GLORIA

GEOMAR Library Ocean Research Information Access

X

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
Filter
  • Ovid Technologies (Wolters Kluwer Health)  (19)
  • Lee, Douglas S  (19)
  • 1
    Online Resource
    Online Resource
    Abstract 9791: Sex Disparities in Implantable Cardioverter Defibrillator (ICD) Outcomes: Findings From the Ontario ICD Database
    Ovid Technologies (Wolters Kluwer Health) ; 2011
    In:  Circulation Vol. 124, No. suppl_21 ( 2011-11-22)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 124, No. suppl_21 ( 2011-11-22)
    Abstract: BACKGROUND: Sex disparities may exist in decisions to implant an ICD, complications and patient outcomes, but contributing factors are not fully elucidated. We determined if men and women who were referred or implanted with an ICD differed in their device use, complications, and outcomes. METHODS: We examined prospectively-enrolled patients referred for consideration of ICD implantation in Ontario between Feb 2007 to Jul 2010 in the Ontario ICD Database. Patients were followed for 45-day complications, and occurrence of ICD-delivered therapies (i.e., appropriate shock, appropriate therapy, and inappropriate therapy) and death within one-year follow-up. Multivariable-adjusted odds ratios (aOR) and hazard ratios (aHR) 〉 1.0 signified increased likelihood of implantation, complications, ICD-delivered therapies, or death in women. RESULTS: Of 6021 patients (4733 men) referred for ICD implantation, 1155 women (89.7%) and 4294 men (90.7%) received devices, with an overall aOR of 0.87 (95%CI; 0.69-1.10, p=0.24). Women were significantly more likely than men to have a minor (aOR 1.55; 95%CI; 1.09-2.20, p=0.014), major (aOR 1.78, 95%CI; 1.24-2.58, p=0.002), or any complication (aOR 1.50, 95%CI; 1.12-2.00, p=0.006). Among 5213 persons (4108 men) contributing 3,860 person-years of follow-up, there was a lower likelihood of appropriate ICD-delivered therapies in women. Adjusted HRs were 0.69 (95%CI; 0.51-0.93, p=0.015) for appropriate shock, 0.73 (95%CI; 0.59-0.90, p=0.003) for appropriate ICD-delivered therapy, and 0.97 (95%CI; 0.64-1.55, p=0.885) for inappropriate shock ( Figure ). Mortality did not differ among male and female ICD recipients: aHR=1.00 (95%CI; 0.64-1.55, p=0.988). CONCLUSIONS: ICD implantation rates were similar in men and women after referral to an electrophysiologist. Female ICD recipients exhibited higher rates of early complications and were less likely to experience appropriate shocks or antitachycardia therapy than men.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.124.suppl_21.A9791
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2011
    detail.hit.zdb_id: 1466401-X
    detail.hit.zdb_id: 80099-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 2
    Online Resource
    Online Resource
    Abstract 11958: Predicting Heart Failure With Preserved and Reduced Ejection Fraction: The International Collaboration on Heart Failure Subtypes
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Circulation Vol. 132, No. suppl_3 ( 2015-11-10)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 132, No. suppl_3 ( 2015-11-10)
    Abstract: Introduction: Heart failure (HF) is a major growing public health burden, and preventive strategies focused on at-risk individuals are needed. Recent initiatives have advocated for early prevention and aggressive treatment in ACC/AHA stage A/B HF, but prior HF risk prediction models remain poorly defined and validated. Moreover, risk factors for HF-specific subtypes have not yet been examined. Methods: We developed and validated separate HF risk prediction models for preserved and reduced ejection fraction (HFPEF, HFREF) in four community-based prospective cohorts (FHS, CHS, PREVEND, MESA). Fine-Gray proportional sub-distribution hazards models were used to account for competing risks (death, other HF subtype, and unclassified HF). FHS, CHS, and PREVEND samples were combined and a 2:1 random split was used for derivation and internal validation. MESA served for external validation. Results: There were 982 incident HFPEF and 909 HFREF events among 28,820 participants during follow-up (median 12 years). We created a HFPEF-specific model which included age, sex, systolic blood pressure, body mass index, hypertension treatment, and prior myocardial infarction; it had good discrimination in derivation (c-statistic 0.80, 95% CI 0.78-0.82) and validation samples (internal 0.79, 95% CI 0.77-0.82; external 0.76, 95% CI 0.71-0.80). The HFREF-specific model added smoking, left ventricular hypertrophy (LVH), left bundle branch block (LBBB), and diabetes; it had good discrimination in derivation (c-statistic 0.82, 95% CI 0.80-0.84) and validation samples (internal 0.80, 95% CI 0.78-0.83; external 0.76, 95% CI 0.71-0.80). Age had a greater effect on HFPEF risk, whereas male sex, LVH, LBBB, previous myocardial infarction, and smoking had greater effects on HFREF risk (P for comparison ≤ 0.02 for all). Conclusions: We describe and validate risk prediction models that are distinct for HF subtypes, and we demonstrate good discrimination in four community-based cohorts. Some risk factors differed in HFPEF vs HFREF, supporting distinct pathogenesis between HF subtypes. Studies are needed to examine the clinical utility of risk models, with the ultimate goal of targeted preventive strategies.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.132.suppl_3.11958
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1466401-X
    detail.hit.zdb_id: 80099-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 3
    Online Resource
    Online Resource
    Abstract 291: Association of Single Nucleotide Polymorphisms in Inflammatory Candidate Genes with Circulating Inflammatory Biomarker Concentrations: The Framingham Heart Study
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Circulation Vol. 116, No. suppl_16 ( 2007-10-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 116, No. suppl_16 ( 2007-10-16)
    Abstract: Background : Chronic subclinical inflammation is a prominent feature of atherosclerotic disease. The genetic background for this pro-inflammatory state is not well-established. Circulating biomarker concentrations have become attractive candidates to measure disease activity and prognosis. Methods : We examined 2356 single-nucleotide polymorphisms (SNPs) in 235 inflammatory pathway genes in association with 11 circulating inflammatory biomarkers in about 1800 Framingham Offspring cohort participants [CD40 ligand, CRP, intercellular adhesion molecule-1, interleukin-6 (IL6), urinary isoprostanes, monocyte chemoattractant protein-1 (MCP1), myeloperoxidase, P-selectin, tumor necrosis factor alpha, tumor necrosis factor receptor-2, fibrinogen]. We created residuals of log transformed biomarker concentrations adjusting for 16 potential confounders. Only SNPs with call rate ≥0.98 and HWE p 〉 0.01, which had at least 5 minor allele carriers entered analyses. False discovery rate (FDR) and q-value methods were applied. Results : We observed similar results with FDR and q-value methods. A total of 45 associations were significant at a cutoff q value of 0.25. The top SNPs were observed in the SELP gene in association with P-selectin concentrations (rs6136 [nonsynonymous], p= 5.17*10 −39 , rs3753305 [intronic], p= 6.17*10 −9 ) and the ICAM1 gene in relation to ICAM-1 concentrations (rs1799969 [coding-nonsynonymous], p= 1.32*10 −8 ). Lowest p-values for trans-acting SNPs were observed for APCS (rs1374486 [function unknown], p= 1.01*10 −7 , and rs6695377 [function unknown], p= 1.85*10 −7 ) with MCP-1 concentrations and for IL6R (rs8192284 [coding-nonsynonimous,intronic], p= 3.36*10 −5 ) with IL6 concentrations. In addition, we could replicate reported findings for rs1799969, and rs5498 in the ICAM-1 gene in relation to ICAM-1 concentrations as well as associations of SNPs rs2857654, rs1024611, and rs2857657 in the CCL-2 gene with MCP-1 concentrations. Conclusions : The results of this candidate gene approach support the relevance of genetic variation for circulating inflammatory biomarker traits. Some former findings were confirmed and novel potential candidates are reported. Our findings merit replication in other cohorts.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.116.suppl_16.II_39
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
    detail.hit.zdb_id: 1466401-X
    detail.hit.zdb_id: 80099-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 4
    Online Resource
    Online Resource
    Abstract 15416: High Neighbourhood-Level Material Deprivation is Associated With Increased Rates of Cardiovascular Outcomes in Patients With ASCVD: A Population-Based Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation Vol. 148, No. Suppl_1 ( 2023-11-07)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 148, No. Suppl_1 ( 2023-11-07)
    Abstract: Background: Disparities in atherosclerotic cardiovascular disease (ASCVD) may persist even in jurisdictions with universal health care. The aim of this study was to examine the relationship between material deprivation and cardiovascular (CV) events in a population with established ASCVD. Methods: This population-based cohort study identified individuals in Ontario, Canada ≥66 years old as of January 1, 2019, with an ASCVD event in the prior 10 years. The primary exposure was neighbourhood-level material deprivation, denoting the inability to attain basic material needs, categorized into quintiles, from Q1 (least deprived) to Q5 (most deprived). Cause-specific hazard models estimated the association between material deprivation and CV outcomes over 3 years, adjusted for baseline characteristics. Trend tests across deprivation quintiles were performed. Results: Among 195,742 individuals with established ASCVD (median age 76 years, 37.3% female), individuals in the most deprived neighbourhoods (Q5) had higher rates of co-morbid conditions and CV disease, including myocardial infarction (MI), angina, peripheral artery disease, and coronary artery bypass grafts, compared to those in the least deprived neighbourhoods (Q1). Q5 residents had higher hazards of the composite outcome of all-cause death, MI, or stroke (hazard ratio [HR], 1.20 [95% CI, 1.16-1.24] ), and component outcomes: all-cause death (HR, 1.23 [95% CI, 1.19-1.28]), MI (HR, 1.20 [95% CI, 1.11-1.31] ), stroke (HR, 1.13 [95% CI, 1.03-1.23]), and heart failure (HR, 1.22 [95% CI, 1.16-1.28] ), compared to Q1 residents. There were no significant differences for Q5 versus Q1 for coronary revascularization (HR, 0.97 [95% CI, 0.90-1.04]). We observed a progressive increase in risk across each quintile of deprivation (P-trend 〈 0.05 for all outcomes). Conclusion: Despite universal health care, increasing deprivation was independently associated with higher rates of CV outcomes.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.148.suppl_1.15416
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1466401-X
    detail.hit.zdb_id: 80099-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 5
    Online Resource
    Online Resource
    Novel markers for heart failure diagnosis and prognosis
    Ovid Technologies (Wolters Kluwer Health) ; 2005
    In:  Current Opinion in Cardiology Vol. 20, No. 3 ( 2005-05), p. 201-210
    Details
    In: Current Opinion in Cardiology, Ovid Technologies (Wolters Kluwer Health), Vol. 20, No. 3 ( 2005-05), p. 201-210
    Type of Medium: Online Resource
    ISSN: 0268-4705
    URL: Article
    DOI: 10.1097/01.hco.0000161832.04952.6a
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2005
    detail.hit.zdb_id: 645186-X
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 6
    Online Resource
    Online Resource
    Ambulatory Cardiology or General Internal Medicine Assessment Prior to Scheduled Major Vascular Surgery is Associated with Improved Outcomes
    Ovid Technologies (Wolters Kluwer Health) ; 2024
    In:  Annals of Surgery
    Details
    In: Annals of Surgery, Ovid Technologies (Wolters Kluwer Health)
    Abstract: To characterize the association between ambulatory cardiology or general internal medicine (GIM) assessment prior to surgery and outcomes following scheduled major vascular surgery. Background: Cardiovascular risk assessment and management prior to high-risk surgery remains an evolving area of care. Methods: This is population-based retrospective cohort study of all adults who underwent scheduled major vascular surgery in Ontario, Canada, April 1, 2004-March 31, 2019. Patients who had an ambulatory cardiology and/or GIM assessment within 6 months prior to surgery were compared to those who did not. The primary outcome was 30-day mortality. Secondary outcomes included: composite of 30-day mortality, myocardial infarction or stroke; 30-day cardiovascular death; 1-year mortality; composite of 1-year mortality, myocardial infarction or stroke; and 1-year cardiovascular death. Cox proportional hazard regression using inverse probability of treatment weighting (IPTW) was used to mitigate confounding by indication. Results: Among 50,228 patients, 20,484 (40.8%) underwent an ambulatory assessment prior to surgery: 11,074 (54.1%) with cardiology, 8,071 (39.4%) with GIM and 1,339 (6.5%) with both. Compared to patients who did not, those who underwent an assessment had a higher Revised Cardiac Risk Index (N with Index over 2= 4,989[24.4%] vs. 4,587[15.4%] , P 〈 0.001) and more frequent pre-operative cardiac testing (N=7,772[37.9%] vs. 6,113[20.6%] , P 〈 0.001) but, lower 30-day mortality (N=551[2.7%] vs. 970[3.3%] , P 〈 0.001). After application of IPTW, cardiology or GIM assessment prior to surgery remained associated with a lower 30-day mortality (weighted Hazard Ratio [95%CI] = 0.73 [0.65-0.82] ) and a lower rate of all secondary outcomes. Conclusions: Major vascular surgery patients assessed by a cardiology or GIM physician prior to surgery have better outcomes than those who are not. Further research is needed to better understand potential mechanisms of benefit.
    Type of Medium: Online Resource
    ISSN: 0003-4932
    URL: Article
    DOI: 10.1097/SLA.0000000000006321
    RVK:
    XA 23900
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2024
    detail.hit.zdb_id: 340-2
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 7
    Online Resource
    Online Resource
    Abstract 13529: Outcomes After Emergency Department Visits for Dyspnea: Population-Based Interrupted Time-Series Analysis of Implementation of B-Type Natriuretic Peptide Assays
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation Vol. 148, No. Suppl_1 ( 2023-11-07)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 148, No. Suppl_1 ( 2023-11-07)
    Abstract: Introduction: The population-level impact of hospital-based natriuretic peptide (NP) implementation in a universal health care system is unclear. We examined temporal associations between introduction of NP testing in-hospital with outcomes after emergency department (ED) visits for dyspnea. Hypothesis: Implementation of NP testing is associated with improved outcomes for ED patients seeking care for dyspnea. Methods: Administrative databases were linked to identify adults ≥40 years of age with a first ED visit for dyspnea between 2014 and 2019 at hospitals introducing onsite NP testing between 2016 and 2018 in Ontario, Canada. We calculated quarterly rates of 1-year age- and sex-standardized mortality and readmission (all-cause, cardiovascular, heart failure [HF]), restricted to 2 years before and after NP introduction to minimize temporal advances in treatment. We conducted an interrupted time series analysis using linear regression and Newey-West autocorrelation adjusted standard errors to quantify rate of change in outcomes before and after NP introduction. Time zero at each hospital was set at 2 years prior to the introduction of NP tests for each hospital (point of interruption). Results: We studied 20,294 patients (median age 69 years, 52% female) before and 21,857 patients (median age 68 years, 53% female) after NP introduction across 16 hospitals. The cohort before NP introduction had a higher prevalence of prior HF and chronic obstructive pulmonary disease (P 〈 0.01). Rates of all outcomes were stable prior to NP introduction. Following NP introduction, there were significant declines in rates of all-cause mortality (-1.5/100 persons per year), all-cause readmission (-3.6/100 persons per year), cardiovascular readmission (-1.4/100 persons per year) and HF readmission (-0.8/100 persons per year; Figure). Conclusions: Introduction of hospital-based NP tests was associated with decreasing rates of adverse outcomes after ED visits for dyspnea.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.148.suppl_1.13529
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1466401-X
    detail.hit.zdb_id: 80099-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 8
    Online Resource
    Online Resource
    Abstract 14312: Comparison of Machine Learning and Conventional Statistical Modeling for Predicting Readmissions Following Acute Heart Failure Hospitalization
    Ovid Technologies (Wolters Kluwer Health) ; 2023
    In:  Circulation Vol. 148, No. Suppl_1 ( 2023-11-07)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 148, No. Suppl_1 ( 2023-11-07)
    Abstract: Introduction: Developing accurate models for predicting risk of 30-day readmission has been a major healthcare interest. Evidence suggests that models developed using machine learning (ML) may have better discrimination than conventional statistical models (CSM), but the calibration of such models is unclear. Objectives: To compare models developed using CSM or ML to predict 30-day readmission for cardiovascular and non-cardiovascular causes in HF patients. Methods: We studied 10,919 patients with HF ( 〉 18 years) discharged alive from a hospital or emergency department (2004-2007) in Ontario, Canada, linked to administrative databases for hospitalization and vital status resulting in complete follow-up. The study sample was randomly divided into training and validation sets in a 2:1 ratio. CSMs to predict 30-day readmission were developed using Fine-Gray subdistribution hazards regression (treating death as a competing risk), and the ML algorithm employed random survival forests. Models were evaluated in the validation set using both discrimination and calibration metrics. Results: In the validation sample of 3602 patients (median age 76 [IQR, 67-82] years, 46.6% females), Random Survival Forests (c-statistic = 0.620) showed similar discrimination to the Fine-Gray competing risk model (c-statistic= 0.621) for 30-day cardiovascular readmission. In contrast, for 30-day non-cardiovascular readmission, the Fine-Gray model (c-statistic= 0.641) slightly outperformed the random survival forests model (c-statistic = 0.632). For both outcomes, The Fine-Gray model displayed better calibration than random survival forests when deciles of observed vs. predicted risks were compared (Panels A-D). Conclusions: In HF patients, time-to-event analysis of outcomes using Fine-Gray models had similar discrimination but superior calibration to ML model, highlighting the importance of reporting calibration metrics for ML-based prediction models.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.148.suppl_1.14312
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2023
    detail.hit.zdb_id: 1466401-X
    detail.hit.zdb_id: 80099-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 9
    Online Resource
    Online Resource
    Abstract 13175: Outcomes of Heart Failure (HF) Patients Admitted to the Intensive Care Unit (ICU): Impact of Early or Late ICU Admission
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Circulation Vol. 134, No. suppl_1 ( 2016-11-11)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 134, No. suppl_1 ( 2016-11-11)
    Abstract: Background: Little is known about the outcomes of HF patients who are admitted to an ICU. We examined the outcomes of HF patients who were admitted to directly to the ICU (early) or admitted to the ICU after initial ward admission (late), compared to non-ICU admitted patients. Methods: We examined 118,595 HF patients (ICD-10 code I50) in Ontario, Canada, who were hospitalized from 2003-2012 using the Canadian Institute for Health Information Discharge Abstract Database. We examined the association of ICU admission and timing with: a) 30-day mortality using multiple Cox regression with time-varying covariates, and b) 30-day hospital readmissions using repeated events analysis approach of Prentice, Williams and Peterson. Results: Of the cohort, 24,119 (20%) were admitted to an ICU during the hospital stay, of whom 84% were admitted early (median age 76 years, 54% men) and 16% were admitted later (age 77 years, 53% men). 30-day mortality was higher in early and late ICU compared to no ICU: 13%, 27%, 10.5% (p 〈 .001). Multivariable-adjusted hazard ratios (HR) were: 1.65 (95%CI; 1.58-1.73) for early ICU (p 〈 .001) and 4.59 (95%CI; 4.31-4.89) for late ICU (p 〈 .001) vs. no ICU (referent). All-cause 30-day readmissions were also highest among late ICU, followed by early ICU, and lowest in non-ICU patients: 24.3, 22.9, 21.7 readmissions per 100 person-months (all p 〈 .001). Multivariable-adjusted repeated events analysis demonstrated a progressively increasing HRs for all-cause readmission: 1.07 (95%CI; 1.04-1.11) for early ICU (p 〈 .001) and 1.13 (95%CI; 1.04-1.22) for late ICU (p 〈 .01) vs. no ICU (referent). Median in-hospital costs were $16,553 for late ICU, $8587 for early ICU, and $7296 for non-ICU admitted patients (p 〈 .001). Conclusions: HF patients who are admitted to the ICU are sicker and experience increased risk of 30-day readmissions and death. Late ICU admissions were associated with the highest risk of death and readmission, and incurred substantially higher costs of care.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.134.suppl_1.13175
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1466401-X
    detail.hit.zdb_id: 80099-5
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
  • 10
    Online Resource
    Online Resource
    The contribution of familial and heritable risks in heart failure
    Ovid Technologies (Wolters Kluwer Health) ; 2007
    In:  Current Opinion in Cardiology Vol. 22, No. 3 ( 2007-05), p. 214-219
    Details
    In: Current Opinion in Cardiology, Ovid Technologies (Wolters Kluwer Health), Vol. 22, No. 3 ( 2007-05), p. 214-219
    Type of Medium: Online Resource
    ISSN: 0268-4705
    URL: Article
    DOI: 10.1097/HCO.0b013e3280d9e855
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2007
    detail.hit.zdb_id: 645186-X
    Location Call Number Limitation Availability
    BibTip Others were also interested in ...
    Online Resource
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...