201 research outputs found
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
Microvascular complications in diabetes patients with heart failure and reduced ejection fraction-insights from the Beta-blocker Evaluation of Survival Trial
Aims:
The role of microvascular complications in the risk conferred by diabetes in heart failure with reduced ejection fraction (HFrEF) is unknown.
Methods and results:
We studied 2707 HFrEF patients in the Betaâblocker Evaluation of Survival Trial (BEST), stratified into three groups: no diabetes and diabetes without or with microvascular complications (neuropathy, nephropathy, or retinopathy). The risks of the composite of cardiovascular death or heart failure hospitalization, and allâcause death, were studied using Cox regression analyses adjusted for other prognostic variables. Overall, 964 (36%) patients had diabetes, of which 313 (32%) had microvascular complications. Patients with microvascular complications had more severe symptoms (New York Heart Association class IV 12% vs. 9% diabetes with no complications and 7% no diabetes), and worse quality of life (Minnesota Living with Heart Failure median score 60 vs. 54 and 51 points). In patients with diabetes and complications, the rate of the composite outcome was 50 per 100 personâyears of followâup (compared with 34 and 29 in those with diabetes and no microvascular complications and participants without diabetes, respectively). Compared to patients without diabetes, the adjusted hazard ratio (HR) for the composite outcome was 1.44 [95% confidence interval (CI) 1.22â1.70] and 1.18 (95% CI 1.03â1.35) for patients with diabetes with and without complications, respectively. The risk of allâcause mortality was similarly elevated: adjusted HR 1.42 (95% CI 1.16â1.74) and 1.20 (95% CI 1.01â1.42), respectively.
Conclusion:
In HFrEF, diabetes with microvascular complications is associated with worse symptoms and outcomes than diabetes without microvascular complications. Prevention of microvascular complications has the potential to improve HFrEF outcomes
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
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.
</jats:sec
Initiation of domiciliary care and nursing home admission following first hospitalization for heart failure, stroke, chronic obstructive pulmonary disease or cancer
Background:
Patients with chronic diseases are at higher risk of requiring domiciliary and nursing home care, but how different chronic diseases compare in terms of risk is not known. We examined initiation of domiciliary care and nursing home admission among patients with heart failure (HF), stroke, COPD and cancer.
Methods:
Patients with a first-time hospitalization for HF, stroke, COPD or cancer from 2008â2016 were identified. Patients were matched on age and sex and followed for five years.
Results:
111,144 patients, 27,786 with each disease, were identified. The median age was 69 years and two thirds of the patients were men. The 5-year risk of receiving domiciliary care was; HF 20.9%, stroke 25.2%, COPD 24.6% and cancer 19.3%. The corresponding adjusted hazard ratios (HRs), with HF patients used as reference, were: stroke 1.35[1.30â1.40]; COPD 1.29[1.25â1.34]; and cancer 1.19[1.14â1.23]. The five-year incidence of nursing home admission was 6.6% for stroke, and substantially lower in patients with HF(2.6%), COPD(2.6%) and cancer (1.5%). The adjusted HRs were (HF reference): stroke, 2.44 [2.23â2.68]; COPD 1.01 [0.91â1.13] and cancer 0.76 [0.67â0.86]. Living alone, older age, diabetes, chronic kidney disease, depression and dementia predicted a higher likelihood of both types of care.
Conclusions:
In patients with HF, stroke, COPD or cancer 5-year risk of domiciliary care and nursing home admission, ranged from 19â25% and 1â7%, respectively. Patients with stroke had the highest rate of domiciliary care and were more than twice as likely to be admitted to a nursing home, compared to patients with the other conditions
Systematic Functional Analysis of Bicaudal-D Serine Phosphorylation and Intragenic Suppression of a Female Sterile Allele of BicD
Protein phosphorylation is involved in posttranslational control of essentially all biological processes. Using mass spectrometry, recent analyses of whole phosphoproteomes led to the identification of numerous new phosphorylation sites. However, the function of most of these sites remained unknown. We chose the Drosophila Bicaudal-D protein to estimate the importance of individual phosphorylation events. Being involved in different cellular processes, BicD is required for oocyte determination, for RNA transport during oogenesis and embryogenesis, and for photoreceptor nuclei migration in the developing eye. The numerous roles of BicD and the available evidence for functional importance of BicD phosphorylation led us to identify eight phosphorylation sites of BicD, and we tested a total of 14 identified and suspected phosphoserine residues for their functional importance in vivo in flies. Surprisingly, all these serines turned out to be dispensable for providing sufficient basal BicD activity for normal growth and development. However, in a genetically sensitized background where the BicDA40V protein variant provides only partial activity, serine 103 substitutions are not neutral anymore, but show surprising differences. The S103D substitution completely inactivates the protein, whereas S103A behaves neutral, and the S103F substitution, isolated in a genetic screen, restores BicDA40V function. Our results suggest that many BicD phosphorylation events may either be fortuitous or play a modulating function as shown for Ser103. Remarkably, amongst the Drosophila serines we found phosphorylated, Ser103 is the only one that is fully conserved in mammalian BicD
The football is medicine plaform-scientific evidence, large-scale implementation of evidence-based concepts and future perspectives
The idea that football can be used as therapy and as a high-intensity and literally breath-taking training regime goes back centuries. To take one prominent example, the French philosopher Voltaire describes in the Book of Fate (1747), how a patient is cured by playing with a sacred football: â⌠full-blown and carefully covered with the softest Leather. You must kick this Bladder, Sir, once a Day about your Hall for a whole Hour together, with all the Vigour and Activity you possibly canâ, âOgul, upon making the first Experiment, was ready to expire for want of Breathâ, âIn short, our Doctor in about 8 days Time, performed an absolute Cure. His Patient was as brisk, active and gay, as One in the Bloom of his Youth.â1 Today, Voltaire and his main character, philosopher Zadig, have been proved right: Football is indeed a breath-taking activity and it can be used as therapy. Albeit today's recommendations suggest a lower training frequency, longer training periods and encourage group-based training, and say that any football can be applied
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