Background
As the population ages, clinicians increasingly encounter ischemic heart disease in patients with underlying dementia. Therefore, we quantified differences in inhospital adverse events and ...30‐day readmission rates among patients with and without dementia undergoing percutaneous coronary intervention (PCI).
Methods
Using the National Readmissions Database 2017–2018, we identified 755,406 index hospitalizations in which PCI was performed, of which 17,309 (2.3%) had a diagnosis of dementia. After propensity score matching patients with and without dementia, we assessed 30‐day readmission and inhospital adverse events by Cox proportional hazards and logistic regression modeling and compared them with those of other common cardiac (pacemaker placement PP) and noncardiac (hip replacement surgery HRS) procedures.
Results
Thirty‐day readmission was significantly higher in patients with dementia than patients without dementia (hazard ratio HR 1.67, 95% confidence interval CI 1.60–1.74). Patients with dementia also experienced higher odds of delirium (odds ratio OR 4.37, CI 3.69–5.16), inhospital mortality (OR 1.15, CI 1.01–1.30), cardiac arrest (OR 1.19, CI 1.01–1.39), acute kidney injury (OR 1.30, CI 1.21–1.39), and fall (OR 2.51, CI 2.06–3.07). On multivariable Cox modeling, dementia independently predicted 30‐day readmission (HR 1.14, CI 1.07–1.20). The higher readmission risk with PCI (11%) among those with dementia was similar to that of patients undergoing PP (10%), but lower than in those undergoing HRS (41%).
Conclusion
Patients with dementia who undergo PCI experience significantly increased rates of inhospital delirium, mortality, kidney injury, falls, and 30‐day readmission. These adverse outcomes should be considered during shared decision‐making with patients and their families.
See related editorial by Bernacki et al. in this issue.
Abstract
Cardiovascular toxicities associated with immune checkpoint inhibitors (ICIs) have been reported in case series but have been underappreciated due to their recent emergence, difficulties in ...diagnosis and non-specific clinical manifestations. ICIs are antibodies that block negative regulators of the T cell immune response, including cytotoxic T lymphocyte-associated protein-4 (CTLA-4), programmed cell death protein-1 (PD-1), and PD-1 ligand (PD-L1). While ICIs have introduced a significant mortality benefit in several cancer types, the augmented immune response has led to a range of immune-related toxicities, including cardiovascular toxicity. ICI-associated myocarditis often presents with arrhythmias, may co-exist with myositis and myasthenia gravis, can be severe, and portends a poor prognosis. In addition, pericardial disease, vasculitis, including temporal arteritis, and non-inflammatory heart failure, have been recently described as immune-related toxicities from ICI. This narrative review describes the epidemiology, diagnosis, pathophysiology, and treatment of cardiovascular toxicities of ICI therapy, highlighting recent developments in the field in the past year.
Much progress has been made in chronic kidney disease (CKD) epidemiology in the last decade to establish CKD as a condition that is common, harmful and treatable. The introduction of the new ...equations for estimating glomerular filtration rate (GFR) and the publication of international reference standards for creatinine and cystatin measurement paved the way for improved global estimates of CKD prevalence. The addition of albuminuria categories to the staging of CKD paved the way for research linking albuminuria and GFR to a wide range of renal and cardiovascular adverse outcomes. The advent of genome-wide association studies ushered in insights into genetic polymorphisms underpinning some types of CKD. Finally, a number of new randomized clinical trials and meta-analyses have informed evidence-based guidelines for the treatment and prevention of CKD. In this review, we discuss the lessons learnt from epidemiological investigations of the staging, etiology, prevalence and prognosis of CKD between 2007 and 2016.
Androgen deprivation therapy is a cornerstone of prostate cancer treatment. Pharmacological androgen deprivation includes gonadotropin-releasing hormone agonism and antagonism, androgen receptor ...inhibition, and CYP17 (cytochrome P450 17A1) inhibition. Studies in the past decade have raised concerns about the potential for androgen deprivation therapy to increase the risk of adverse cardiovascular events such as myocardial infarction, stroke, and cardiovascular mortality, possibly by exacerbating cardiovascular risk factors. In this review, we summarize existing data on the cardiovascular effects of androgen deprivation therapy. Among the therapies, abiraterone stands out for increasing risk of cardiac events in meta-analyses of both randomized controlled trials and observational studies. We find a divergence between observational studies, which show consistent positive associations between androgen deprivation therapy use and cardiovascular disease, and randomized controlled trials, which do not show these associations reproducibly.
Abstract
BACKGROUND
In the United States, current guidelines recommend a total sodium intake <2,300 mg/day, a guideline which does not consider kilocalorie intake. However, kilocalorie intake varies ...substantially by age and sex. We hypothesized that compared with sodium density, total sodium intake overestimates adherence to sodium recommendations, especially in adults consuming fewer kilocalories.
METHODS
In the National Health and Nutrition Examination Survey (NHANES), we estimated the prevalence of adherence to sodium intake recommendations (<2,300 mg/day) and corresponding sodium density intake (<1.1 mg/kcal = 2,300 mg at 2,100 kcal) by sex, age, race/ethnicity, and kilocalorie level. Adherence estimates were compared between the 2005–2006 (n = 5,060) and 2015–2016 (n = 5,266) survey periods.
RESULTS
In 2005–2006, 23.1% (95% confidence interval CI: 21.5, 24.9) of the US population consumed <2,300 mg of sodium/day, but only 8.5% (CI: 7.6, 9.4) consumed <1.1 mg/kcal in sodium density. In 2015–2016, these figures were 20.9% (CI: 18.8, 23.2) and 5.1% (CI: 4.4, 6.0), respectively. In 2015–2016, compared with 2005–2006, adherence by sodium density decreased more substantially (odds ratio = 0.59; CI: 0.48, 0.72; P < 0.001) than adherence by total sodium consumption (odds ratio = 0.85; CI: 0.73, 0.98; P = 0.03). The difference in adherence between total sodium and sodium density goals was greater among those with lower kilocalorie intake, namely, older adults, women, and Hispanic adults.
CONCLUSIONS
Adherence estimated by sodium density is substantially less than adherence estimated by total sodium intake, especially among persons with lower kilocalorie intake. Further efforts to achieve population-wide reduction in sodium density intake are urgently needed.
Purpose of Review
The role of neuroimmune modulation and inflammation in cardiovascular disease has been historically underappreciated. Physiological connections between the heart and brain, termed ...the heart-brain axis (HBA), are bidirectional, occur through a complex network of autonomic nerves/hormones and cytokines, and play important roles in common disorders.
Recent Findings
At the molecular level, advances in the past two decades reveal complex crosstalk mediated by the sympathetic and parasympathetic nervous systems, the renin-angiotensin aldosterone and hypothalamus-pituitary axes, microRNA, and cytokines. Afferent pathways amplify proinflammatory signals via the hypothalamus and brainstem to the periphery, promoting neurogenic inflammation. At the organ level, while stress-mediated cardiomyopathy is the prototypical disorder of the HBA, cardiac dysfunction can result from a myriad of neurologic insults including stroke and spinal injury. Atrial fibrillation is not necessarily a causative factor for cardioembolic stroke, but a manifestation of an abnormal atrial substrate, which can lead to the development of stroke independent of AF.
Summary
Central and peripheral neurogenic proinflammatory factors have major roles in the HBA, manifesting as complex bi-directional relationships in common conditions such as stroke, arrhythmia, and cardiomyopathy.
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