Objective
This study aims to update the current reference for sex-specific birth weight percentiles by gestational age, overall and for specific ethnic groups, based on data from all singleton ...live-birth deliveries from 2005 to 2014 in Alberta, Canada.
Methods
Infant and maternal information were captured in the Alberta Vital Statistics-Births Database for 473,115 singleton infants born to 311,800 women between January 1, 2005 and December 31, 2014. Within each sex, and each sex-ethnic group, birth weights were modelled by gestational age using generalized additive models and natural cubic splines. Crude and corrected estimates for birth weight percentiles including cut-off values for large for gestational age (LGA) and small for gestational age (SGA) were calculated by sex and sex-ethnic group, and gestational age for singleton live births.
Results
LGA and SGA cut-offs were lower for females than for males for all gestational ages. The SGA and LGA percentiles were greater for both male and female very preterm infants in Alberta compared to previous national references. Ethnicity-specific LGA and SGA cut-offs for term Chinese and preterm and at-term South Asian infants were consistently lower than those for both the general population in Alberta and the previous national reference. South Asian infants had lower birth weights at almost all gestational ages compared with the other groups.
Conclusion
The updated birth weight percentiles presented in this study highlight the differences in SGA and LGA cut-offs among infants from South Asian, Chinese, and the general population, which may be important for clinical perinatal care.
Background The long-term incidence of heart failure (HF) in ST-elevation myocardial infarction (STEMI), non–ST-elevation myocardial infarction (NSTEMI), or unstable angina (UA) patients is uncertain. ...We examined the 1-year incidence of HF and its association with mortality among patients surviving their first acute coronary syndrome (ACS) hospitalization. Methods and results A retrospective cohort study of patients, aged ≥20 years, with no prior HF, hospitalized for the first time with ACS between April 1, 2002, and December 31, 2008, in Alberta, Canada, and followed up for 1 year. Index HF was defined as HF that developed as a complication during the index ACS hospitalization, and post-discharge HF , as HF developing after discharge from the index ACS hospitalization. Among 9,406 STEMI, 11,008 NSTEMI, and 4,910 UA patients, 13.6%, 14.8%, and 5.2% had index HF, respectively ( P < .01). At 1-year, cumulative HF rates were 23.4% in STEMI, 25.4% in NSTEMI, and 16% in UA patients. Among hospital survivors, 1-year mortality rate was 13.9% in patients with index HF, 10.6% in patients with postdischarge HF, and 2.4% in patients with no HF. In multivariable analysis, both index HF (adjusted hazard ratio 3.2, 95% CI 2.7-3.7) and postdischarge HF (adjusted hazard ratio 4.6, 95% CI 3.9-5.4) were associated with 1-year mortality. Conclusions There are significant differences in the incidence of HF among STEMI, NSTEMI, and UA patients. The increased mortality risk associated with index HF and postdischarge HF suggests a need for vigilant follow-up of all ACS patients for prompt detection and treatment of HF.
Abstract
We introduce and study a model for the movement of surfaces, namely the conserved, restricted solid-on-solid model. The surface configurations are restricted such that the difference between ...the heights at adjacent sites is no more than one. In addition, the total number of particles is preserved by the dynamics of the model. Mean-field approximations are used to approximate the one-site probability function of the model in both time-independent and time-dependent regimes. In the time-dependent regime, we found that for the height at one site, the average evolves like
t
1/6
and squared fluctuations like
t
1/3
.
Abstract Background Peripartum cardiomyopathy (PPCM) is a form of heart failure associated with pregnancy. The objectives of our study were to determine the incidence and outcomes (maternal and ...neonatal) of PPCM and its association with diabetes mellitus (DM) in a contemporary population-based cohort. Methods The cohort consisted of 309,825 women with a birth of at least 1 live newborn between January 01, 2005 and September 30, 2014, resulting in 469,150 birth events and 477,089 live newborns. A modified PPCM definition was used, allowing from 32 weeks' gestation and up to 6 months postpartum. Women were categorized according to DM status. Results A total of 194 PPCM birth events were identified, for an incidence rate of 1/2418 births. Women with PPCM were older, often primiparous, and more likely to have multiple gestations, pre-existing DM, and hypertensive disorders of pregnancy. Although the overall numbers were low, the incidence of PPCM was higher in pregnancies in women with pre-existing DM (1/613 birth events) and gestational DM (1/1751 birth events) vs those with neither (1/2550 birth events). Over a mean follow-up of 3.9 years, the mortality rate was higher in women affected by PPCM than in those who were not, with few deaths overall. Neonatal death was uncommon in the entire cohort but was numerically greater in the PPCM group. Conclusions The incidence of PPCM in Alberta, Canada was approximately 1/2400 births and was modulated by the presence of DM in pregnancy. The relationship between DM status and PPCM may be confounded by other vascular risk factors, including hypertensive disorders of pregnancy. There were few maternal or neonatal deaths in the overall cohort, but they were numerically higher in the PPCM group.
Abstract Background Despite being a common intervention to restore sinus rhythm for patients in atrial fibrillation (AF), limited data exists on the impact of electrical cardioversion on quality of ...life (QoL) outcomes in clinical practice. Methods Prospective cohort study of consecutive AF patients referred for an outpatient electrical cardioversion at two hospitals in Edmonton from 2013-2014. Baseline demographics, clinical characteristics, medications and procedure details were obtained. Quality-of-life was assessed at baseline and 3 months using the global Short-Form health survey (SF-36) and the Atrial Fibrillation Effect on Quality-of-life (AFEQT) questionnaire. Results One hundred patients underwent electrical cardioversion and completed follow-up. The median age was 62 (IQR, 56-68) years, 80% were male; the majority had non-paroxysmal AF (90%) with a mean left ventricular ejection fraction of 50.0% ( + 12.4). At baseline, scores were lower than those reported from healthy individuals across all domains of the SF-36. The overall mean AFEQT score was 55.6 + 24.4, and the domain-specific scores were as follows: symptoms 66.2 + 26.6, daily activities 48.5 + 29.5, treatment concern 57.6 + 25.8, treatment satisfaction 56.7 + 26.1. There were significant improvements in the vast majority of the SF-36 and AFEQT domains for the 51 patients who maintained sinus rhythm at 3 months. Patients who were in AF by 3 months demonstrated improvements in the AFEQT treatment concern score (p=0.02) and SF-36 emotional role value (p <0.01) compared to baseline which may be the result of treatment expectations related to cardioversion. Conclusions There are significant qualify of life benefits for patients who maintain sinus rhythm after electrical cardioversion.
Abstract Background In 2007, the American Heart Association (AHA) published revised guidelines for infective endocarditis (IE) prophylaxis. Population-based data with respect to the potential impact ...of these revised guidelines are lacking. Methods The Canadian Institute for Health Information Discharge Abstract Database was used to identify all hospitalizations between April 2002 and March 2013 having IE as a primary diagnosis. Hospitalization rates were determined using age-specific population data from Statistics Canada. Interrupted time series analysis was used to evaluate changes in the slope of hospitalization rates after the AHA guidelines were published. Results There were 9431 hospitalizations during the study period among 8055 patients (63% male patients). Time trend analysis showed an increase of 0.05 IE hospitalizations per 10 million population per month (95% confidence interval, 0.005-0.09; P = 0.029) from April 2002-March 2007 and an increase of 0.07 IE hospitalizations per 10 million population per month from April 2007-March 2013 (interaction P = 0.5213). Change-point analysis showed that a change in the slope occurred in April 2011, 4 years after publication of the revised AHA guidelines. Staphylococcus aureus was the most commonly reported organism (29.4%). Streptococcal infections decreased over time, beginning before the 2007 guidelines ( P < 0.0001). The presence of a pacemaker or defibrillator was an increasingly prevalent risk factor over time (4% increase per year; P = 0.0178). Conclusions The rate of IE hospitalizations increased in Canada before and after the publication of the 2007 AHA guidelines, with no significant change in slope after 2007. These guidelines had no impact on the incidence of IE hospitalizations.
Background
Given that pregnant women taking medications are excluded from clinical trials, real-world evidence is essential. We aimed to build a Canadian Mother-Child Cohort Active Surveillance ...Initiative (CAMCCO) and compare frequency of prematurity, low-birth-weight (LBW), major malformations, multiplicity, and gestational medication use across four provinces.
Methods
CAMCCO is a collaborative research infrastructure that uses real-world data from large provincial health care databases in Canada; developed with standardized methods to similarly construct population-based pregnancy/child cohorts with longitudinal follow-up by linking administrative/hospital/birth databases. CAMCCO also includes a common repository to i) share algorithms and case definitions based on diagnostic and procedural codes for research/training purpose, and ii) download aggregate data relevant to primary care providers, researchers, and decision makers. For this study, data from Quebec (1998–2015), Manitoba (1995–2019), Saskatchewan (1996–2020), and Alberta (2005–2018) are compared (Chi-square tests, p-values), and trends are calculated using Cochran-Armitage trend tests.
Results
Almost two-thirds (61%) of women took medications during pregnancy, mostly antibiotics (26%), asthma drugs (8%), and antidepressants (4%). Differences in the prevalence of prematurity (5.9–6.8%), LBW (4.0–5.2%), and multiplicity (1.0–2.5%) were statistically significant between provinces (p<0.001). Frequency of major malformations increased over time in Quebec (7–11%; p<0.001), Saskatchewan (5–11%; p<0.001), and Alberta (from 7–8%; p<0.001), and decreased in Manitoba (5–3%; p<0.001). Cardiovascular and musculoskeletal malformations were the most prevalent.
Interpretation
Medications are often used among Canadian pregnancies but adverse pregnancy outcomes vary across provinces. Digitized health data may help researchers and care providers understand the risk-benefit ratios related to gestational medication use, as well as province-specific trends.
Endomyocardial biopsy (EMB) is the current gold standard to screen for heart transplant rejection but has important risks and limitations. Cardiovascular magnetic resonance imaging (CMRI) is ...increasingly used to characterize cardiac function and myocardial tissue. We evaluated the diagnostic accuracy of CMRI compared with EMB and clinically diagnosed heart transplant rejection.
Comprehensive CMRI scans were performed on adult heart transplant recipients within 24 hours of EMB (routine or clinically indicated), before initiation of any anti-rejection therapy, and blinded to EMB results. Multivariable analysis was used to create CMRI diagnostic criteria for comparison with a positive EMB (Grade ≥ 2R or antibody-mediated rejection) and clinical rejection (change in medical therapy to treat rejection).
Sixty participants (75% male; mean age, 51 ± 14 years) were recruited, providing 73 comparisons between CMRI and EMB for the diagnosis of rejection. Multivariable logistic regression identified myocardial edema (T2 relaxation time) and right ventricular end-diastolic volume index as independent predictors of a positive EMB. Combining threshold right ventricular end-diastolic volume index and edema values predicted a positive EMB with very good accuracy: sensitivity, 93%; specificity, 78%; positive predictive value, 52%; and negative predictive valve, 98%. CMRI was more sensitive than EMB at predicting clinical rejection (sensitivity of 67% vs 58%).
CMRI has high sensitivity and high negative predictive value in predicting biopsy-positive heart transplant rejection and may be useful as a screening test before routine EMB. CMRI also has better sensitivity for clinically diagnosed heart transplant rejection and could be helpful in cases of negative rejection on the biopsy specimen.
Background Improving health-related quality of life is an important goal in the management of patients with heart failure (HF). Defining health-related quality of life changes over time in patients ...with HF with preserved (HFpEF) or reduced ejection fraction and showing their association with other important clinical events could support the use of health-related quality of life as a measure of quantifying HF care. Methods and Results In the Alberta HEART (Heart Failure Aetiology and Analysis Team) cohort (n=621), patients were categorized into 4 subgroups: healthy controls (n=98), at risk (n=163), HFpEF (n=191), and HF with reduced ejection fraction (n=169). The change of the Kansas City Cardiomyopathy Questionnaire (KCCQ), EuroQOL 5 dimensions, and Functional Assessment of Cancer Therapy-Anemia over 12 months, and its association with a composite of death or rehospitalization within 3 years were assessed. At baseline, the KCCQ overall summary score was 73 (interquartile range, 53-86) in HFpEF and 78 (interquartile range, 56-90) in HF with reduced ejection fraction (
=0.22). Overall, 30.5% of patients with HF experienced ≥5-point improvements and 32.4% had ≥5-point worsening in KCCQ overall summary score at 12 months, which did not differ between HFpEF and HF with reduced ejection fraction (
=0.23). Clinical events were higher in patients with HF who had a decline in KCCQ over 12 months as compared with those with stable KCCQ scores (70.2% versus 52.0%,
=0.012). The results were similar for the Functional Assessment of Cancer Therapy-Anemia and EuroQOL 5 dimensions. Conclusions In patients with HF, the KCCQ quantified clinically meaningful changes over time, which were associated with important clinical outcomes in patients with HFpEF. Given the observed variability and prognostication in different patient trajectories, health-related quality of life measures could be valuable for quantifying the quality of care in healthcare systems.
Objectives To examine differences in health services utilization (HSU) costs in the first year of life between low birth weight (LBW) and normal birth weight (NBW) infants, identify maternal and ...child characteristics associated with HSU costs, and estimate annual HSU cost of LBW infants for the province of Alberta, Canada. Study design A retrospective cohort study including all live births between 2004 and 2010. Data from the Alberta Perinatal Health Program database were linked to health care administrative data including inpatient, outpatient, and practitioner claims to identify HSU within the first year of life. Results One-year HSU costs among LBW infants (n = 16 209) were $33 096 compared with $3942 among NBW infants (n = 189 586). There was a strong negative correlation between HSU costs and increasing birth weight, with health care costs among extreme LBW (<1000 g), very LBW (1000 and 1499 g), and moderate LBW (1500 and 2499 g) of $117 000, $84 000, and, $20 000, respectively. Maternal characteristics such as high prepregnancy weight, aboriginal status, and lower socioeconomic status were associated with higher HSU costs among the infants. LBW accounted for 7% of all infants but 37% of the total costs, amounting to $108 million annually. Conclusions Compared with NBW infants, LBW infants consume more health resources not only in terms of initial hospitalization but also of re-hospitalizations, outpatient, and physician visits during the first year of their life. Interventions targeting social determinants of health are required to improve birth weight outcomes in Alberta.
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