Manufacturing and Disposal of Building Materials and Inventorying Infrastructure in ecoinvent (8 pp)

Goal, Scope and Background: The present paper describes the goal and scope of building material inventories in the ecoinvent database and gives an overview of its content. The ecoinvent database provides generic life cycle inventories for building material production and related processing. They can be used as background data for different LCA applications. Their geographical and temporal scope is Switzerland or Europe and the year 2000. Methods: Data is inventoried as unit processes. Consistency throughout different sources is heeded by systematically estimating missing data. Infrastructure is consequently considered. Different disposal options are modelled. Results and Conclusion: The ecoinvent data provide a harmonised basis for different kinds of building materials. Even though not all datasets could be established on the same quality level, the results generally are believed to be comparable. Since data are generic, they are, however, not suitable to directly compare specific products. Disposal is relevant for the environmental burdens of uses of building materials. Complete life cycles have to be assessed. For this purpose, cumulative energy demand (CED) is not a suitable indicator. Recommendation and Perspective: In future versions of ecoinvent, data quality could be further improved. The database should be extended to include further building materials from secondary materials. To do so, the methodological treatment of secondary materials needs special attentio

The ecoinvent Database: Overview and Methodological Framework (7 pp)

Introduction: This paper provides an overview on the content of the ecoinvent database and of selected metholodogical issues applied on the life cycle inventories implemented in the ecoinvent database. Goal, Scope and Background: In the year 2000, several Swiss Federal Offices and research institutes of the ETH domain agreed to a joint effort to harmonise and update life cycle inventory (LCI) data for its use in life cycle assessment (LCA). With the ecoinvent data-base and its actual data v1.1, a consistent set of more than 2'500 product and service LCIs is now available. Method: Nearly all process datasets are transparently documented on the level of unit process inputs and outputs. Methodological approaches have been applied consistently throughout the entire database content and thus guarantee for a coherent set of LCI data. This is particularly true for market and trade modelling (see, for example, electricity modelling), for the treatment of multi-out-put and of recycling processes, but also for the recording and reporting of elementary flows. The differentiation of diameter size for particulate matter emissions, for instance, allows for a more comprehensive impact assessment of human health effects. Data quality is quantitatively reported in terms of standard deviations of the amounts of input and output flows. In many cases qualitative indicators are reported additionally on the level of each individual input and output. The information sources used vary from extensive statistical works to individual (point) measurements or assumptions derived from process descriptions. However, all datasets passed the same quality control procedure and all information relevant and necessary to judge the suitability of a dataset in a certain context are provided in the database. Data documentation and exchange is based on the EcoSpold data format, which complies with the technical specification ISO/TS 14048. Free access to process information via the Internet helps the user to judge the appropriateness of a dataset. Concluding Remarks: The existence of the ecoinvent database proves that it is possible and feasible to build up a large interlinked system of LCI unit processes. The project work proved to be demanding in terms of co-ordination efforts required and consent identification. One main characteristic of the database is its transparency in reporting to enable individual assessment of data appropriateness and to support the plurality in methodological approaches. Outlook: Further work on the ecoinvent database may comprise work on the database content (new or more detailed data-sets covering existing or new economic sectors), LCI (modelling) methodology, the structure and features of the data-base system (e.g. extension of Monte Carlo simulation to the impact assessment phase) or improvements in eco-invent data supply and data query. Furthermore, the deepening and building up of international co-operations in LCI data collection and supply is in the focus of future activitie

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURObservational Research Programme in AF (EORP-AF) General Long-Term Registry

Background: Epidemiological studies in atrial fibrillation (AF) illustrate that clinical complexity increase the risk of major adverse outcomes. We aimed to describe European AF patients\u2019 clinical phenotypes and analyse the differential clinical course. Methods: We performed a hierarchical cluster analysis based on Ward\u2019s Method and Squared Euclidean Distance using 22 clinical binary variables, identifying the optimal number of clusters. We investigated differences in clinical management, use of healthcare resources and outcomes in a cohort of European AF patients from a Europe-wide observational registry. Results: A total of 9363 were available for this analysis. We identified three clusters: Cluster 1 (n = 3634; 38.8%) characterized by older patients and prevalent non-cardiac comorbidities; Cluster 2 (n = 2774; 29.6%) characterized by younger patients with low prevalence of comorbidities; Cluster 3 (n = 2955;31.6%) characterized by patients\u2019 prevalent cardiovascular risk factors/comorbidities. Over a mean follow-up of 22.5 months, Cluster 3 had the highest rate of cardiovascular events, all-cause death, and the composite outcome (combining the previous two) compared to Cluster 1 and Cluster 2 (all P <.001). An adjusted Cox regression showed that compared to Cluster 2, Cluster 3 (hazard ratio (HR) 2.87, 95% confidence interval (CI) 2.27\u20133.62; HR 3.42, 95%CI 2.72\u20134.31; HR 2.79, 95%CI 2.32\u20133.35), and Cluster 1 (HR 1.88, 95%CI 1.48\u20132.38; HR 2.50, 95%CI 1.98\u20133.15; HR 2.09, 95%CI 1.74\u20132.51) reported a higher risk for the three outcomes respectively. Conclusions: In European AF patients, three main clusters were identified, differentiated by differential presence of comorbidities. Both non-cardiac and cardiac comorbidities clusters were found to be associated with an increased risk of major adverse outcomes

The ecoinvent database: Overview and methodological framework

ISSN:0948-3349ISSN:1614-750