.45 [95% CI, 0.28-0.72]; <i>P</i> <.001). In conclusion, use of glucose-regulating medications such as GLP-1R agonists, DPP-4 inhibitors, or pioglitazone may improve outcomes for COVID-19 patients with T2DM; randomized clinical trials are needed to further investigate this possibility.

scholarly journals Cardiovascular and non-cardiovascular hospital admissions associated with atrial fibrillation: a Danish nationwide, retrospective cohort study

BMJ Open ◽  
2013 ◽  
Vol 3 (1) ◽  
pp. e001800 ◽  
Author(s):  
Christine Benn Christiansen ◽  
Jonas Bjerring Olesen ◽  
Gunnar Gislason ◽  
Morten Lock-Hansen ◽  
Christian Torp-Pedersen
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hospital Admissions

Molecular Epidemiology ofClostridium difficileInfections in Children: A Retrospective Cohort Study

2015 ◽  
Vol 36 (4) ◽  
pp. 445-451 ◽  
Author(s):  
Larry K. Kociolek ◽  
Sameer J. Patel ◽  
Stanford T. Shulman ◽  
Dale N. Gerding
Keyword(s):  
Cohort Study ◽  
Molecular Epidemiology ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Restriction Endonuclease Analysis ◽  
The United States ◽  
Fourth Generation ◽  
Epidemic Strain ◽  
Different Strains ◽  
Low Prevalence

OBJECTIVEThe molecular epidemiology of pediatricClostridium difficileinfection (CDI) is poorly understood. We aimed to identify the restriction endonuclease analysis (REA) groups causing CDI and to determine risk factors and outcomes associated with CDI caused by epidemic strains in children.DESIGNRetrospective cohort studyPATIENTSInpatients and outpatients >1 year old receiving care between December 2012 and December 2013SETTINGAn academic children’s hospital in Chicago, IllinoisMETHODSC. difficilePCR-positive stools were cultured, andC. difficileisolates were typed by REA. REA of isolates from patients with multiple CDIs was performed to differentiate relapse (infection with same strain) from reinfection (different strains) irrespective of time between CDIs.RESULTSA total of 189 CDIs occurred among 145 patients. REA groups were widely distributed. The BI/NAP1/027 strain caused CDI in only 1 patient. DH/NAP11/106, the predominant epidemic strain identified, was associated with the use of third- or fourth-generation cephalosporins (risk ratio [RR], 3.2; 95% confidence interval [CI], 1.1–9.9;P=.04). CDI relapse commonly occurred up to 20 weeks later. Compared with CDI caused by non-DH/NAP11/106 strains, CDI caused by DH/NAP11/106 was more likely to result in multiple CDI relapses (40% vs 8%;P=.05) among children with multiple CDIs.CONCLUSIONSREA identified the exceedingly low prevalence of BI/NAP1/027 and the high prevalence of DH/NAP11/106, a common epidemic strain in the United Kingdom that is less often reported in the United States. CDI relapse commonly occurred up to 20 weeks from the previous CDI. Defining recurrent CDI as that occurring only within 8 weeks of the original infection may lead to misclassification of some recurrent CDIs as new CDIs in children.Infect Control Hosp Epidemiol2015;00(0): 1–7

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