Building a tuberculosis-free world: The Lancet Commission on tuberculosis

___Key messages___ The Commission recommends five priority investments to achieve a tuberculosis-free world within a generation. These investments are designed to fulfil the mandate of the UN High Level Meeting on tuberculosis. In addition, they answer

Increased mortality and hospital readmission risk in patients with dementia and a history of cardiovascular disease : results from a nationwide registry linkage study

Objective: To evaluate the impact of cardiovascular disease (CVD) on mortality and readmission risk in patients with dementia. Methods: Prospective hospital-based cohort of 59 194 patients with dementia admitted to hospital or visiting a day-clinic between 2000 and 2010. Patients were divided in those with and without a history of CVD (ie, previous admission for CVD; coronary heart disease, heart failure, stroke, atrial fibrillation, or other CVD). Absolute mortality risks (ARs), median survival times, and hazard ratios (adjusted for age, sex, and comorbidity) were calculated. Results: Three-year ARs and HRs were higher, and survival times were shorter among patients visiting a day-clinic with a history of CVD than in those without. The differences were less pronounced for inpatients. Readmission risk was further increased in the presence of CVD in both day clinic and inpatients. Conclusion: Clinicians need to be more aware of worse prognosis of the population with CVD and dementia

Evaluation of Underlying Causes of Death in Patients with Dementia to Support Targeted Advance Care Planning

Background: Insight in causes of death in demented patients may help physicians in end-of-life care. Objectives: To investigate underlying causes of death (UCD) in demented patients stratified by age, sex, dementia subtype [Alzheimer's disease (AD), vascular dementia (VaD)] and to compare them with UCD in the general population (GP). Methods: A nationwide cohort of 59,201 patients with dementia (admitted to a hospital or visiting a day clinic) was constructed [38.7 men, 81.4 years (SD 7.0)] from 2000 through 2010. UCDs were reported and compared to the GP by calculating relative risks (RRs). Results: During follow up [median follow up time 1.3 years (IQR 0.3- 3.0)], 64.2 of women and 69.3 of men died. Leading UCDs were dementia (17.5 in men and 23.7 in women) and cardiovascular disease (CVD) (18.7 and 19.2, respectively). When compared to the GP, dementia was a more common UCD (RR in men 4.65, 95 CI 4.43-4.88), while CVD (RR in men 0.67, 95 CI 0.65-0.68) and cancer (RR 0.40, 95 CI 0.39-0.41) were less common. These differences were more pronounced in patients aged between 60-69 as compared to those aged≥90 years. Patients with AD died less often of cerebrovascular diseases as compared to VaD (RR in men 0.53, 95 CI 0.47-0.59). Conclusion: UCDs in patients with dementia differs from that of the GP, as dementia is more often and cancer less often an UCD. Although less frequent compared to the GP, CVD also is one of the leading UCDs in patients with dementia. This information is valuable for targeted advance care planning

Increased mortality and hospital readmission risk in patients with dementia and a history of cardiovascular disease: Results from a nationwide registry linkage study

Objective: To evaluate the impact of cardiovascular disease (CVD) on mortality and readmission risk in patients with dementia. Methods: Prospective hospital-based cohort of 59 194 patients with dementia admitted to hospital or visiting a day-clinic between 2000 and 2010. Patients were divided in those with and without a history of CVD (ie, previous admission for CVD; coronary heart disease, heart failure, stroke, atrial fibrillation, or other CVD). Absolute mortality risks (ARs), median survival times, and hazard ratios (adjusted for age, sex, and comorbidity) were calculated. Results: Three-year ARs and HRs were higher, and survival times were shorter among patients visiting a day-clinic with a history of CVD than in those without. The differences were less pronounced for inpatients. Readmission risk was further increased in the presence of CVD in both day clinic and inpatients. Conclusion: Clinicians need to be more aware of worse prognosis of the population with CVD and dementia

Decline in mortality in patients with dementia : Results from a nationwide cohort of 44 258 patients in the Netherlands during 2000 to 2008

Objective: To investigate whether mortality and readmission risk have changed over the last decade. Methods: Prospective hospital-based cohort of 44 258 patients with dementia admitted to hospital or visiting a day clinic between 2000 and 2008. Absolute risks (ARs) of 1- and 3-year mortality and 1-year hospital readmission were quantified and stratified by type of care (day clinic or inpatient care). Cox models were used to compare hazard ratios (HRs), adjusted for age, sex, comorbidity, of death, and readmission across the years using 2000 as the reference group. Results: One-year mortality declined among men visiting a day clinic (AR in 2008 versus 2000: 13.0%, 29.9%; HR 0.41, 95% CI, 0.30-0.55). Among inpatients, these ARs were 48.7%, 53.0% (HR 0.85, 95% CI, 0.77-0.94). Three-year mortality also declined (AR for men visiting a day clinic: 37.5%, 58.4%, HR 0.53, 95% CI, 0.43-0.64; for inpatients: 74.4%, 78.9%, HR 0.80, 95% CI, 0.73-0.88). Whereas 1-year readmission risk decreased among men visiting a day clinic (AR 44.1%, 65.9%, HR 0.52, 95% CI, 0.43-0.63), the risk increased among inpatients (AR 36.9%, 27.6%, HR 1.48, 95% CI, 1.28-1.72). Conclusion: One- and 3-year mortality remarkably declined. One-year hospital readmission risk increased among inpatients and decreased among patients visiting a day clinic. The results should raise awareness for the increased survival with dementia, as this has direct consequences for patients and (in)formal caregivers, and probably also for health care costs

Increased mortality and hospital readmission risk in patients with dementia and a history of cardiovascular disease : results from a nationwide registry linkage study

Objective: To evaluate the impact of cardiovascular disease (CVD) on mortality and readmission risk in patients with dementia. Methods: Prospective hospital-based cohort of 59 194 patients with dementia admitted to hospital or visiting a day-clinic between 2000 and 2010. Patients were divided in those with and without a history of CVD (ie, previous admission for CVD; coronary heart disease, heart failure, stroke, atrial fibrillation, or other CVD). Absolute mortality risks (ARs), median survival times, and hazard ratios (adjusted for age, sex, and comorbidity) were calculated. Results: Three-year ARs and HRs were higher, and survival times were shorter among patients visiting a day-clinic with a history of CVD than in those without. The differences were less pronounced for inpatients. Readmission risk was further increased in the presence of CVD in both day clinic and inpatients. Conclusion: Clinicians need to be more aware of worse prognosis of the population with CVD and dementia

Socioeconomic Disparities and Mortality after a Diagnosis of Dementia: Results from a Nationwide Registry Linkage Study

Low socioeconomic status (SES) has been linked to a higher incidence of dementia. Less is known about the association between SES and mortality in persons with dementia. We studied this association in a prospective cohort of 15,558 patients in the Netherlands between 2000 and 2010. SES was measured using disposable household income and divided in tertiles. Overall, there was a negative relationship between SES and mortality in both sexes and both settings of care. For men who visited a day clinic, the 5-year mortality rate was 74% among those in the lowest tertile of SES and 57% among those in the highest; for women, the rates were 60% and 50%, respectively. The differences in median survival times between persons in the lower and upper tertiles of SES were 260 days for men and 300 days for women. For men who were admitted to the hospital, the 5-year mortality rate was 89% among those in the lowest tertile of SES and 86% among those in the highest; for women, the rates were 83% and 77%, respectively. The differences in median survival times between persons in the lower and upper tertiles of SES were 80 days for men and 130 days for women. Among patients who visited a day clinic, for patients in the lowest tertile of SES versus those in the highest, the adjusted hazard ratio was 1.41 (95% confidence interval: 1.26, 1.57); for those admitted to the hospital, it was 1.14 (95% confidence interval: 1.07, 1.20). In summary, lower SES was associated with a higher mortality risk in both men and women with dementia. The results of the present study should raise awareness in clinicians and caregivers about the unfavorable prognosis in the most deprived patients

Prognosis of patients with dementia : Results from a prospective nationwide registry linkage study in the Netherlands

OBJECTIVE: To report mortality risks of dementia based on national hospital registry data, and to put these risks into perspective by comparing them with those in the general population and following cardiovascular diseases. DESIGN: Prospective cohort study from 1 January 2000 through 31 December 2010. SETTING: Hospital-based cohort. PARTICIPANTS: A nationwide hospital-based cohort of 59 201 patients with clinical diagnosis of dementia (admitted to a hospital or visiting a day clinic) was constructed (38.7% men, 81.4 years (SD 7.0)). MAIN OUTCOMES AND MEASURES: 1-year and 5-year age-specific and sex-specific mortality risks were reported for patients with dementia visiting a day clinic compared with the general population; for patients hospitalised with dementia compared with patients hospitalised for acute myocardial infarction (AMI), heart failure or stroke, these were presented as absolute and relative risks (RRs). RESULTS: 1-year mortality was 38.3% in men and 30.5% in women. 5-year risk was 65.4% and 58.5%, respectively. Mortality risks were significantly higher in patients with dementia admitted to the hospital than in those visiting a day clinic (1-year RR 3.29, 95% CI 3.16 to 3.42; and 5-year RR 1.79, 95% CI 1.76 to 1.83). Compared with the general population, mortality risks were significantly higher among patients visiting a day clinic (1-year RR for women 2.99, 95% CI 2.84 to 3.14; and for men 3.94, 95% CI 3.74 to 4.16). 5-year RRs were somewhat lower, but still significant. Results were more pronounced at younger ages. Mortality risks among admitted patients were comparable or even exceeded those of cardiovascular diseases (1-year RR for women with dementia vs AMI 1.24, 95% CI 1.19 to 1.29; vs heart failure 1.05, 95% CI 1.02 to 1.08; vs stroke 1.07, 95% CI 1.04 to 1.10). 5-year RRs were comparable. For men, RRs were slightly higher. CONCLUSIONS: Dementia has a poor prognosis as compared with other diseases and the general population. The risks among admitted patients even exceeded those following cardiovascular diseases

Effect of Vascular Risk Factors and Diseases on Mortality in Individuals with Dementia : A Systematic Review and Meta-Analysis

Objectives To assess the effect of cardiovascular diseases and risk factors on mortality in individuals with dementia. Design Systematic review and meta-analysis. English- and Dutch-language studies in PubMed, EMBASE, and PsycINFO databases were searched in April 2014 with hand-searching of in-text citations and no publication limitations. Inclusion criteria were original studies reporting on cardiovascular risk factors or diseases and their relationship with survival in individuals with dementia. The Quality In Prognosis Studies tool was used to appraise all included articles. Setting Population-, hospital-, and nursing home-based. Participants Community-dwelling, hospitalized individuals and nursing home residents with dementia. Measurements A random-effects meta-analysis was performed to investigate the effect of several cardiovascular diseases and risk factors on overall mortality. Results Twelve studies with 235,865 participants were included. In pooled analyses, male sex (hazard ratio (HR) = 1.67, 95% confidence interval (CI) = 1.56-1.78), diabetes mellitus (DM) (HR = 1.49, 95% CI = 1.33-1.68), smoking (ever vs never) (HR = 1.37, 95% CI = 1.17-1.61), coronary heart disease (CHD) (HR = 1.21, 95% CI = 1.02-1.44) and congestive heart failure (CHF) (HR = 1.37, 95% CI = 1.18-1.59) were associated with mortality. Stroke, high blood pressure, being overweight, and hypercholesterolemia were not statistically significantly related to mortality. Conclusion Individuals with dementia and DM, smoking, CHD, and CHF have a greater risk of death than individuals with dementia without these risk factors or diseases