Aim
To evaluate the associations between metabolically healthy obesity (MHO) and different types of incident cardiovascular events in a contemporary population.
Materials and Methods
All patients ...discharged from French hospitals in 2013 with at least 5 years of follow‐up and without a history of major adverse cardiovascular event (MACE; myocardial infarction, heart failure HF, ischaemic stroke or cardiovascular death MACE‐HF) or underweight/malnutrition were identified. They were categorized by phenotypes defined by obesity and three metabolic abnormalities (diabetes, hypertension and hyperlipidaemia). Hazard ratios (HRs) for cardiovascular events during follow‐up were adjusted on age, sex and smoking status at baseline.
Results
In total, 2 873 039 individuals were included in the analysis, among whom 272 838 (9.5%) had obesity. During a mean follow‐up of 4.9 years, when pooling men and women, individuals with MHO had a higher risk of MACE‐HF (multivariate‐adjusted HR 1.22, 95% confidence interval CI: 1.19‐1.24), new‐onset HF (HR 1.34, 95% CI 1.31‐1.37) and atrial fibrillation (AF; HR 1.33, 95% CI 1.30‐1.37) compared with individuals with no obesity and zero metabolic abnormalities. By contrast, risks were not higher for myocardial infarction (HR 0.92, 95% CI 0.87‐0.98), ischaemic stroke (HR 0.93, 95% CI 0.88‐0.98) and cardiovascular death (HR 0.99, 95% CI 0.93‐1.04). MHO in men was associated with a higher risk of clinical events compared with metabolically healthy men of normal weight (HR 1.12‐1.80), while women with MHO had a lower risk for most events than metabolically healthy women of normal weight (HR 0.49‐0.99).
Conclusions
In a large and contemporary analysis of patients seen in French hospitals, individuals with MHO did not have a higher risk of myocardial infarction, ischaemic stroke or cardiovascular death than metabolically healthy individuals with no obesity. By contrast, they had a higher risk of new‐onset HF and new‐onset AF. However, notable differences were observed in men and women in the sex‐stratified analysis.
Background
The number of patients with atrial fibrillation (AF) and cancer is rapidly increasing in clinical practice. The impact of cancer on clinical outcomes in this patient population is unclear, ...as is the performance of the HAS‐BLED (Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile INR, Elderly, Drugs/Alcohol) and CHA2DS2‐VASc (Congestive Heart Failure, Hypertension, Age ≥ 75 years, Diabetes Mellitus, Stroke or Transient Ischemic Attack, Vascular Disease, Age 65 to 74 Years, Sex Category) scores.
Methods
This was an observational, retrospective cohort study including 2,435,541 adults hospitalized with AF. The authors investigated the incidence rates (IRs) of all‐cause and cardiovascular mortality, ischemic stroke, major bleeding, and intracranial hemorrhage (ICH) according to the presence of cancer and cancer types.
Results
Overall, 399,344 (16.4%) had cancer, with the most common cancers being metastatic, prostatic, colorectal, lung, breast, and bladder. During a mean follow‐up of 2.0 years, cancer increased all‐cause mortality (hazard ratio HR, 2.00; 95% confidence interval CI, 1.99‐2.01). The IR of ischemic stroke was higher with pancreatic cancer (2.8%/y), uterine cancer (2.6%/y), and breast cancer (2.6%/y), whereas it was lower with liver/lung cancer (1.9%/y) and leukemia/myeloma (2.0%/y), in comparison with noncancer patients (2.4%/y). Cancer increased the risk of major bleeding (HR, 1.27; 95% CI, 1.26‐1.28) and ICH (HR, 1.07; 95% CI, 1.05‐1.10). Leukemia, liver cancer, myeloma, and metastatic cancers showed the highest IRs for major bleeding/ICH. Major bleeding and ICH rates progressively increased with the HAS‐BLED score, which showed generally good predictivity with C indexes > 0.70 for all cancer types. The CHA2DS2‐VASc score's predictivity was slightly lower in AF patients with cancer.
Conclusions
Cancer increased all‐cause mortality, major bleeding, and ICH risk in AF patients. The association between cancer and ischemic stroke differed among cancer types, and in some types, the risk of bleeding seemed to exceed the thromboembolic risk.
Cancer increases all‐cause and cardiovascular mortality and bleeding risk in atrial fibrillation patients. The association between cancer and ischemic stroke is variable and depends on the cancer type, and in some types, the risk of bleeding seems to exceed the thromboembolic risk.
There remain uncertainties regarding diabetes mellitus and the incidence of atrial fibrillation (AF), in relation to type of diabetes, and the interactions with sex and age. We investigated whether ...diabetes confers higher relative rates of AF in women compared to men, and whether these sex-differences depend on type of diabetes and age.
All patients aged ≥ 18 seen in French hospitals in 2013 with at least 5 years of follow-up without a history of AF were identified and categorized by their diabetes status. We calculated overall and age-dependent incidence rates, hazard ratios, and women-to-men ratios for incidence of AF in patients with type 1 and type 2 diabetes (compared to no diabetes).
In 2,921,407 patients with no history of AF (55% women), 45,389 had prevalent type 1 diabetes and 345,499 had prevalent type 2 diabetes. The incidence rates (IRs) of AF were higher in type 1 or type 2 diabetic patients than in non-diabetics, and increased with advancing age. Among individuals with diabetes, the absolute rate of AF was higher in men than in women. When comparing individuals with and without diabetes, women had a higher adjusted hazard ratio (HR) of AF than men: adjusted HR 1.32 (95% confidence interval 1.27-1.37) in women vs. 1.12(1.08-1.16) in men for type 1 diabetes, adjusted HR 1.17(1.16-1.19) in women vs. 1.10(1.09-1.12) in men for type 2 diabetes.
Although men have higher absolute rates for incidence of AF, the relative rates of incident AF associated with diabetes are higher in women than in men for both type 1 and type 2 diabetes.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Risk-benefit assessment for transcatheter aortic valve implantation (TAVI) is still a matter of debate. We aimed to identify patients with a bad outcome within 1 year after TAVI, and to develop a ...Futile TAVI Simple score (FTS). Based on the administrative hospital-discharge database, all consecutive patients treated with percutaneous TAVI in France between 2010 and 2018 were included. A prediction model was derived and validated for 1-year all-cause death after TAVI (considered as futility) by using split-sample validation: 20,443 patients were included in the analysis (mean age 83 ± 7 years). 7,039 deaths were recorded (yearly incidence rate 15.5%), among which 3,702 (53%) occurred in first year after TAVI procedure. In the derivation cohort (n = 10,221), the final logistic regression model included male sex, history of hospital stay with heart failure, history of pulmonary oedema, atrial fibrillation, previous stroke, vascular disease, renal disease, liver disease, pulmonary disease, anaemia, history of cancer, metastasis, depression and denutrition. The area under the curve (AUC) for the FTS was 0.674 (95%CI 0.660 to 0.687) in the derivation cohort and 0.651 (95%CI 0.637 to 0.665) in the validation cohort (n = 10,222). The Hosmer–Lemeshow test had a p-value of 0.87 suggesting an accurate calibration. The FTS score outperformed EuroSCORE II, Charlson comorbidity index and frailty index for identifying futility. Based on FTS score, 7% of these patients were categorized at high risk with a 1-year mortality at 43%. In conclusion, the FTS score, established from a large nationwide cohort of patients treated with TAVI, may provide a relevant tool for optimizing healthcare decision.
Ventricular septal myectomy (SM) and alcohol septal ablation (ASA), 2 septal reduction therapies (SRTs), are recommended in symptomatic obstructive hypertrophic cardiomyopathy (HCM) despite maximum ...tolerated medical therapy. Contradictory results between the outcomes of these 2 types of therapies persist to this day. The objective of this study was to compare in-hospital and mid-term outcomes of SM versus ASA, at a nationwide level in France. We collected information on patients who underwent SRT for HCM using the French nationwide Programme de Médicalisation des Systèmes d'Information database between 2010 and 2019. A total of 1,574 patients were identified in the database, including 340 patients in the SM arm and 1,234 patients in the ASA arm. No difference during the median follow-up of 1.3 years between the 2 groups was noted in terms of mortality (adjusted incidence rate ratio 0.687, 95% confidence interval 0.361 to 1.309, p = 0.25). However, there was a significantly lower risk of all-cause stroke (adjusted incidence rate ratio 0.180, 95% confidence interval 0.058 to 0.554, p = 0.003) in the ASA group. In conclusion, in our “real-life” data from France, mortality after SRT in patients with HCM was similar after ASA or SM. Moreover, ASA was more widely used than SM despite European Society of Cardiology guidelines recommendations.
Objectives: To demonstrate the association between the Hospital Frailty Risk Score (HFRS) and 30-day mortality, 30-day hospital readmission and length of stay (LOS) in France. Methods: Logistic ...regressions were performed using data recorded in the French national health data system (SNDS) for elderly patients (≥75 years old) hospitalized in France in 2017. Results: Over the 1,111,090 patients included, 30-day mortality was associated with the HFRS: adjusted OR (aOR) for an intermediate HFRS (5–15 points) was 1.91 95% confidence interval (95% IC); 1.87–1.95 and aOR 2.57 95% IC; 2.50–2.64 for high HFRS (>15 points), as compared to low HFRS (<5 points). LOS >10 days increased with the HFRS (aOR = 1.36 95% IC; 1.34–1.38 for an intermediate HFRS and aOR 1.51 95% IC; 1.48–1.54 for a high HFRS). A high HFRS was associated with 30-day hospital readmission (aOR = 1.06 95% IC; 1.04–1.08). Discussion: This real-life analysis of in- and out-patient healthcare pathways confirmed the HFRS’s ability to predict adverse outcomes, after adjustment on social deprivation.
Background
In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both ...conditions are associated with similar outcomes is a matter of debate.
Methods
We collected information for all patients with AMI seen in French hospitals between 2010 and 2019. Among 797,212 patients seen with STEMI or NSTEMI, 75,701 (9.5%) had history of AF, and 34,768 (4.4%) had new AF diagnosed between day 1 and day 30 after AMI.
Results
Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. During follow-up mean (SD) 1.8 (2.4) years, median (interquartile range) 0.7 (0.1–3.1) years, 163,845 deaths and 30,672 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.17, 95% CI 1.16–1.19) and this was also the case for patients with new AF (adjusted HR 2.11, 2.07–2.15). Both history of AF and new AF were associated with a higher risk of ischemic stroke compared to patients with no AF: adjusted HR 1.19 (1.15–1.23) for history of AF, adjusted HR 1.78 (1.68–1.88) for new AF. New AF was associated with a higher risk of death and of ischemic stroke than history of AF: adjusted HR 1.74 (1.70–1.79) and 1.32 (1.23–1.42), respectively.
Conclusions
In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was independently associated with higher risks of death and ischemic stroke than those in patients with no AF or previously known AF.
Graphic abstract
Background Leadless ventricular permanent pacemakers (leadless VVI or LPM) were designed to reduce lead‐related complications of conventional VVI pacemakers (CPM). The aim of our study was to assess ...and compare real‐life clinical outcomes within the first 30 days and during a midterm follow‐up with the 2 techniques. Methods and Results This French longitudinal cohort study was based on the national hospitalization database. All adults (age ≥18 years) hospitalized in French hospitals from January 1, 2017 to September 1, 2020, who underwent a first LPM or CPM were included. The study included 40 828 patients with CPM and 1487 with LPM. After propensity score matching 1344 patients with CPM were matched 1:1 with patients treated with LPM. Patients with LPM had a lower rate of all‐cause and cardiovascular death within the 30 days after implantation. During subsequent follow‐up (mean: 8.6±10.5 months), risk of all‐cause death in the unmatched population was significantly higher in the LPM group than in the CPM group, whereas risk of cardiovascular death and of endocarditis was not significantly different. After matching on all baseline characteristics including comorbidities (mean follow‐up 6.2±8.7 months), all‐cause death, cardiovascular death, and infective endocarditis were not statistically different in the 2 groups. Conclusions Patients treated with leadless VVI pacemakers had better clinical outcomes in the first month compared with the patients treated with conventional VVI pacing. During a midterm follow‐up, risk of all‐cause death, cardiovascular death, and endocarditis in patients treated with leadless VVI pacemaker was not statistically different after propensity score matching.
Background
Breast cancer (BC) is one of the most common cancers worldwide, and the treatments are frequently cardiotoxic. Whether BC is associated with a higher risk of cardiovascular events is a ...matter of debate. We evaluated the associations among BC and incident cardiovascular events in a contemporary population.
Methods
All female patients discharged from French hospitals in 2013 with at least 5 years of follow‐up and without a history of major adverse cardiovascular event (myocardial infarction MI, heart failure HF, ischaemic stroke or all‐cause death, and MACE‐HF, which includes cardiovascular death, MI, ischaemic stroke or HF) or cancer (except BC) were identified. After propensity score matching, patients with BC were matched 1:1 with patients with no BC. Hazard ratios (HRs) for cardiovascular events during follow‐up were adjusted on age, sex and smoking status at baseline.
Results
1,795,759 patients were included, among whom 64,480 (4.3%) had history of BC. During a mean follow‐up of 5.1 years, matched female patients with BC had a higher risk of all‐cause death (HR 3.55, 95% confidence interval CI: 3.47–3.64), new‐onset HF (HR 1.08, 95% CI 1.04–1.11), major bleeding (HR 1.43, 95% CI 1.36–1.49), MACE‐HF (HR 1.07, 95% CI 1.04–1.11) and net adverse clinical events (NACE) including all‐cause death, MI, ischaemic stroke, HF or major bleeding (HR 2.53, 95% CI 2.48–2.58) compared with those with no BC. By contrast, risks were not higher for cardiovascular death (HR 0.94, 95% CI 0.88–1.00) and were lower for MI (HR 0.81, 95% CI 0.75–0.88) and ischaemic stroke (HR 0.85, 95% CI 0.79–1.11).
Conclusions
In a large and contemporary analysis of female patients seen in French hospitals, women with history of breast cancer had a higher risk of all‐cause mortality, new‐onset heart failure and major bleeding compared to a matched cohort of women without breast cancer. In contrast, they have a reduced risk of cardiovascular mortality, MI and stroke.
PDF
