138 research outputs found
Time in therapeutic range and risk of thromboembolism and bleeding in patients with a mechanical heart valve prosthesis
Return to the workforce following first hospitalization for heart failure: a Danish nationwide cohort study
Background: Return to work is important financially, as a marker of functional status and for self-esteem in patients developing chronic illness. We examined return to work after first heart failure (HF) hospitalization.
Methods: By individual-level linkage of nationwide Danish registries, we identified 21455 patients of working age (18-60 years) with a first HF hospitalization in the period of 1997-2012. Of these 11880 (55%) were in the workforce prior to HF hospitalization and comprised the study population. We applied logistic regression to estimate odds ratios (OR) for associations between age, sex, length of hospital stay, level of education, income, comorbidity and return to work.
Results: One year after first HF hospitalization, 8040 (67.7%) returned to the workforce, 2981 (25.1%) did not, 805 (6.7%) died and 54 (0.5%) emigrated. Predictors of return to work included younger age (18-30 vs. 51-60 years, OR 3.12; 95% CI 2.42-4.03), male sex (OR 1.22 [1.18-1.34]) and level of education (long-higher vs. basic school OR 2.06 [1.63-2.60]). Conversely, hospital stay >7 days (OR 0.56 [0.51-0.62]) and comorbidity including history of stroke (OR 0.55 [0.45-0.69]), chronic kidney disease (OR 0.46 [0.36-0.59]), chronic obstructive pulmonary disease (OR 0.62 [0.52-0.75]), diabetes (OR 0.76 [0.68-0.85]) and cancer (OR 0.49 [0.40-0.61]) were all significantly associated with lower chance of return to work.
Conclusions: Patients in the workforce prior to HF hospitalization had low mortality but high risk of detachment from the workforce one year later. Young age, male sex, and higher level of education were predictors of return to work
Low immediate scientific yield of the PhD among medical doctors
BACKGROUND: We studied the scientific yield of the medical PhD program at all Danish Universities. METHODS: We undertook a retrospective observational study. Three PhD schools in Denmark were included in order to evaluate the postdoctoral research production over more than 18Â years through individual publications accessed by PubMed. RESULTS: A total of 2686 PhD-graduates (1995â2013) with a medical background were included according to registries from all PhD schools in Denmark. They had a median age of 35Â years (interquartile range (IQR), 32â38) and 53Â % were women at the time of graduation. Scientific activity over time was assessed independently of author-rank and inactivity was measured relative to the date of graduation. Factors associated with inactivity were identified using multivariable logistic regression. 88.6Â % of the PhD theses were conducted in internal medicine vs. 11.4Â % in surgery. During follow-up (median 6.9Â years, IQR 3.0â11.7), PubMed data searches identified that 87 (3.4Â %) of the PhD graduates had no publication after they graduated from the PhD program, 40Â % had 5 or less, and 90Â % had 30 or less. The median number of publications per year after PhD graduation was 1.12 (IQR 0.61â1.99) papers per year. About 2/3 of the graduates became inactive after 1Â year and approximately 21Â % of the graduates remained active during the whole follow-up. Female gender was associated with inactivity: adjusted odds ratio 1.59 (95Â % confidence interval 1.24â2.05). CONCLUSIONS: The scientific production of Danish medic PhD-graduates was mainly produced around the time of PhD-graduation. After obtaining the PhD-degree the scientific production declines suggesting that scientific advance fails and resources are not harnessed
LONG-TERM SAFETY OF ANTITHROMBOTIC THERAPY IN NON-ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION PATIENTS WITH ATRIAL FIBRILLATION
Stroke and recurrent haemorrhage associated with antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation:nationwide cohort study
Study question What are the risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding associated with restarting antithrombotic treatment after gastrointestinal bleeding in patients with atrial fibrillation? Methods This Danish cohort study (1996-2012) included all patients with atrial fibrillation discharged from hospital after gastrointestinal bleeding while receiving antithrombotic treatment. Restarted treatment regimens were single or combined antithrombotic drugs with oral anticoagulation and antiplatelets. Follow-up started 90 days after discharge to avoid confounding from use of previously prescribed drugs on discharge. Risks of all cause mortality, thromboembolism, major bleeding, and recurrent gastrointestinal bleeding were estimated with competing risks models and time dependent multiple Cox regression models. Study answer and limitations 4602 patients (mean age 78 years) were included. Within two years, 39.9% (95% confidence interval 38.4% to 41.3%, n=1745) of the patients had died, 12.0% (11.0% to 13.0%, n=526) had experienced thromboembolism, 17.7% (16.5% to 18.8%, n=788) major bleeding, and 12.1% (11.1% to 13.1%, n=546) recurrent gastrointestinal bleeding. 27.1% (n=924) of patients did not resume antithrombotic treatment. Compared with non-resumption of treatment, a reduced risk of all cause mortality was found in association with restart of oral anticoagulation (hazard ratio 0.39, 95% confidence interval 0.34 to 0.46), an antiplatelet agent (0.76, 0.68 to 0.86), and oral anticoagulation plus an antiplatelet agent (0.41, 0.32 to 0.52), and a reduced risk of thromboembolism was found in association with restart of oral anticoagulation (0.41, 0.31 to 0.54), an antiplatelet agent (0.76, 0.61 to 0.95), and oral anticoagulation plus an antiplatelet agent (0.54, 0.36 to 0.82). Restarting oral anticoagulation alone was the only regimen with an increased risk of major bleeding (1.37, 1.06 to 1.77) compared with non-resumption of treatment; however, the difference in risk of recurrent gastrointestinal bleeding was not significant between patients who restarted an antithrombotic treatment regimen and those who did not resume treatment. What this study adds Among patients with atrial fibrillation who experience gastrointestinal bleeding while receiving antithrombotic treatment; subsequent restart of oral anticoagulation alone was associated with better outcomes for all cause mortality and thromboembolism compared with patients who did not resume treatment. This was despite an increased longitudinal associated risk of bleeding. Funding, competing interests, data sharing This study was supported by a grant from Boehringer-Ingelheim. Competing interests are available in the full paper on bmj.com. The authors have no additional data to share
Initiation of domiciliary care and nursing home admission following first hospitalization of heart failure patients:A nationwide cohort study
Background: Heart failure (HF) has a major impact on a patientâs quality of life and functional
status. This impact may be sufficiently profound to prevent independent living although how
often this is the case is unknown. We examined the need for domiciliary assistance and admission
to a nursing home following first HF hospitalization.
Methods: In nationwide Danish registries, we identified a cohort of patients discharged alive
after a first-time HF hospitalization in the period 2008â2014 who were matched 1:5 with comparison
subjects based on age and sex and followed for 5 years.
Results: We included 37,547 patients (69% men) discharged after a first-time HF-hospitalization
and 187,735 comparison subjects. The 5-year incidence of initiation of domiciliary care was
24.1% [23.7%â24.6%] among HF patients and 9.2% [9.1%â9.4%] among the comparison
cohort and yielded a corresponding adjusted HR of 2.02 [1.96â2.09]. Covariates associated with
initiation of domiciliary support included older age (HR 1.08 [1.07â1.08] per 1 year increase
in age), living alone (HR 2.09 [2.04â2.15]) and comorbidities. The 5-year incidence of nursing
home admission was 3.9% [3.7%â4.0%] among HF patients and 1.7% [1.7%â1.8%] among the
comparison cohort and this resulted in an adjusted HR of 1.91 [1.77â2.06]. Covariates associated
with nursing home admission included older age (HR 1.10 [1.10â1.11]), living alone (HR
2.15 [2.02â2.28]) and history of stroke (HR 2.71 [2.53â2.90]).
Conclusion: Hospitalization for HF is associated with increased need for domiciliary support
and nursing home admissions. Older age, living alone, and comorbidities were associated with
higher risk of both outcomes
Ischemic Stroke Severity and Mortality in Patients With and Without Atrial Fibrillation
Background Our objective was to investigate stroke severity and subsequent rate of mortality among patients with and without atrial fibrillation (AF). Contemporary data on stroke severity and prognosis in patients with AF are lacking. Methods and Results Firstâtime ischemic stroke patients from the Danish Stroke Registry (January 2005âDecember 2016) were included in an observational study. Patients with AF were matched 1:1 by sex, age, calendar year, and CHA2DS2âVASc score with patients without AF. Stroke severity was determined by the Scandinavian Stroke Scale (0â58 points). The rate of death was estimated by KaplanâMeier plots and multivariable Cox regression. Among 86Â 458 identified patients with stroke, 17Â 205 had AF. After matching, 14Â 662 patients with AF and 14Â 662 patients without AF were included (51.8% women; median age, 79.6Â years [25thâ75th percentile, 71.8â86.0]). More patients with AF had very severe stroke (0â14 points) than patients without AF (13.7% versus 7.9%, P<0.01). The absolute rates of 30âday and 1âyear mortality were significantly higher for patients with AF (12.1% and 28.4%, respectively) versus patients without AF (8.7% and 21.8%, respectively). This held true in adjusted models for 30âday mortality (hazard ratio [HR], 1.40 [95% CI, 1.30â1.51]). However, this association became nonsignificant when additionally adjusting for stroke severity (HR, 1.10 [95% CI, 1.00â1.23]). AF was associated with a higher rate of 1âyear mortality (HR, 1.39 [95% CI, 1.32â1.46]), although it was mediated by stroke severity (HR, 1.15 [95% CI, 1.09â1.23], model including stroke severity). Conclusions In a contemporary nationwide cohort of patients with ischemic stroke, patients with AF had more severe strokes and higher mortality than patients without AF. The difference in mortality was mainly driven by stroke severity
Temporal trends in utilization of transcatheter aortic valve replacement and patient characteristics:A nationwide study
Nursing Home Admission and Initiation of Domiciliary Care After Ischemic Stroke - The Importance of Time to Thrombolysis
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