9 research outputs found
Socioeconomic position and first-time major cardiovascular event in patients with type 2 diabetes:a Danish nationwide cohort study
Impact of socioeconomic position on initiation of SGLT-2 inhibitors or GLP-1 receptor agonists in patients with type 2 diabetes â a Danish nationwide observational study
BACKGROUND: Low socioeconomic position may affect initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucacon-like-peptide-1 receptor agonists (GLP-1RA) among patients with type 2 diabetes (T2D). We examined the association between socioeconomic position and initiation of SGLT-2i or GLP-1RA in patients with T2D at time of first intensification of antidiabetic treatment. METHODS: Through nationwide registers, we identified all Danish patients on metformin who initiated second-line add-on therapy between December 10, 2012, and December 31, 2020. For each time period (2012-2014, 2015-2017, and 2018-2020), we used multivariable multinomial logistic regression to associate disposable income, as proxy for socioeconomic position, with the probability of initiating a specific second-line treatment at time of first intensification. We reported probabilities standardised to the distribution of demographics and comorbidities of patients included in the last period (2018-2020). FINDINGS: We included 48915 patients (median age 62 years; 61¡7% men). In each time period, high-income patients were more often men and had less comorbidities as compared with low income-patients. In each time period, the standardised probability of initiating a SGLT-2i or a GLP-1RA was significantly higher in the highest income group compared with the lowest: 11¡4% vs. 9¡5% (probability ratio [PR] 1¡21, 95 % confidence interval [CI] 1¡01-1¡44) in 2012-2014; 22¡6% vs. 19.6% (PR 1¡15, CI 1¡05-1¡27) in 2015-2017; and 65¡8% vs. 54¡8% (PR 1¡20, CI 1¡16-1¡24) in 2018-2020. The differences by income were consistent across multiple subgroups. INTERPRETATION: Despite a universal healthcare system, low socioeconomic position was consistently associated with a lower probability of initiating a SGLT-2i or a GLP-1RA. These disparities may widen the future socioeconomic gap in cardiovascular outcomes. FUNDING: The work was funded by unrestricted grants from âRegion Sjaelland Den Sundhedsvidenskabelige Forskningsfondâ and âMurermester Lauritz Peter Christensen og hustru Kirsten Sigrid Christensens Fondâ
MR-proADM as a Prognostic Marker in Patients With ST-Segment-Elevation Myocardial Infarction - DANAMI-3 (a Danish Study of Optimal Acute Treatment of Patients With STEMI) Substudy
Background
Midregional proadrenomedullin (
MR
âpro
ADM
) has demonstrated prognostic potential after myocardial infarction (
MI
). Yet, the prognostic value of
MR
âpro
ADM
at admission has not been examined in patients with STâsegmentâelevation
MI
(
STEMI
).
Methods and Results
The aim of this substudy, DANAMIâ3 (The Danish Study of Optimal Acute Treatment of Patients with
ST
âsegmentâelevation myocardial infarction), was to examine the associations of admission concentrations of
MR
âpro
ADM
with shortâ and longâterm mortality and hospital admission for heart failure in patients with
ST
âsegmentâelevation myocardial infarction. Outcomes were assessed using Cox proportional hazard models and area under the curve using receiver operating characteristics. In total, 1122 patients were included. The median concentration of
MR
âpro
ADM
was 0.64Â nmol/L (25thâ75th percentiles, 0.53â0.79). Within 30Â days 23 patients (2.0%) died and during a 3âyear followâup 80 (7.1%) died and 38 (3.4%) were admitted for heart failure. A doubling of
MR
âpro
ADM
was, in adjusted models, associated with an increased risk of 30âday mortality (hazard ratio, 2.67; 95% confidence interval, 1.01â7.11;
P
=0.049), longâterm mortality (hazard ratio, 3.23; 95% confidence interval, 1.97â5.29;
P
<0.0001), and heart failure (hazard ratio, 2.71; 95% confidence interval, 1.32â5.58;
P
=0.007). For 30âday and 3âyear mortality, the area under the curve for
MR
âpro
ADM
was 0.77 and 0.78, respectively. For 3âyear mortality, area under the curve (0.84) of the adjusted model marginally changed (0.85;
P
=0.02) after addition of
MR
âpro
ADM
.
Conclusions
Elevation of admission
MR
âpro
ADM
was associated with longâterm mortality and heart failure, whereas the association with shortâterm mortality was borderline significant.
MR
âpro
ADM
may be a marker of prognosis after STâsegmentâelevation myocardial infarction but does not seem to add substantial prognostic information to established clinical models.
Clinical Trial Registration
URL
:
http:/www.ClinicalTrials.gov
/. Unique identifiers:
NCT
01435408 and
NCT
01960933.
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Initiation of SGLT2 inhibitors and GLP-1 receptor agonists according to level of frailty in people with type 2 diabetes and cardiovascular disease in Denmark: a cross-sectional, nationwide study
Background:
Whether frailty influences the initiation of two cardioprotective diabetes drug therapies (ie, SGLT2 inhibitors and GLP-1 receptor agonists) in people with type 2 diabetes and cardiovascular disease is unknown. We aimed to assess rates of initiation of SGLT2 inhibitors and GLP-1 receptor agonists according to frailty in people with type 2 diabetes and cardiovascular disease.
Methods:
For this cross-sectional, nationwide study, all people with type 2 diabetes and cardiovascular disease in Denmark between Jan 1, 2015, and Dec 31, 2021, from six Danish health-data registers were identified. People younger than 40 years, with end-stage renal disease, with registered contraindications to SGLT2 inhibitors or GLP-1 receptor agonists, or with previous use of either drug therapy were excluded. The Hospital Frailty Risk Score was used to categorise people as either non-frail, moderately frail, or severely frail. Cox proportional hazards models were used to analyse the association between frailty and initiation of an SGLT2 inhibitor or a GLP-1 receptor agonist.
Findings:
Of 119â390 people with type 2 diabetes and cardiovascular disease, 103â790 were included. Median follow-up time was 4¡5 years (IQR 2¡7â6¡1) and median age across the three frailty groups was 71 years (64â79). 65 959 (63¡6%) of 103â790 people were male and 37â831 (36¡5%) were female. At index date, 66â910 (64¡5%) people were non-frail, 29â250 (28¡2%) were moderately frail, and 7630 (7¡4%) were severely frail. Frailty was associated with a significantly lower probability of initiating therapy with an SGLT2 inhibitor or a GLP-1 receptor agonist than in people who were non-frail (moderately frail hazard ratio 0¡91, 95% CI 0¡88â0¡94, p<0¡0001; severely frail 0¡75, 0¡70â0¡80, p<0¡0001). This association persisted after adjustment for age, sex, socioeconomic status, year of inclusion, duration of type 2 diabetes, duration of cardiovascular disease, polypharmacy, and comorbidity.
Interpretation:
In people with type 2 diabetes and cardiovascular disease in Denmark, frailty was associated with a significantly lower probability of SGLT2-inhibitor or GLP-1 receptor-agonist initiation, despite their benefits. Formulating clear and updated guidelines on the use of SGLT2 inhibitors and GLP-1 receptor agonists in people who are frail with type 2 diabetes and cardiovascular disease should be a priority.
Funding: Department of Cardiology, Herlev and Gentofte University Hospital.
Translation: For the Danish translation of the abstract see Supplementary Materials section
Risk of first-time major cardiovascular event among individuals with newly diagnosed type 2 diabetes:data from Danish registers
Frailty, Treatments, and Outcomes in Older Patients With Myocardial Infarction: A Nationwide RegistryâBased Study
Background Guidelines recommend that patients with myocardial infarction (MI) receive equal care regardless of age. However, withholding treatment may be justified in elderly and frail patients. This study aimed to investigate trends in treatments and outcomes of older patients with MI according to frailty. Methods and Results All patients aged âĽ75âyears with firstâtime MI during 2002 to 2021 were identified through Danish nationwide registries. Frailty was categorized using the Hospital Frailty Risk Score. Oneâyear risk and hazard ratios (HRs) for days 0 to 28 and 29 to 365 were calculated for allâcause death. A total of 51â022 patients with MI were included (median, 82âyears; 50.2% women). Intermediate/high frailty increased from 26.7% in 2002 to 2006 to 37.1% in 2017 to 2021. Use of treatment increased substantially regardless of frailty: for example, 28.1% to 48.0% (statins), 21.8% to 33.7% (dual antiplatelet therapy), and 7.6% to 28.0% (percutaneous coronary intervention) for high frailty (all Pâtrend <0.001). Oneâyear death decreased for low frailty (35.1%â17.9%), intermediate frailty (49.8%â31.0%), and high frailty (62.8%â45.6%), all Pâtrend <0.001. Ageâ and sexâadjusted 29â to 365âday HRs (2017â2021 versus 2002â2006) were 0.53 (0.48â0.59), 0.62 (0.55â0.70), and 0.62 (0.46â0.83) for low, intermediate, and high frailty, respectively (Pâinteraction=0.23). When additionally adjusted for treatment, HRs attenuated to 0.74 (0.67â0.83), 0.83 (0.74â0.94), and 0.78 (0.58â1.05), respectively, indicating that increased use of treatment may account partially for the observed improvements. Conclusions Use of guidelineâbased treatments and outcomes improved concomitantly in older patients with MI, irrespective of frailty. These results indicate that guidelineâbased management of MI may be reasonable in the elderly and frail
Frailty and Recurrent Hospitalization After Transcatheter Aortic Valve Replacement
Background For frail patients with limited life expectancy, time in hospital following transcatheter aortic valve replacement is an important measure of quality of life; however, data remain scarce. Thus, we aimed to investigate frailty and its relation to time in hospital during the first year after transcatheter aortic valve replacement. Methods and Results From 2008 to 2020, all Danish patients who underwent transcatheter aortic valve replacement and were alive at discharge were included. Using the validated Hospital Frailty Risk Score, patients were categorized in the low, intermediate, and high frailty groups. Time in hospital and mortality up to 1âyear are reported according to frailty groups. In total, 3437 (57.6%), 2277 (38.1%), and 257 (4.3%) were categorized in the low, intermediate, and high frailty groups, respectively. Median age was â81âyears. Female sex and comorbidity burden were incrementally higher across frailty groups (low frailty: heart failure, 24.1%; stroke, 7.2%; and chronic kidney disease, 4.5%; versus high frailty: heart failure, 42.8%; stroke, 34.2%; and chronic kidney disease, 29.2%). In the low frailty group, 50.5% survived 1âyear without a hospital admission, 10.8% were hospitalized >15âdays, and 5.8% of patients died. By contrast, 26.1% of patients in the high frailty group survived 1âyear without a hospital admission, 26.4% were hospitalized >15âdays, and 15.6% died within 1âyear. Differences persisted in models adjusted for sex, age, frailty, and comorbidity burden (excluding overlapping comorbidities). Conclusions Among patients undergoing transcatheter aortic valve replacement, frailty is strongly associated with time in hospital and mortality. Prevention strategies for frail patients to reduce hospitalization burden could be beneficial