Characteristics, Outcomes and Predictors of Long-Term Mortality for Patients Hospitalized for Acute Heart Failure: A Report From the Korean Heart Failure Registry

BACKGROUND AND OBJECTIVES: Acute heart failure (AHF) is associated with a poor prognosis and it requires repeated hospitalizations. However, there are few studies on the characteristics, treatment and prognostic factors of AHF. The aims of this study were to describe the clinical characteristics, management and outcomes of the patients hospitalized for AHF in Korea. SUBJECTS AND METHODS: We analyzed the clinical data of 3,200 hospitalization episodes that were recorded between June 2004 and April 2009 from the Korean Heart Failure (KorHF) Registry database. The mean age was 67.6±14.3 years and 50% of the patients were female. RESULTS: Twenty-nine point six percent (29.6%) of the patients had a history of previous HF and 52.3% of the patients had ischemic heart disease. Left ventricular ejection fraction (LVEF) was reported for 89% of the patients. The mean LVEF was 38.5±15.7% and 26.1% of the patients had preserved systolic function (LVEF ≥50%), which was more prevalent in the females (34.0% vs. 18.4%, respectively, p<0.001). At discharge, 58.6% of the patients received beta-blockers (BB), 53.7% received either angiotensin converting enzyme-inhibitors or angiotensin receptor blockers (ACEi/ARB), and 58.4% received both BB and ACEi/ARB. The 1-, 2-, 3- and 4-year mortality rates were 15%, 21%, 26% and 30%, respectively. Multivariate analysis revealed that advanced age {hazard ratio: 1.023 (95% confidence interval: 1.004-1.042); p=0.020}, a previous history of heart failure {1.735 (1.150-2.618); p=0.009}, anemia {1.973 (1.271-3.063); p=0.002}, hyponatremia {1.861 (1.184-2.926); p=0.007}, a high level of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) {3.152 (1.450-6.849); p=0.004} and the use of BB at discharge {0.599 (0.360-0.997); p=0.490} were significantly associated with total death. CONCLUSION: We present here the characteristics and prognosis of an unselected population of AHF patients in Korea. The long-term mortality rate was comparable to that reported in other countries. The independent clinical risk factors included age, a previous history of heart failure, anemia, hyponatremia, a high NT-proBNP level and taking BB at discharge.ope

Natural History and Predictors of Progression to Sjögren's Syndrome Among Participants of the Sjögren's International Collaborative Clinical Alliance Registry

ObjectiveTo explore changes in the phenotypic features of Sjögren's syndrome (SS), and in SS status among participants in the Sjögren's International Collaborative Clinical Alliance (SICCA) registry over a 2-3-year interval.MethodsAll participants in the SICCA registry who were found to have any objective measures of salivary hypofunction, dry eye, focal lymphocytic sialadenitis in minor salivary gland biopsy, or anti-SSA/SSB antibodies were recalled over a window of 2 to 3 years after their baseline examinations to repeat all clinical examinations and specimen collections to determine whether there was any change in phenotypic features and in SS status.ResultsAs of September 15, 2013, a total of 3,514 participants had enrolled in SICCA, and among 3,310 eligible, 771 presented for a followup visit. Among participants found to have SS using the 2012 American College of Rheumatology (ACR) classification criteria, 93% again met the criteria after 2 to 3 years, and this proportion was 89% when using the 2016 ACR/European League Against Rheumatism (EULAR) criteria. Among those who did not meet ACR or ACR/EULAR criteria at baseline, 9% and 8%, respectively, had progressed and met them at followup. Those with hypergammaglobulinemia and hypocomplementemia at study entry were, respectively, 4 and 6 times more likely to progress to SS by ACR criteria than those without these characteristics (95% confidence interval 1.5-10.1 and 1.8-20.4, respectively).ConclusionWhile there was stability over a 2-3-year period of both individual phenotypic features of SS and of SS status, hypergammaglobulinemia and hypocomplementemia at study entry were predictive of progression to SS

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment

Background: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. Findings: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. Funding: UK Medical Research Council, US National Institutes of Health. © 2014 Elsevier Ltd

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

A measurement of ∆Γs

Using a dataset corresponding to 9 fb−1 of integrated luminosity collected with the LHCb detector between 2011 and 2018 in proton-proton collisions, the decay-time distributions of the decay modes Bs 0→J/ψη′ and Bs 0→J/ψπ+π− are studied. The decay-width difference between the light and heavy mass eigenstates of the Bs 0 meson is measured to be ∆Γs = 0.087 ± 0.012 ± 0.009 ps−1, where the first uncertainty is statistical and the second systematic

Search for D0 meson decays to π+π−e+e− and K+K−e+e− final states

A search for D0 meson decays to the πþπ−eþe− and KþK−eþe− final states is reported using a sample of proton-proton collisions collected by the LHCb experiment at a center-of-mass energy of 13 TeV, corresponding to an integrated luminosity of 6 fb−1. The decay D0 → πþπ−eþe− is observed for the first time when requiring that the two electrons are consistent with coming from the decay of a φ or ρ0=ω meson. The corresponding branching fractions are measured relative to the D0 → K−π−1⁄2eþe−ρ0=ω decay, where the two electrons are consistent with coming from the decay of a ρ0 or ω meson. No evidence is found for the D0 → KþK−eþe− decay and world-best limits are set on its branching fraction. The results are compared to, and found to be consistent with, the branching fractions of the D0 → πþπ−μþμ− and D0 → KþK−μþμ− decays recently measured by LHCb and confirm lepton universality at the current precision

Test of Lepton Flavor Universality with B+→K+π+π−l+l− Decays

The first test of lepton flavor universality between muons and electrons using Bþ → Kþπþπ−lþl− (l 1⁄4 e, μ) decays is presented. The measurement is performed with data from proton-proton collisions collected by the LHCb experiment at center-of-mass energies of 7, 8, and 13 TeV, corresponding to an integrated luminosity of 9 fb−1. The ratio of branching fractions between Bþ → Kþπþπ−eþe− and Bþ → Kþπþπ−μþμ− decays is measured in the dilepton invariant-mass-squared range 1.1 &lt; q2 &lt; 7.0 GeV2=c4 and is found to be R−1 Kππ 1⁄4 1.31þ0.18 −0.17 ðstatÞ þ0.12 −0.09 ðsystÞ, in agreement with the standard model prediction. The first observation of the Bþ → Kþπþπ−eþe− decay is also reporte

Search for resonance-enhanced CP and angular asymmetries in the Λc+→pμ+μ− decay at LHCb

The first measurement of the CP asymmetry of the decay rate (ACP) and the CP average (ΣAFB) and CP asymmetry (ΔAFB) of the forward-backward asymmetry in the muon system of Λþ c → pμþμ− decays is reported. The measurement is performed using a data sample of proton-proton collisions, recorded by the LHCb experiment from 2016 to 2018 at a center-of-mass energy of 13 TeV, which corresponds to an integrated luminosity of 5.4 fb−1. The asymmetries are measured in two regions of dimuon mass near the φ-meson mass peak. The dimuon-mass integrated results are ACP 1⁄4 ð−1.1 4.0 0.5Þ%, ΣAFB 1⁄4 ð3.9 4.0 0.6Þ%, ΔAFB 1⁄4 ð3.1 4.0 0.4Þ%, where the first uncertainty is statistical and the second systematic. The results are consistent with the conservation of CP symmetry and the Standard Model expectations

Search for events with a pair of displaced vertices from long-lived neutral particles decaying into hadronic jets in the ATLAS muon spectrometer in pp collisions at root s=13 TeV

A search for events with two displaced vertices from long-lived particle (LLP) pairs using data collected by the ATLAS detector at the LHC is presented. This analysis uses 139 fb-1 of proton-proton collision data at s=13 TeV recorded in 2015-2018. The search employs techniques for reconstructing vertices of LLPs decaying to jets in the muon spectrometer displaced between 3 and 14 m with respect to the primary interaction vertex. The observed numbers of events are consistent with the expected background and limits for several benchmark signals are determined. For the Higgs boson with a mass of 125 GeV, the paper reports the first exclusion limits for branching fractions into neutral long-lived particles below 0.1%, while branching fractions above 10% are excluded at 95% confidence level for LLP proper lifetimes ranging from 4 cm to 72.4 m. In addition, the paper present the first results for the decay of LLPs into tt¯ in the ATLAS muon spectrometer