Stroke mortality in a teaching hospital in South Western Nigeria

Stroke, a major cause of morbidity and mortality, is on the increase and with increasing mortality. Our retrospective review of all stroke admissions from 1990-2000 show that cerebrovascular disease accounted for 3.6% (293/8144) of all medical admissions; it has a case fatality rate of 45% with the majority (61%) occurring in the first week; the mean age of stroke deaths was 62 years (standard deviation+/-13); and severe as well as uncontrolled hypertension is the most important risk factor. Community-based programmes aimed at early detection and treatment of hypertension, in addition to screening for those with high risk factors, should be put in place.     

Current trends in admissions and outcomes of cardiac diseases in Ghana

Cardiovascular diseases (CVDs) pose a major burden in Africa, but data on temporal trends in disease burden are lacking. We assessed trends in CVD admissions and outcomes in central Ghana using a retrospective analysis of data from January 2004 to December 2015 among patients admitted to the medical wards of a tertiary medical center in Kumasi, Ghana. Rates of admissions and mortality were expressed as CVD admissions and deaths divided by the total number of medical admissions and deaths, respectively. Case fatality rates per specific cardiac disease diagnosis were also computed. Over the period, there were 4226 CVD admissions, with a male‐to‐female ratio of 1.1 to 1. There was a progressive increase in percentage of CVD admissions from 4.6% to 8.2%, representing an 78% increase, between 2004 and 2014. Of the 2170 CVD cases whose data were available, the top 3 causes of CVD admissions were heart failure (HF; 88.3%), ischemic heart disease (IHD; 7.2%), and dysrhythmias (1.9%). Of all HF admissions, 52% were associated with hypertension. IHD prevalence rose by 250% between 2005 and 2015. There were 976 deaths (23%), with an increase in percentage of hospital deaths that were cardiovascular in nature from 3.6% to 7.3% between 2004 and 2014, representing a 102% increase. Cardiac disease admissions and mortality have increased progressively over the past decade, with HF as the most common cause of admission. Once rare, IHD is emerging as a significant contributor to the CVD burden in sub‐Saharan Africa.     

Upper gastrointestinal bleeding in Scotland 2000-2010: Improved outcomes but a significant weekend effect

AIM: To assess numbers and case fatality of patients with upper gastrointestinal bleeding(UGIB),effects of deprivation and whether weekend presentation affected outcomes.METHODS: Data was obtained from Information Services Division(ISD) Scotland and National Records of Scotland(NRS) death records for a ten year period between 2000-2001 and 2009-2010. We obtained data from the ISD Scottish Morbidity Records(SMR01) database which holds data on inpatient and daycase hospital discharges from non-obstetric and nonpsychiatric hospitals in Scotland. The mortality data was obtained from NRS and linked with the ISD SMR01 database to obtain 30-d case fatality. We used 23 ICD-10(International Classification of diseases) codes which identify UGIB to interrogate database. We analysed these data for trends in number of hospital admissions with UGIB,30-d mortality over time and assessed effects of social deprivation. We compared weekend and weekday admissions for differences in 30-d mortality and length of hospital stay. We determined comorbidities for each admission to establish if comorbidities contributed to patient outcome. RESULTS: A total of 60643 Scottish residents were admitted with UGIH during January,2000 and October,2009. There was no significant change in annual number of admissions over time,but there was a statistically significant reduction in 30-d case fatality from 10.3% to 8.8%(P 0.001) over these 10 years. Number of admissions with UGIB was higher for the patients from most deprived category(P 0.05),although case fatality was higher for the patients from the least deprived category(P 0.05). There was no statistically significant change in this trend between 2000/01-2009/10. Patients admitted with UGIB at weekends had higher 30-d case fatality compared with those admitted on weekdays(P 0.001). Thirty day mortality remained significantly higher for patients admitted with UGIB at weekends after adjusting for comorbidities. Length of hospital stay was also higher overall for patients admitted at the weekend when compared to weekdays,although only reached statistical significance for the last year of study 2009/10(P 0.0005). CONCLUSION: Despite reduction in mortality for UGIB in Scotland during 2000-2010,weekend admissions show a consistently higher mortality and greater lengths of stay compared with weekdays.     

Decreases in mortality on a large urban medical service by facilitating access to critical care. An alternative to rationing

The admission and case fatality rate (CFR) on a large urban medical service for 12 months before and after the creation of an intermediate care unit were examined. In the year after the intermediate care unit was opened, total admissions to the ICU/CCU decreased by 7.1% as a result of a 14.6% decrease in admission of low-risk patients who did not require critical care services. The CFR of patients on the medical service decreased by 13.3% in the year after implementation of the intermediate care unit. The decrease in mortality was accounted for by a 25.0% decrease in general ward deaths and a 38.8% decrease in ward cardiac arrests. There was no significant difference in the ICU/CCU CFR. The admission of low-risk patients to an intermediate care unit provided greater access to intensive care and was associated with an overall lower medical service CFR.     

Clinical intervention and molecular characteristics of a dengue hemorrhagic fever outbreak in Timor Leste, 2005

In response to a January 2005 report of dengue hemorrhagic fever (DHF) in Timor Leste, the World Health Organization sent a team to assist the National Hospital Guido Valadares (NHGV) in Dili with clinical case management and diagnostic support. The hospital reported 67 admissions including 8 deaths (case fatality rate approximately 12%) over the previous weeks with case histories clinically compatible with DHF. During the intervention, an additional 44 suspected dengue patients were admitted to the pediatric ward of NHGV. Among 41 patients with clinical diagnoses of dengue fever or DHF, 38 (93%) were laboratory confirmed. Although cause and effect cannot be definitely attributed, the case fatality rate decreased to 3.6% after the intervention with education about dengue management strategies.     

Etiology and mortality of bacterial meningitis in northeastern Brazil

Little is known of the current incidence and mortality of meningitis in developing nations, especially in Latin America. We reviewed all cases of meningitis in an isolation-fever hospital in Salvador, Brazil, for the decade 1973-1982. Of all admissions, 6,751 (27%) were for meningitis; 4,100 (61%) of these cases were of definite or probable bacterial etiology. Children younger than 15 years accounted for 79% of cases, and 45% of cases were in children under 2 years. The overall case fatality rate was 33%, with 50% of these deaths occurring within 48 hours of hospitalization. Neisseria meningitidis was the etiologic agent in 32% of the cases, with a case fatality rate of 14%. Epidemics caused by N. meningitidis group C, then group A, in 1974-1978 accounted for 60% of the cases. Streptococcus pneumoniae caused 17% of cases, with a case fatality rate of 59%. Haemophilus influenzae type b, the most common cause of nonepidemic meningitis, caused 23% of all cases, with a case fatality rate of 38%. Enterobacteriaceae were the etiology in only 3.6% of patients, but the case fatality rate was 86%. Cultures were negative in 18% of cases with purulent cerebrospinal fluid. A total of 84% of H. influenzae, 40% of S. pneumoniae, 78% of Enterobacteriaceae, and 15% of N. meningitidis cases occurred in children less than 2 years of age. Case fatality rates were highest in this group. Vaccines protective for this age group are urgently needed.     

Type 2 diabetes increases the risk of hospital admission for heart failure and reduces the risk of in hospital mortality in Spain (2001–2015)

BackgroundTo compare trends in incidence, clinical characteristics and outcomes of heart failure (HF) hospitalizations among patients with or without type 2 diabetes (T2DM) in Spain (2001–2015).MethodsWe used national hospital discharge data to select hospital admissions for HF as primary diagnosis. Incidence, comorbidities, diagnostic and therapeutic procedures, and in hospital mortality (IHM) were analyzed.ResultsWe identified a total of 1,501,811 admissions for HF (36.87% with T2DM). Incidences were higher among those with T2DM than those without diabetes. The adjusted incidence of HF among T2DM patients was 4.93 higher than for non-diabetic subjects (IRR 4.93;95%CI 4.91–4.95). Jointpoint analysis showed that sex-age-adjusted admissions in T2DM patients with HF increased by 7.12% per year from 2001 to 2007 and stabilized afterwards. For non-diabetic patients a constant increase overtime of around 1% was found.Patients with T2DM were significantly younger than patients without diabetes (77.22 vs. 79.36 years) and had more coexisting medical conditions according to the Charlson Comorbidity Index (mean CCI 1.99 ± 0.88 vs. 1.90 ± 0.86). For the total time period, crude IHM was lower for T2DM patients than for non-diabetic people (8.35% vs, 10.57%; p < 0.05) and the association remained significant after multivariable adjustment ((OR, 0.84; 95%CI 0.83–0.86).). Female sex, older age and multiple comorbidities were significant risk factors for IHM.ConclusionsT2DM increases the risk of admission for HF by five-fold. Our study demonstrates an increase in hospitalization for HF in diabetic patients from 2001 to 2007 and stabilization afterwards. T2DM was associated with a lower IHM after hospitalization for HF.     

Exploring the declining case fatality in acute stroke. Population-based observations in the northern Sweden MONICA Project

Objectives. Declining case fatality in acute stroke has been reported from many western countries. The aim of this study was to explore in what subset of patients the decline in case fatality has occurred.
Setting. In a population-based study, acute stroke events were recorded in the age group 25–74 years in northern Sweden during the years 1985–1993 within the framework of the WHO MONICA Project.
Subjects. In total 3486 men and 2212 women with a first-ever stroke (except subarachnoid haemorrhage) were included.
Main outcome. Change in stroke incidence, case fatality and neurological deficits at onset over a 9-year period.
Results. The incidence (first-ever stroke) did not change over the years, while the overall case fatality decreased from 18.2% in 1985–1987 to 13.5% in 1991–1993. In both men and women with non-haemorrhagic stroke, a trend was seen towards an increasing incidence of mild stroke events over the years. In both sexes, a significant decline in case fatality was seen in patients with minor deficits at onset, while no change in case fatality was seen in patients with extensive deficits. There was no change in incidence of intracerebral haemorrhage, but the case fatality in patients with intracerebral haemorrhage declined significantly from 36% to 29% during the study period.
Conclusions. A declining case fatality was observed in both men and women. Among patients with non-haemorrhagic stroke, the decline was confined to patients with minor deficits. The declining case fatality can be attributed both to a shift in the severity towards more patients presenting with mild symptoms, and an improved prognosis in patients with minor deficits at onset, probably because of improved medical management.     

Admissions to a rural hospital in the West Nile District of Uganda over a 27 year period

An analysis is presented of data on all 30 129 inpatient admissions to a mission hospital in the West Nile District of Uganda in the 27 year period from July 1951 to August 1978. For most of this period the hospital was staffed by the same two doctors. For each patient admitted, a record was made of their age (adult or child), sex, place of residence, duration of stay in hospital, diagnosis and vital status at discharge. The annual number of admissions increased steadily from around 300 in 1952 to over 1600 in 1966 and subsequently declined to about 900 in 1977. Sixty-five per cent of admissions were medical, 12% surgical, 11% obstetric and 9% gynaecological. Thirty per cent of admissions were children (aged 0-9 years). Forty-five per cent of admissions were from those resident in the same county as the hospital and another 20% were from an immediately adjacent county. Infective and parasitic conditions (including respiratory diseases) accounted for over 60% of admissions among children and over 38% of admissions among adults (excluding obstetric patients). The six most common causes of admission were: uncomplicated delivery (2308 admissions), pneumonia (2020), hookworm (1999), malaria (1806), schistosomiasis (1742) and diarrhoea (1041). In total 1960 deaths were recorded (6.5% of all admissions). High case fatality rates were observed for tetanus (61%), immaturity (54%), meningitis (38%), kwashiorkor (21%), other malnutrition (19%) and anaemia (19%). A striking increase in the number of admissions for measles was observed in the period 1976 to 1978. Admission rates for schistosomiasis (S. mansoni) appeared to be highest from counties adjacent to the Nile and 104 deaths were recorded among the 1742 patients with this as the primary diagnosis. Admissions for diabetes, as a percentage of all admissions increased from 0.2% in 1951-54 to 1.5% at the end of the study period. Marked seasonal variations in admission patterns were found for diarrhoea, measles, meningitis and respiratory infections, the last two, but not diarrhoea, being most common in the wettest months. Admissions for malaria showed no strong seasonal associations. Despite the limitations of hospital-based data, it is argued that the data analysed provide a reasonable indication of the important causes of severe morbidity and mortality in the district. Furthermore, some of the changes in admission patterns over time are likely to represent true changes in disease rates rather than artefacts of diagnosis or referral. The analyses presented indicate the value of simple record systems, carefully maintained.     

Chloroquine-resistant Plasmodium falciparum cerebral malaria in a chloroquine-susceptible area.

Chloroquine-resistant Plasmodium falciparum is endemic in many areas. Saudi Arabia was considered to have chloroquine-susceptible P. falciparum. During the 1997-1998 season, an outbreak of malaria occurred in the southwestern region. Over a 4-month period, 32 cases (6.2%) of 520 malaria admissions met the World Health Organization criteria for cerebral malaria. The mean patient age was 28 years. Thirteen male and 19 female patients were admitted in coma. The mean duration of coma was 4.3 days; the case fatality rate was 41%. Compared with those who recovered, patients who died had a lower mean admission diastolic blood pressure and hemoglobin level, higher mean blood urea nitrogen and blood glucose levels, and thrombocytopenia. Logistic regression analysis identified treatment with quinine rather than chloroquine to be associated with survival. These findings show the potential of P. falciparum to emerge as chloroquine resistant in previously susceptible areas, resulting in significant morbidity and mortality in spite of sophisticated medical care.     

Are diabetes and its medications risk factors for the development of COVID-19? Data from a population-based study in Sicily

Background and aimsDiabetes mellitus (DM) has been associated with higher incidence of severe cases of COVID-19 in hospitalized patients, but it is unknown whether DM is a risk factor for the overall COVID-19 incidence. The aim of present study was to investigate whether there is an association of DM with COVID-19 prevalence and case fatality, and between different DM medications and risk for COVID-19 infection and death.Methods and resultsretrospective observational study on all SARS-CoV-2 positive (SARS-CoV-2⁺) cases and deaths in Sicily up to 2020, May 14th. No difference in COVID-19 prevalence was found between people with and without DM (RR 0.92 [0.79–1.09]). Case fatality was significantly higher in SARS-CoV-2⁺ with DM (RR 4.5 [3.55–5.71]). No diabetes medication was associated with differences in risk for SARS-Cov2 infection.Conclusionsin Sicily, DM was not a risk factor for COVID-19 infection, whereas it was associated with a higher case fatality.     

Some aspects of management and outcome of acute coronary heart disease in Oxford region.

(1) Over 15 months, 532 consecutive admissions to the CCU at the Radcliffe Oxford were studied; of these 333 were cases of myocardial infarction, and 319 were first admissions for this condition. Information about survival and return to work was collected for 300. A further 30 had artificial pacemakers inserted; there were 141 (26%) of the 532 cases which did not require the special care offered by the CCU. (2) Of 300 patients for whom data were available, 27 were recorded as having received DC shock. In hospital, case fatality was significantly higher among those requiring DC shock than among the remainder. Overall the 3-year survival rates were 47 per cent among those receiving shock, and 62 per cent among the remainder, compared with an expected 91 per cent for a population of the same age and sex. (3) Among men aged under 65 years, 6 of 11 who received shock, compared with 117 (77%) who did not receive shock, returned to work after leaving hospital. (4) Rates of admission to the CCU of cases of myocardial infarction per 1000 standardised population among people living in the areas around Oxford City were estimated as being 58 per cent of admission rates of cases among residents of the city. (5) The case incidence of ventricular fibrillation and the case fatality rate were both higher among those living in the environs than among those living in the city, but these differences were not statistically significant. (6) It is also concluded that insufficient is known about the factors underlying the general practitioner's decision to commit a case of myocardial infarction to other than short ambulance journeys or about the effects of such journeys on prognosis.     

Deliberate self‐harm and suicide by pesticide ingestion in the Sundarban region,India

Objective To examine the clinical epidemiology, including case fatality and determinants of self‐harm in six island blocks of the Sundarban region of West Bengal, India. Methods We examined the clinical records of 1277 patients admitted for deliberate self‐harm (DSH) to the six island hospitals from 1999 to 2001. Results 77.7% of the patients survived their attempt, 11.9% died and for 10.4% the outcome was not recorded. Women accounted for 65.2% of the DSH admissions and 67.1% of the deaths. Pesticides were the most commonly used means (88.7%). The case fatality of self‐harm reported in these hospitals ranged from 6.0% to 50.0% (mean 13.3%; CI, 11.3–15.3). The age group 55–64 years was at highest risk of death, the age group 15–24 years at lowest risk. Higher lethality of pesticide ingestion compared to other methods was suggestive but not significant. Case fatality within the region varied but was high compared to industrialized nations. Case records and management of DSH were poor. Conclusion Effective DSH prevention in the Sundarban region would require better surveillance at clinical facilities and an intersectoral approach, linking the agricultural interests of pesticide safety and mental health interests for preventing DSH.     

Diphtheria in Afghanistan--review of 155 cases

During the 3-year study period, 155 culture-positive cases of diphtheria were reviewed at the Institute of Child Health, Kabul. They comprised 0.6% of hospital admissions due to medical disorders in our institute. About 80% of patients belonged to an age group of 1-10 years and only two patients were less than 1 year old. The male to female ratio was 1.3:1. There was no history of previous vaccination against diphtheria in 96.7% of patients. In the majority of patients faucial diphtheria was diagnosed (77.4%), followed by laryngeal (16.1%) an combined pharyngolaryngeal (6.5%). Clinical presentation was with a mild to moderate degree of fever, sore throat, cervical lymphadenopathy, toxaemia, tachycardia and a characteristic thick greyish-white membrane. The main early complications were laryngeal obstruction (35), myocarditis (18), shock (3), polyneuritis (3) and renal failure (2). The overall case fatality rate was 19.3%. Prognosis was unfavourable in patients with laryngeal diphtheria when there was a delay of more than 4 days before reaching the hospital and if there was a delay in relieving laryngeal obstruction by tracheostomy. Outcome was unrelated to the age of the patient.     

Adult minor trauma patients: good outcome in small hospitals.

STUDY PURPOSE: To determine if adult minor injury trauma admissions to small hospitals have a mean length of stay (LOS) and fatality rate similar to those of admissions to larger hospitals. POPULATION: The first 10,000 Oregon hospital trauma discharges during 1987. Exclusions were age of 17 years or younger, an Injury Severity Score (ISS) of more than 10, transfer to another health care facility, and leaving against medical advice. There were 6,739 patients meeting study criteria. METHODS: This study was a retrospective cohort analysis of a hospital discharge data base. Outcome measures were LOS for survivors and fatality rate. Predictor variables included patient age, hospital bed size, Level I or II trauma facility, designation, and county population. Chi 2 and analysis of variance were used to test significance (P less than .05). RESULTS: Two of 72 hospitals were US-government-sponsored facilities and showed a longer mean LOS (21.3 and 16.4 vs 5.5 days for all other hospitals; P less than .005). Mean LOS correlated positively with patient age, ISS, and hospital bed size (P less than .0001). There were 136 deaths in this low-ISS population. The fatality rate was independent of hospital size and trauma facility designation. Age was significantly greater for patients who died versus survivors (76.2 vs 49.1 years; P less than .0001). CONCLUSION: For minor trauma patients, smaller hospitals have a shorter mean LOS and a similar fatality rate when compared with larger hospitals and Level I and II trauma facilities. Despite a low ISS, admitted elderly patients have a higher death rate regardless of hospital size.     

Outcome of diabetic foot ulcer admissions at the medical wards of University of Nigeria Teaching Hospital Enugu,Nigeria

Diabetic foot ulcer (DFU) is associated with a high rate of morbidity, prolonged hospital stay, and serious complications including limb amputation. The objective of this study was to determine the outcome of DFU among medical inpatients in the University of Nigeria Teaching Hospital Enugu, Nigeria. Data from case records of diabetes-related admissions into the medical wards of the University of Nigeria Teaching Hospital Enugu (UNTH) between January 2009 and December 2012 were analyzed. Statistical analysis was done using SPSS v17. Out of 726 diabetes mellitus (DM)-related admissions (59.1 % males, 40.9 % females), DFU accounted for 119 (16.4 %), of which 65.5 % were males and 34.5 % were females. The mean duration of diabetes in DFU patients was 7.2?±?5.8 years, while the median (interquartile range) duration of the ulcer before the presentation was 24 (14–60)?days. The mean age of patients with DFU was 55.2?±?13.2 years, while the duration of hospital stay ranged from 2 to 98 days, median (interquartile range (IQR)) of 16 (9.8–30.3)?days. Out of the 119 DFU admissions, 88 (73.9 %) were discharged, 15 (12.6 %) died, while 16 (13.5 %) discharged themselves against medical advice (DAMA). Of those who were discharged, about 75 % were discharged with non-healed ulcers either for outpatient care or to surgical units. The most common Wagner grade of ulcer was grade 3 (41.5 %). Risk factors for ulceration were peripheral vascular disease in 47.1 % and peripheral neuropathy in 57.6 %. Mortality due to DFU accounted for 10.6 % of all diabetes mortality. Diabetic foot ulcer was a common reason for admission and characterized by late presentation and advanced ulcer stage. Diabetes foot ulcers admitted and managed in the medical wards were associated with poor outcome.     

Early predictors of mortality in pneumococcal bacteraemia

OBJECTIVES: Pneumococcal bacteraemia carries a mortality of about 20%. Approximately 50% of deaths from pneumococcal bacteraemia occur within the first 48 h of admission. In order to influence outcome, critically ill patients should be identified at the time of presentation. This study enables the clinician to rapidly make an evidence-based assessment of a patient's prognosis, allowing the identification of patients who should be placed in a high-risk category at an early stage, when appropriate management is most likely to be effective. METHODS: Data were collected from the medical record of history, physical examination, radiological examination and laboratory investigations done on initial presentation using a standardized proforma. The data were first examined by Pearson's Chi-squared test, with Yates' correction if needed. Variables found to be significantly associated with case fatality ( P < 0.05) by these methods were examined by stepwise logistic regression analysis in order to identify those factors which were independent predictors of case fatality. RESULTS: The overall case fatality was 21%. Older age, apyrexia, tachypnoea, bilateral consolidation, hypoalbuminaemia, elevated aminotransferases, renal impairment, acidosis and leucopaenia were significantly associated with higher case fatality. Older age, acidosis and elevated serum alanine aminotransferase (ALT) were independent predictors of case fatality. Fifty-five percent of isolates belonged to serotypes 4, 6B, 9V, 14, 19F and 23F, to which good antibody levels have been documented in both young and elderly patients post-vaccination. Serotype 14 was most common, and was significantly associated with higher case fatality. Colder weather was associated with a higher incidence of both infection and case fatality. The case fatality amongst patients receiving ITU management was 44%. Less than 50% of patients who died received ITU management. CONCLUSIONS: Despite the increased availability of new antibiotics and vaccines, the mortality of patients with pneumococcal bacteraemia remains unchanged. The parameters above allow early identification of patients with a higher case fatality; these patients may benefit from being placed in a "high-risk" category early on in their management. Vaccination of the elderly may reduce the incidence and/or mortality from pneumococcal bacteraemia. Further studies are required to understand the reasons for referral for intensive therapy in acute pneumococcal bacteraemia and whether ITU management affects outcome.     

Gender-Specific short and long-term mortality in diabetic versus nondiabetic patients with incident acute myocardial infarction in the reperfusion era (the MONICA/KORA Myocardial Infarction Registry)

The aim of this study was to investigate gender-specific short- and long-term mortalities after a first acute myocardial infarction (AMI) in patients with and without diabetes mellitus (DM). The study was based on 505 men and 196 women with DM and 1,327 men and 415 women without DM consecutively hospitalized with a first-ever AMI from January 1998 to December 2003 recruited from a population-based MI registry. Patients were followed until December 31, 2005 (median follow-up time 4.3 years). In men and women, no significantly independent association between DM and short-term mortality was observed. After multivariable adjustment odds ratios (95% confidence intervals [CIs]) for 28-day case fatality were 1.45 (95% CI 0.90 to 2.34) in men with DM compared to men without DM and 1.44 (95% CI 0.66 to 3.15) in women with DM compared to women without DM. Conversely, in 28-day AMI survivors DM was significantly associated with long-term mortality in age-adjusted analyses, in which men with DM had a hazard ratio (HR) of 1.57 (95% CI 1.18 to 2.10) for all-cause mortality compared to non-DM men; the corresponding HR in women with DM was 2.91 (95% CI 1.82 to 4.65). After multivariable adjustment the strong association in women with DM remained significant (HR 2.56, 95% CI 1.53 to 4.27); however, in men with DM it became borderline significant (HR 1.36, 95% CI 1.00 to 1.85). In conclusion, short-term mortality was not significantly increased in men and women with DM after a first-ever AMI, although estimates were relatively high, indicating a possible relation. However, long-term mortality was higher in patients with AMI and DM, particularly in women.     

Impact of concurrent macrovascular co‐morbidities on healthcare utilization in patients with type 2 diabetes in Europe: a matched study

Aim: To examine and to quantify the impact of concurrent macrovascular co‐morbidities (MVC) on healthcare resource utilization among patients with type 2 diabetes mellitus (T2DM) in Europe. Methods: This is a matched cohort study based on the Real‐Life Effectiveness and Care Patterns of Diabetes Management study, a multicentre, observational study with retrospective medical chart reviews of T2DM patients in Spain, France, UK, Norway, Finland, Germany and Poland. Included patients were aged ≥30 years at time of diagnosis of T2DM who added a sulfonylurea or a PPARγ agonist to failing metformin monotherapy (index date) and had concurrent MVC (cases). A control cohort with T2DM but without concurrent MVC was identified using 1:1 propensity score matching. Logit models were used to identify the relationship between concurrent MVC and the likelihood of emergency room admission, receiving medical/surgical procedures, and hospitalization during the study period after controlling for baseline demographics, clinical information and baseline treatment. Negative binomial models were used to predict the number of office visits and length of hospital stay per year attributable to the concurrent MVC. Results: Relative to controls, patients with MVC were significantly more likely to have emergency department admissions [odds ratio (OR) 2.69; 95% CI: 1.56–4.65], receiving medical/surgical procedures (OR 2.57; 95% CI: 1.56–4.21) and hospitalizations (OR 2.58; 95% CI: 1.64–4.07) after controlling for other predictors. Similarly, MVC were associated with 1.49 additional office visits per year (p = 0.036) and 0.32 days of hospital stay per year (p = 0.023). Conclusions: Within a seven‐country European sample, this study showed that T2DM patients with MVC were more likely to use healthcare resources compared with T2DM patients without MVC.     

Outcomes of Acute Myocardial Infarction in Patients with Familial Hypercholesteremia

BackgroundThere is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia.MethodsWe queried the Nationwide Readmissions Database (2016-2018) for hospitalizations with acute myocardial infarction. Multivariable regression analysis was used to compare in-hospital outcomes and 30-day readmissions among patients with and without familial hypercholesteremia.ResultsThe analysis included 1,363,488 hospitalizations with acute myocardial infarction. The prevalence of familial hypercholesteremia was 0.07% among acute myocardial infarction admissions. Compared with those without familial hypercholesteremia, admissions with familial hypercholesteremia were younger and had less comorbidities but were more likely to have had prior infarct and revascularization. Admissions with familial hypercholesteremia were more likely to present with ST-elevation myocardial infarction and undergo revascularization. After multivariable adjustment, there was no difference in in-hospital case fatality among patients with hypercholesteremia compared with those without it (adjusted odds ratio [aOR] = 0.76; 95% confidence interval [CI] 0.41-1.39). Admissions with acute myocardial infarction and familial hypercholesteremia had higher adjusted rates of cardiac arrest and utilization of mechanical support. There were no group differences in overall 30-day readmission (aOR 0.75; 95% CI 0.51-1.10) or 30-day readmission for acute myocardial infarction. However, a nonsignificant trend toward higher readmission for percutaneous coronary intervention was observed among patients with familial hypercholesteremia (aOR 1.89; 95% CI 0.98-3.64).ConclusionIn this contemporary nationwide observational analysis, patients with familial hypercholesteremia represent a small proportion of the overall population with acute myocardial infarction and have a distinctive clinical profile but do not appear to have worse in-hospital case fatality compared with those without familial hypercholesteremia.