Abstract
Background
Heart Failure (HF) is a major public health problem resulting in high rates of hospitalization and mortality. Frequency of HF increase due to the aging of population and ...improvement of treatments. Therefore, we hypothetized that elderly is a factor that might limit access to appropriate HF Care.
Purpose and methods
Our aim was to analyzed the optimization therapy and participation in rehabilitation and education programs depending according to classes of age (<40 years, 40–50; 50–60; 60–70; 70–80 and >80) in a large French HF population (out and in-patients, de novo/chronique/acute; consultation/hospitalization/rehabilitation; all LVEF classes and any type of cardiologist practice). Data were analized according to age groups
Results
A total of 2729 HF patients from 79 French departments were included of whom 36% were out patients, 53% were in-patients and 11% were in rehabilitation center. 16% were de novo Chronic HF and 31% were in Acute HF. Elderly patients were more frequently included in acute HF. Main data according on classes of age are presented in the table. Ischemic etiology and valvular diseases increased with age (p<0.0001). Cardiovascular risk factors (HTA, hypercholesterolemia) and atrial fibrillation were more frequent with ageing (p<0.0001).
Beta-blockers, angiotensin converting enzyme inhibitors, and anti-aldosterone, were less prescribed after 60 years old (p<0.0001) as therapeutic education or rehabilitation programs (p<0.0001). Modern means of communication (e-mail, smartphone and internet) were less used by elderly patients.(p<0.0001).
Main data according on classes of age
Characteristics
All (n=2729)
<40 (n=91)
40–50 (n=197)
50–60 (n=447)
60–70 (n=706)
70–80 (n=715)
>80 (n=573)
p
SBP
120±21
107±15
117±21
117±21
118±21
122±20
126±22
<0.0001
NYHA Class
<0.0001
I
339 (13.8)
16 (19.3)
42 (23.5)
87 (21.4)
103 (16.1)
57 (8.8)
34 (6.7)
II
1187 (48.2)
45 (54.2)
95 (53.1)
213 (52.3)
311 (48.5)
314 (48.4)
209 (41.3)
III
763 (31.0)
20 (24.1)
34 (19.0)
97 (23.8)
199 (31.0)
206 (31.7)
207 (40.9)
IV
176 (7.1)
2 (2.4)
8 (4.5)
10 (2.5)
28 (4.4)
72 (11.1)
56 (11.1)
LVEF
36 (29–50)
33 (26–44)
35 (25–45)
35 (25–42)
35 (25–45)
40 (30–50)
44 (32–55)
<0.0001
NTproBNP
1808 (690–4323)
1176 (569–2434)
737 (294–1945)
1072 (346–2611)
1480 (619–3597)
2287 (1015–5689)
3275 (1500–6240)
<0.0001
Plus-minus values are means ± SD, n (%) median (IQR).
Origin of patients according on classes
Conclusion
Elderly patients receive less Chronic HF treatment, and are less included in patient education and rehabilitation program despite having more comorbidities and cardiovascular risk factors. Thus, to improve outcome, the health care system needs to be adapt to the patients'age.
Acknowledgement/Funding
SFC, CNCF, CNCH, FFC, Alliance du coeur, GERS, SNSMCV
Self-reported questionnaires are useful for estimating the health-related quality of life (HR-QoL), impact of interventions, and prognosis. To our knowledge, no HR-QoL questionnaire has been ...developed for cardiac amyloidosis (CA). This study aimed to validate Amylo-AFFECT-QOL questionnaire to assess HR-QoL and its prognostic value in CA.
A self-reported questionnaire, "Amylo-AFFECT" had been designed and validated for CA symptoms evaluation and screening by physicians. It was adapted here to assess HR-QoL (Amylo-AFFECT-QOL) and its prognostic value in CA. To validate the theoretical model, internal consistency and convergent validity were assessed, particularly correlations between Amylo-AFFECT-QOL and the HR-QoL Minnesota Living Heart Failure (MLHF) questionnaire.
Amylo-AFFECT-QOL was completed by 515 patients, 425 of whom (82.5%) had CA. Wild-type and hereditary transthyretin amyloidosis (ATTRwt and ATTRv) and immunoglobulin light-chain amyloidosis (AL) were diagnosed in 47.8, 14.7, and 18.8% of cases, respectively. The best HR-QoL evaluation was obtained with five dimensions: "Heart failure," "Vascular dysautonomia," "Neuropathy," "Ear, gastrointestinal, and urinary dysautonomia," and "Skin or mucosal involvement." The global Amylo-AFFECT-QOL and MLHF scores showed significant positive correlations (rs = 0.72,
< 0.05). Patients with a final diagnosis of CA had a global Amylo-AFFECT-QOL score significantly higher than the control group composed by patients with other diagnoses (22.2 ± 13.6 vs. 16.2 ± 13.8, respectively,
-value < 0.01). According to the Amylo-AFFECT-QOL global results, ATTRv patients' QoL was more affected than AL patients' QoL or ATTRwt patients' QoL. Patients with a higher HR-QoL score had a greater risk of death or heart transplant after 1 year of follow-up (log-rank < 0.01).
Amylo-AFFECT-QOL demonstrates good psychometric properties and is useful for quantifying HR-QoL and estimating CA prognosis. Its use may help to improve overall management of patients with CA.
Background
The introduction of cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy (HIPEC) improved the prognosis of selected patients with peritoneal ...mesothelioma (PM).
Objective
The objective of our study was to evaluate whether different HIPEC agents were associated with different outcomes in patients with PM.
Methods
From the RENAPE database, we selected all patients with histology-proven PM who underwent CRS + HIPEC from 1989 to 2014. Inclusion criteria were age ≤ 80 years, performance status ≤ 2, and no extraperitoneal metastases.
Results
Overall, 249 patients underwent CRS + HIPEC for PM. The HIPEC regimen included five chemotherapeutic agents (CAs), consisting of cisplatin, doxorubicin, mitomycin-C, oxaliplatin, and irinotecan. When considering all CAs (alone or in combination), there was no significant statistical difference in regard to postoperative overall survival (OS). However, OS was better when using two CAs (group 2 drugs) versus one CA (group 1 drug) (
p
= 0.03). The different CA regimens were equally distributed between the two groups. This association between OS and HIPEC agent, as well as a trend for better progression-free survival, were both observed in the two-drug group versus the one-drug group (
p
= 0.009) for patients undergoing complete cytoreductive surgery (CC-0) with an epithelioid subtype.
Conclusions
This large study seems to show improved OS when combined CAs, especially with platinum-based regimens, are used for HIPEC in patients with PM, but needs to be confirmed by a randomized controlled trial.
The multidimensional, multiprofessional gerontological evaluation helps identify geriatric syndromes and situations of fragility. This is a first step to establish a plan of care and assistance, to ...reduce the risk of falls, hospitalization, entry into institutions and to prevent a decline in independence. Older people with cardiovascular disease such as heart failure are at very high risk of repeated hospitalizations, with an average of 45% of patients re-hospitalized in the year following all-cause hospitalization. In the context of heart failure, frailty is an independent risk factor for mortality within 30 days of leaving hospital. Screening for frailty before transcatheter aortic valve implantation (TAVI) or interventional rhythmic procedure is a determining factor in decision-making for benefit in terms of survival and quality of life in elderly patients. Vascular diseases by their cerebral complications represent the first cause of mortality and the first cause of loss of functional independence in the subjects of more than 65 years. Vascular disease is a risk factor for cognitive impairment in the elderly.
L’évaluation gérontologique multidimensionnelle, multiprofessionnelle, permet de repérer les syndromes gériatriques et les situations de fragilité.
C’est une première étape qui permet d’établir un ...plan de soins et d’aide, pour diminuer le risque de chutes, d’hospitalisations, d’entrée en institution et pour prévenir un déclin de l’indépendance.
Les personnes âgées qui ont une maladie cardiovasculaire telle que l’insuffisance cardiaque sont à très haut risque d’être hospitalisées de façon répétée, avec en moyenne 45 % des patients ré-hospitalisés dans l’année qui suit une hospitalisation toutes causes confondues.
Dans le cadre de l’insuffisance cardiaque, la fragilité est un facteur de risque indépendant de mortalité dans les 30 jours qui suivent la sortie d’hospitalisation.
Le dépistage de la fragilité avant un transcatheter aortic valve implantation (TAVI) ou une procédure de rythmologie interventionnelle est un facteur déterminant dans la prise de décision pour un bénéfice en termes de survie et de qualité de vie chez les patients âgés.
Les maladies vasculaires par leurs complications cérébrales représentent la première cause de mortalité et la première cause de perte d’indépendance fonctionnelle chez les sujets de plus de 65 ans.
La maladie vasculaire est un facteur de risque d’altération cognitive chez les personnes âgées.
The multidimensional, multiprofessional gerontological evaluation helps identify geriatric syndromes and situations of fragility.
This is a first step to establish a plan of care and assistance, to reduce the risk of falls, hospitalization, entry into institutions and to prevent a decline in independence.
Older people with cardiovascular disease such as heart failure are at very high risk of repeated hospitalizations, with an average of 45% of patients re-hospitalized in the year following all-cause hospitalization.
In the context of heart failure, frailty is an independent risk factor for mortality within 30 days of leaving hospital.
Screening for frailty before transcatheter aortic valve implantation (TAVI) or interventional rhythmic procedure is a determining factor in decision-making for benefit in terms of survival and quality of life in elderly patients.
Vascular diseases by their cerebral complications represent the first cause of mortality and the first cause of loss of functional independence in the subjects of more than 65 years.
Vascular disease is a risk factor for cognitive impairment in the elderly.
Epithelioid mesothelioma is the most prevalent subtype of diffuse malignant peritoneal mesothelioma. The relationship between a strong adaptive immune response and a better prognosis in malignant ...solid tumors is widely known. Due to the low incidence of epithelioid malignant peritoneal mesothelioma (EMPM), very little is known about their immune micro-environment. We encountered several cases of tertiary lymphoid structures in EMPM in a previous study and aimed to investigate in the same series the prevalence, clinicopathological features, and the prognostic impact associated with tertiary lymphoid structures in EMPM (TLS-EMPM). Cases of EMPM, from 1995 to 2018, were retrieved from 7 French institutions from the RENAPE Network. The predictions in terms of overall survival (OS) and progression-free survival (PFS) of TLS-EMPM were analyzed. We report 52 cases of TLS-EMPM among a series of 138 cases of EMPM. TLS-EMPM was significantly associated with neoadjuvant chemotherapy, and was not a prognostic indicator for OS (
p
= 0.652) and PFS (
p
= 0.804) in our series. TLS is a component of the host immune response to EMPM significantly associated with neoadjuvant chemotherapy, but was not a predictor of prognosis for overall and progression-free survivals in this series. These findings provide another possible etiology for tertiary lymphoid structures.
Background
RAS
mutation status is an important prognostic factor after resection of liver metastases (LiM) from colorectal cancer (CRC). The prognostic significance of
RAS
after resection of lung ...(LuM) and peritoneal (PM) metastases from CRC is unknown.
Methods
Between 2005 and 2014, all consecutive patients with known
RAS
status who underwent potentially curative resection for LiM, LuM, or PM were evaluated.
Results
A total of 720 patients with known
RAS
status underwent resection of LiM (
n
= 468), LuM (
n
= 102), and PM (
n
= 150).
RAS
mutations were identified in 63 and 58% of patients with LuM and PM, respectively, compared with 41% of patients with LiM (
p
< 0.001). Five-year overall survival (OS) after resection of PM was 45%, compared with 52% after resection of LiM (
p
= 0.018) and 64% after resection of LuM (
p
= 0.005).
RAS
mutations were associated with significantly worse OS after resection of LiM (
p
< 0.001), but did not affect OS among patients undergoing resection of LuM (
p
= 0.41) and PM (
p
= 0.65).
Conclusions
RAS
mutations are more prevalent among patients undergoing resection of LuM and PM than LiM but do not affect survival after lung and peritoneal metastasectomy, as they do after hepatectomy. These results suggest that the prognostic significance of
RAS
mutations after resection of metastatic CRC depends on the specific site of metastases.
BACKGROUNDEarly cardiac amyloidosis (CA) diagnosis enables patients to access effective treatments for better long-term outcomes, yet it remains under-recognised, misdiagnosed and inadequately ...managed. AIMTo reduce diagnostic delays, we aimed to describe the epidemiological and clinical characteristics and changes over an 11-year period. METHODSThis was a retrospective, observational cohort study of all patients referred to the Henri-Mondor Hospital for suspected CA. RESULTSOverall, 3194 patients were identified and 3022 were included and analysed. Our patients came from varied ethnic backgrounds, and more than half (55.2%) had confirmed CA. Over 11 years, referrals increased 4.4-fold, mostly from cardiologists. Notably, wild-type transthyretin amyloidosis (ATTRwt) became the predominant diagnosis, with referrals increasing 15-fold from 20 in 2010-2012 to 308 in 2019-2020. The number of amyloid light chain (AL) diagnoses increased, whilst variant transthyretin amyloidosis (ATTRv) numbers remained relatively stable. Concerning disease severity, AL patients presented more frequently with severe cardiac involvement whereas an increasing number of ATTRwt patients presented with National Amyloid Centre stage I (22.0% in 2013-2014 to 45.9% in 2019-2020). Lastly, among patients diagnosed with ATTRv in 2019-2020, 83.9% had ATTR Val122Ile cardiac phenotype. CONCLUSIONSThis study shows that increasing cardiologist awareness and referrals have increased CA diagnoses. With improved awareness and non-invasive diagnostic techniques, more patients with ATTRwt with milder disease and more ATTRv Val122Ile mutations are being referred and diagnosed. Although more AL cases are being recognised, patients are diagnosed with severe cardiac involvement.
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