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This cohort study assesses the interventions and patient factors associated with emergency department return following an initial emergency department visit for hidradenitis suppurativa.
This cohort study compares oxaliplatin delivery between MOSAIC trial participants and patients treated in the US Oncology Network with stage III colon cancer using a longitudinal cumulative dose.
Appello da 4 campionesse per praticarlo anche nella terza e quarta età
Sono rivolte alla medicina territoriale e ospedaliera per favorire un uso ottimale degli antibiotici
Sono rivolte alla medicina territoriale e ospedaliera per favorire un uso ottimale degli antibiotici
Sono rivolte alla medicina territoriale e ospedaliera per favorire un uso ottimale degli antibiotici
This study assesses temporal trends of biomarkers among adult nicotine and nonnicotine e-cigarette users and cigarette smokers.
This study examines whether reducing oxygen fraction following resuscitation from out-of-hospital cardiac arrest improves survival at hospital discharge.
Potenziale cura per cardiomiopatia amiloide da transtiretina
Circulation, Ahead of Print. Background:Long term outcomes of antiplatelet monotherapy in patients who receive percutaneous coronary intervention (PCI) are unknown. The HOST-EXAM Extended study reports the post-trial follow-up results of the original HOST-EXAM trial.Methods:From March 2014 through May 2018, 5438 patients who maintained dual antiplatelet therapy without clinical events for 12±6 months after PCI with drug-eluting stents (DES) were randomly assigned in a 1:1 ratio to receive clopidogrel 75mg once daily or aspirin 100mg once daily. The primary endpoint (a composite of all-cause death, nonfatal myocardial infarction (MI), stroke, readmission due to acute coronary syndrome (ACS), and BARC type ≥3 bleeding), secondary thrombotic endpoint (cardiac death, non-fatal MI, ischemic stroke, readmission due to ACS, and definite or probable stent thrombosis), bleeding endpoint (BARC type ≥2 bleeding) were analyzed during the extended follow-up period. Analysis was performed on the per-protocol population (2431 patients in the clopidogrel group and 2286 patients in the aspirin group).Results:During median follow-up of 5.8 years (interquartile range, 4.8 and 6.2 years), the primary endpoint occurred in 12.8% and 16.9% in the clopidogrel and aspirin groups, respectively (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.63 to 0.86, p
This randomized noninferiority trial establishes the effectiveness and tolerability of theta burst stimulation compared with standard repetitive transcranial magnetic stimulation in older adults with treatment-resistant depression.
This randomized clinical trial examines 5-year outcomes and prognostic factors for overall survival for treatment with modified FOLFIRINOX for patients with pancreatic ductal adenocarcinoma.
This randomized clinical trial compares the short-term efficacy of laparoscopic surgery vs open surgery for treatment of low rectal cancer.
Circulation, Volume 146, Issue Suppl_1, Page A10931-A10931, November 8, 2022. Background:Type of atrial fibrillation (AF) (paroxysmal or non-paroxysmal) is important for determining the therapeutic management. However, prognostic impact of AF type on incidence of cardiovascular events remains uncertain.Methods:We investigated patients with AF who were selected from an observational, multicenter, prospective registry (RAFFINE) comprising 4 university hospitals and 50 general hospital / clinics in Japan between 2013 and 2015. In this subanalysis of the RAFFINE trial, patients were divided into 2 groups according to their AF pattern at the time of enrollment. The primary outcome was composite of all-cause death, ischemic stroke, and heart failure related hospitalization.Results:Among 3,845 patients, 1,472 (38.3%) and 2,373 (61.7%) were paroxysmal and non-paroxysmal AF, respectively. Patients with non-paroxysmal AF were older, higher CHADS2score and had higher prevalence of comorbidities compared with those with paroxysmal AF. During a median follow-up of 3.7 years, 681 (17.7%) primary endpoints were identified. Cumulative incidences of primary endpoint were significantly higher in non-paroxysmal AF group (log-rank p
Circulation, Volume 146, Issue Suppl_1, Page A13987-A13987, November 8, 2022. Background:Several studies have shown the cost-effectiveness of direct oral anticoagulants (DOACs), compared with warfarin, to prevent atrial fibrillation (AF) related complications. However, few have reported cost-effectiveness of DOACs in AF patients with intermediate stroke risk. Thus, we investigated the cost-effectiveness of DOACs vs. warfarin in non-valvular AF patients with intermediate stroke risk using national representative data.Methods:We identified 7,954 newly diagnosed non-valvular AF patients (≥18 years) with intermediate stroke risk (CHA2DS2-VASc score: 1 for men and 2 for women) using the national healthcare utilization data from August 1, 2016, to July 31, 2019. Annual incidence rate of AF-related composite outcomes (heat failure, myocardial infarction, ischemic stroke, intracerebral hemorrhage, and gastrointestinal bleeding) was estimated. Cost-effectiveness was estimated using a Markov chain model with the transition probability of 1 year. The willingness-to-pay (WTP) was set at $32,000 per quality-adjusted life-year (QALY) gained.Results:The total cost of warfarin, rivaroxaban, apixaban, dabigatran and edoxaban was $2,874, $5,761, $5,151, $5,761 and $5,851, respectively. The QALYs gained were 10.83, 10.95, 11.10, 10.49 and 10.99 years, respectively. The incremental cost-effectiveness ratio of rivaroxaban, apixaban, dabigatran and edoxaban was $29,743.99, $8,426.71, -$8,483.04 and $18,483.55, respectively. The WTP was set at $32,000. DOACs (except dabigatran) were more cost-effective compared with warfarin because they did not exceed the WTP in the base-case analysis.Conclusion:Our findings showed that DOACs were more cost-effective than warfarin in non-valvular AF patients with intermediate stroke risk.Figure 1. Cost-effectiveness acceptability curve of Warfarin vs. DOACs in AF patients with intermediate stroke risk.
Circulation, Volume 146, Issue Suppl_1, Page A15873-A15873, November 8, 2022. Introduction:Takotsubo Syndrome (TTS), also known as stress-induced cardiomyopathy can be primary/idiopathic or secondary to physical stressor including acute illness. There is limited data on cardiovascular outcomes among primary TTS (pTTS) and secondary (sTTS).Methods:The National Inpatient Sample from the year 2016 to 2019 was queried to assess outcomes in pTTS and sTTS. The primary outcome was all-cause mortality, and secondary outcomes were acute kidney injury (AKI) heart failure (HF), stroke, cardiogenic shock (CS), and sudden cardiac arrest (SCA).We did trend analysis of outcomes, length of stay (LOS) and inflation adjusted hospital charges. The primary analysis used was pearson chi-Square, linear regression, and multivariate matching using STATA 17MP.Results:A total of 158,715 patients (pTTS n= 57,560 (38%); sTTS n= 101,155 (62%)). The cohorts were female predominant. On univariate and chi-square linear regression, we found higher odds and incidence of all-cause mortality, AKI, heart failure, and stroke in sTTS as compared to pTTS. After matching for confounding variables, all-cause mortality (OR 1.3; CI 1.1 – 1.56; p < 0.001), and AKI (OR 1.10; CI 1.03 - 1.03; p < 0.001) was still high in sTTS, but interestingly HF (OR 0.93; CI 0.88 - 0.99 ; p = 0.023), stroke (aOR 0.50; CI 0.43-0.59; p < 0.001), and MCS (aOR 0.61; CI 0.47-0.79; p < 0.001) were lower in sTTS as compared to pTTS. There was no difference in CS and SCA between pTTS and sTTS. Self-pay and prior CABG were most predictive of mortality for sTTS. Yearly trend analysis showed an uptrend for all non-HF outcomes in both pTTS and sTTS, a stable trend for HF, while trends showed higher incidence of CS in sTTS as compared to pTTS. Mean LOS and inflation adjusted hospital charges were higher in sTTS compared to pTTS.Conclusions:sTTS have worse cardiovascular outcomes as compared to pTTS and associated with higher inflation adjusted hospital charges and length of stay likely due to critical underlying primary illness.
