Stereotypes and sexism? Effects of gender, topic, and user comments on journalists’ credibility

Gendered social roles raise assumptions about what female and male journalists ought to do. Prior studies have suggested that covering counter-stereotypical topics may decrease journalists’ source and their work’s message credibility. Pertaining also to prior studies on heuristic cues for credibility evaluation, user comments have been shown to serve as corrective, both positively and negatively affecting the perception of accompanying content. In an online survey with 417 German participants, we employed a 3 (author: female, male, and computer) × 2 (topic: stereotypically masculine and feminine) × 2 (comments: sexist and non-sexist) experimental design to investigate source and message credibility. Findings do not show differences in gender perception but between human authors (either female or male) and a computer (the control group). Covering counter-stereotypical topics indicates slightly less credibility for men and women if presented with non-sexist comments. In turn, sexist comments lead to slightly higher credibility, suggesting more elaborate engagement with sexism-affected content.

Chronic amiodarone therapy and mortality among atrial fibrillation patients; insights from a real-life contemporary population

Background

Although associated with potentially serious side effects, amiodarone is the most effective pharmacotherapy to achieve rhythm control among patients with atrial fibrillation (AF). Recent clinical trials advocate early rhythm control in AF. The effect of amiodarone treatment on mortality among patients with AF in real-life remains largely debatable. The primary aim of this analysis was to compare all-cause mortality rates across amiodarone treatment status

Methods

This is a retrospective study among patients from the Southern district of Clalit Health Services in Israel between January 1st, 1999 and July 1st, 2021 including all prevalent atrial fibrillation cases, hospitalized with AF as a primary diagnosis. Patients treated with amiodarone were matched in a 1:1 manner with controls not exposed to amiodarone based on age, sex, living area, and atrial fibrillation diagnosis duration. To avoid immortal time bias, follow-up times of the matched controls were left adjudicated to truncate the amiodarone-free period of their matched cases. We performed survival analyses using multivariable Cox regression controlling for potential confounders.

Results

During the study period, 7,048 patients who initiated amiodarone treatment were identified, of whom 6,449 were matched with controls. The mean age was 71.5 years, and 46.4% were women among the matched population. At baseline, the amiodarone-treatment group had higher rates of diabetes (38.3% vs. 32.6%, chronic renal failure (17.2% vs. 10.8%), coronary heart disease (31.6% vs. 19.6%) peripheral vascular disease (13.1% vs. 9.8%), and congestive heart failure (33.8% vs. 20.7%; p<0.001 for all). The amiodarone-treatment group had higher rates of oral-anticoagulant therapy (82.0% vs. 59.4%, p<0.001). During a mean follow-up time of 5.7 years, 2849 (44.2%) patients died in the amiodarone group and 3072 (47.6%) patients in the control group [adjusted-hazard-ratio: 0.85 (confidence-interval 95%: 0.80,0.91), p<0.001].

Conclusion

In a large contemporary real-life population with AF, amiodarone treatment was associated with a lower risk for death, despite a higher burden of comorbidities among patients treated with amiodarone. These results support findings from randomized clinical trials advocating aggressive rhythm control therapy to reduce mortality and suggest that amiodarone is a potentially effective treatment to achieve this aim.

Funding Acknowledgement

Type of funding sources: None.

Amiodarone and lung toxicity in a real-life contemporary population

Background

Amiodarone-induced lung toxicity (ALT) is severe and potentially fatal. Most data on ALT are derived from previous decades when amiodarone was administrated chronically in higher doses, while currently, low-dose amiodarone 200 mg is routinely used. Whether low-dose amiodarone treatment is associated with ALT remains untested.

Methods

This is a retrospective study among patients from the Southern district of Clalit Health Services (CHS) in Israel between 1st January 1999 and 1st July 2021. The study population comprised solely of patients with atrial fibrillation since this is the most prevalent condition for prescribing amiodarone. Patients treated with amiodarone were matched in a 1:1 manner with controls not exposed to amiodarone based on age, sex, living area, and atrial fibrillation diagnosis duration. To avoid immortal time bias, follow-up times of the matched controls were left adjudicated to truncate the amiodarone-free period of their matched cases. Patients with prior interstitial lung disease (ILD) were excluded. The primary outcome was the incidence of any ILD. We performed survival analyses using multivariable Cox regression controlling for potential confounders.

Results

During the study period, 7,048 patients who initiated amiodarone treatment were identified, of whom 6,449 were matched with controls. The mean age was 71.5 years, and 46.4% were women among the matched population. The amiodarone-treatment group had higher rates of smoking (30.3% vs. 26.8%, p<0.001), rheumatic disease (4.5% vs. 3.5%, p=0.003), background myocardial infarction (31.6% vs. 19.6%), renal failure (17.2% vs. 10.8%) and congestive heart failure (33.8% vs. 20.7%; p<0.05 for all). During the study, with a mean follow-up time of 5.6 years, ILD occurred in 357 (5.5%) patients in the amiodarone group and 289 (4.5%) patients in the control group [adjusted hazard ratio: 1.09 (confidence interval 95%: 0.91, 1.3), p=0.4].

Conclusion

In a large contemporary real-life population, the incidence of ILD during 5.6 years was relatively low, and treatment with low-dose amiodarone was not associated with an increased risk of ILD. These results, if confirmed by other cohorts, may call for a change in the surveillance policy of patients treated with amiodarone

Funding Acknowledgement

Type of funding sources: None.

Cardiac dysrhythmias among coronavirus-19 recovered symptomatic patients

Background

The coronavirus (COVID-19) pandemic, which affected millions of people worldwide, is associated with a chronic fatigue sequela, also known as long-COVID. While various adverse effects of COVID-19 on the cardiovascular system were reported, the prolonged sequela of COVID-19 on heart rhythm remains unknown.

Aim

To describe the prevalence of cardiac dysrhythmias among patients who presented with Long Covid following recovery from COVID-19 infection.

Methods

We conducted a prospective study among 87 patients who suffered from Long Covid syndrome following recovery from COVID-19 and were treated in the COVID-19 recovery clinic between December 2020 and June 2021. All patients were referred for transthoracic echocardiography (TTE) and 24-hour Holter examination.

Results

The mean age was 52+13 years, and 52 (59.8%) patients were females. Seventy-nine (90.8%) of the patients had normal sinus rhythm without evidence of any arrhythmias. Atrial premature beats were recorded in 70 (80.5%) patients with a median of 6/day (interquartile range 3–20/day; maximum: 5180/day). Ventricular premature beats were recorded in 50 (57.5%) patients with a median of 4/day (interquartile range 2–19/day; maximum: 6847/day). Overall, seven patients (8%) had sustained atrial dysrhythmias: one had atrial fibrillation, one had atrial flutter, and five had atrial tachycardia. Sixty-six (75.9%) patients underwent TTE, which was mainly unremarkable as 65 patients had a normal left ventricular function, and three (4.5%) patients had evidence of pulmonary hypertension.

Discussion

Cardiac arrhythmias are not uncommon among symptomatic COVID-19 recovered patients. Atrial arrhythmias were most common, with an up to 8% incidence rate. These findings may suggest that atrial dysrhythmias may be associated with long-term symptomatic sequela of COVID-19 infection.

Funding Acknowledgement

Type of funding sources: None.

Amiodarone therapy and risk of primary lung cancer; insights from a real-life contemporary population study

Background

Amiodarone is the most effective antiarrhythmic therapy to maintain sinus rhythm in atrial fibrillation (AF) patients. There is a controversy regarding the association of amiodarone therapy with an increased risk of lung cancer. We aimed to assess the relationship between amiodarone treatment and primary lung cancer (PLC) incidence in a contemporary population of AF patients.

Methods

This is a retrospective study among patients from the Southern district of Clalit Health Services in Israel between 1st January 1999 and 1st July 2021. The study population comprised solely of patients with atrial fibrillation since this is the most prevalent condition for prescribing amiodarone. Patients treated with amiodarone were matched in a 1:1 manner with controls not exposed to amiodarone based on age, sex, living area, and atrial fibrillation diagnosis duration. To avoid immortal time bias, follow-up times of the matched controls were left adjudicated to truncate the amiodarone-free period of their matched cases. Patients with prior PLC were excluded. The primary outcome was the incidence of any PLC. We performed survival analyses using multivariable Cox regression controlling for potential confounders.

Results

During the study period, 7,048 patients who initiated amiodarone treatment were identified, of whom 6,449 were matched with controls. The mean age was 71.5 years, and 46.4% were women among the matched population. The amiodarone-treatment group had higher rates of smoking (30.3% vs. 26.8%), prior non-lung-related malignancy (14.9% vs. 13.5%), rheumatic disease (4.5% vs. 3.5%), diabetes (38.3% vs. 32.6%), history of myocardial infarction (316% vs. 19.6%), renal failure (17.2% vs. 10.8%) and congestive heart failure (33.8% vs. 20.7%); p<0.05 for all. During the study, with a mean follow-up time of 5.7 years, PLC occurred in 94 (1.5%) patients in the amiodarone group and 79 (1.2%) patients in the control group [adjusted-hazard-ratio (aHR) 1.10 (confidence-interval 95% (CI95%, 0.78,1.55), p=0.6]. Factors independently associated with increased PLC risk were smoking [aHR 4.25 CI95% (3.01,5.99), p<0.001], non-lung-related malignancy [aHR 1.56, CI95% (1.00,2.42), p=0.050], and peripheral vascular disease [aHR 1.77, CI95% (1.16,2.71), p=0.008]

Conclusion

Chronic amiodarone treatment is not associated with increased risk for PLC. Smoking and prior non-lung-related malignancy and peripheral vascular disease were independently associated with increased PLC risk, suggesting that such patients should undergo closer surveillance for early detection of PLC.

Funding Acknowledgement

Type of funding sources: None.

Sex differences among patients with tachyarrhythmias and bradyarrhythmias following acute myocardial infarction

Background

Acute myocardial infarction (AMI) is commonly complicated by ventricular, supraventricular tachycardias and high-grade atrioventricular block (HAVB) which may result in increased morbidity and mortality.

Purpose

To evaluate the sex differences in tachyarrhythmias and HAVB, and their associated outcomes following AMI.

Methods

Using the Acute Coronary Syndrome Israeli Survey (ACSIS) survey database from 2000–2018, we analyzed the specific incidence rates for arrhythmias including: sustained ventricular tachycardia (VT), ventricular fibrillation (VF), new-onset atrial fibrillation (AF) and HAVB in men and women after AMI. Unadjusted and multivariable-adjusted logistic regression analyses were performed to assess the sex differences of in-hospital arrhythmias after AMI. Multivariate cox proportional hazard models were performed to assess the impact of arrhythmias on 1-year mortality.

Results

In this cohort study of 14280 patients with 3159 (22.1%) women and 11121 (77.9%) men, 316 (2.2%) experienced ventricular arrhythmias (VAs) (sustained VT or secondary VF) with similar rates among men and women (2.3% and 2.2%, respectively, p=0.62). Compared to men, women were less likely to experience primary VF (1.6% vs 2.3%, p=0.034), but more likely to experience AF (8.6% and 5.0%, p<0.001). 372 (2.6%) patients experienced HAVB with higher rates of HAVB in women than men (3.7% and 2.3%, respectively, p<0.001).

After multivariate analyses, the association with primary VF was attenuated (adjusted Odds Ratio (OR) = 0.80, p=0.15) but women remained more likely to experience AF (adjusted OR =1.24, p=0.01) and HAVB (adjusted OR =1.28, p=0.04). The occurrence of VAs was found to be associated with increased mortality in both men (adjusted Hazard Ratio (HR) =3.68, p<0.01) and women (adjusted HR=3.87, p<0.01) without a significant difference between the groups (p for interaction=0.203). The occurrence of AF was found to be associated with increased mortality in both men (adjusted HR=1.64, p<0.001) and women (adjusted HR=1.34, p<0.001) with a significant difference between the groups (p for interaction<0.001). HAVB was found to be associated with increased mortality in both men (adjusted HR=2.31, p<0.001) and women (adjusted HR=2.26, p<0.001) without a significant difference between the groups (p of interaction=0.21).

Conclusions

The incidence rates of VAs after AMI were similar in men and women, except for primary VF, which was more common among men. Women experienced more AF and HAVB than men. VAs, AF and HAVB were found to be associated with increased mortality.

Funding Acknowledgement

Type of funding sources: None.

Cardiac implantable electronic devices: a marker for poor outcome in patients with COVID-19 infection

Background

A high percentage of SARS-CoV-2 patients suffer from comorbidities and there is increasing evidence that previous cardiac disease contributes to poor outcome in these patients (1,2). There is a paucity of information regarding the implications of the disease in patients with cardiac implantable electronic devices (CIEDs). Due to the increasing use of CIEDs in the management of arrhythmias and heart failure, determining the association between CIEDs and the severity of this disease is essential.

Aim

To obtain an adequate understanding regarding the association between cardiac devices and severity of COVID-19 infection in order to achieve optimum management of these patients.

Methods

All clinical and demographic parameters were collected retrospectively from a cohort of patients who underwent implantation of CIED in our Medical Center, Israel. We included 42 patients who tested positive for SARS-CoV-2, between January and December of 2020. Propensity score matching based on age and gender and adjusted Kaplan Meier curve of mortality were performed in order to evaluate the clinical outcome of patients with CIEDs and SARS- CoV-2 infection in comparison to the control group.

Results

The mean age of patients was 72.9 years, compose of 50% male and 50% female in both groups. In the group of patients with CIEDs, 11 (26.1%) patients had implantable defibrillator, and 31 (73.8%) had pacemaker. Univariate analysis revealed that patients with CIEDs suffered more from heart failure, coronary artery disease and atrial fibrillation, as well as hypertension, diabetes, and chronic kidney disease. Four patients (9.5%) with cardiac devices were hospitalized in the ICU due to critical illness, as compared to 1 (0.6%) patient in the control group (p=0.005). Moreover, 10 patients in the cardiac devices group (23.8%) died of SARS-CoV-2 infection, versus 25 (14.9%) in the control group.

Conclusions

CIEDs are a marker of poor outcome in patients with SARS-CoV-2 infection. Patients with CIEDs suffer from increased comorbidities in comparison with age and gender matched population and therefore should be managed with the utmost caution.

Funding Acknowledgement

Type of funding sources: None. KM curve of all-cause mortality

How search engines may help reduce drug-related suicides

BACKGROUND AND AIMS

Numbers of drug-overdose deaths, both intentionally and unintentionally, have been increasing in the United States. Of interest, Google spotlights counselling services as helpful resources when users query for suicide-related search terms. However, the search engine does so at varying display rates, depending on terms used. Display rates in the drug-overdose deaths domain are unknown.

METHODS

We emulated suicide-related potentially harmful searches at large scale across the U.S. to explore Google's response to search queries including or excluding additional drug-related terms. Employing agent-based testing we conducted 215,999 search requests with varying combinations of search terms.

RESULTS

Counseling services such as helpline telephone numbers were displayed at high rates after suicide-related potentially harmful search queries (e.g., "how to commit suicide"). While this is a desirable outcome, display rates were substantially lower when drug-related terms, indicative of users' suicidal overdosing tendencies, were added (e.g., "how to commit suicide fentanyl"). Importantly, the addition of any drug-related search term to the suicide-related queries decreased the display frequency of helpful prevention-related resources substantially.

CONCLUSIONS

Search queries such as "easy way to commit suicide fentanyl" may indicate acute suicidal crises. Helpful resources should be displayed right in such search moments. Search engines should adjust their algorithms to increase these display rates to direct users to such resources. By doing this, search engines may contribute to the prevention of drug-related suicides.

Gütekriterien und Handlungsempfehlungen für die Entwicklung von Forschungssoftware in der Kommunikations- und Medienwissenschaft

Die Entwicklung von Forschungssoftware ist für die empirische Kommunikations- und Medienwissenschaft (KMW) aufgrund sozialer, gesetzlicher, normativer und technologischer Veränderungen unabdingbar. Forschungssoftware umfasst dabei Skripte und Programme, die für den Zweck der Forschung und innerhalb des Fachs entwickelt werden, deren Entwicklung in der KMW jedoch, im Gegensatz zu einigen anderen Disziplinen, häufig innerhalb einzelner Forschungsprojekte und nicht selten durch (autodidaktisch) programmierende Forschende erfolgt - ein Umstand, der zwar Innovation fördert, gleichzeitig aber einer Institutionalisierung von Forschungssoftware entgegensteht. Dieser Beitrag leitet daher aus in dieser Hinsicht fortschrittlicheren Disziplinen neun Gütekriterien für Forschungssoftware in der KMW ab: Forschungssoftware sollte demnach zugänglich, anschlussfähig, verständlich, nachvollziehbar, autonom, strukturiert, verifiziert, umsichtig und nutzbar sein. Darauf aufbauend schlägt der Beitrag vier Handlungsempfehlungen vor, um diese Güte auch nachhaltig zu institutionalisieren: frühzeitige und gestärkte Methodenausbildung, angemessene Möglichkeiten der Sichtbarkeit und Anerkennung, mehr und passendere Förderformate sowie institutionalisierte Anreize, die eine professionelle Auseinandersetzung mit Forschungssoftware auch in Karriereoptionen übersetzen.

Algorithmic Actants in Practice, Theory, and Method

What changes as algorithms proliferate within journalism and become more sophisticated? In this essay, we synthesize the articles in this thematic issue, which offer empirical evidence for how algorithms—and especially those designed to automate news production—are being incorporated not only into journalistic activities but also into the logics of journalism itself. They underscore that journalists have neither feared nor rejected such algorithms, as might be expected given the recent history of technological adoption in journalism. Instead, journalists have sought to normalize the technology by negotiating them against existing values and practices, and perhaps even reified some normative ideological constructs by finding unique value in what they offer as humans. These articles also highlight the shortcomings of those algorithms, giving pause to postulations of algorithms as potential solutions to shortcomings of trust in news and market failures. Indeed, such algorithms may end up amplifying the very biases that seed distrust in news all the while appearing less valuable to readers than their human counterparts. We also point to new opportunities for research, including examinations of how algorithms shape other stages in the journalistic workflow, such as interviewing sources, organizing knowledge, and verifying claims. We further point to the need to investigate higher analytic levels and incorporate additional perspectives, both from more diverse contexts (e.g., Global South) and from our sister academic fields (e.g., human–computer interaction). We conclude with optimism about the continued contributions this stream of work is poised to make in the years to come.

307Clinical outcomes of pacing induced cardiomyopathy in patients with preserved left ventricular systolic function and atrioventricular block

Funding Acknowledgements

None

Background

Patients with preserved LVEF and atrioventricular block (AVB) who are anticipated for high-burden of right ventricular (RV) pacing possess a risk to develop pacing induced cardiomyopathy (PICM).

Aims

To evaluate the incidence and outcomes of RV-PICM in this patient"s population.

Methods

1013 patients with AVB underwent first time pacemaker (PM) implantation between 2002 and 2016. A total of 203 patients with normal LVEF were included. Follow-up echocardiography was examined for a decrease in LVEF > 10%. Alternative causes for cardiomyopathy were excluded. Patient"s characteristics, mortality and hospitalizations for heart failure (HF) were compared between the PICM and non-PICM groups. 

Results

51 patients (25%) developed PICM, with 22 patients (11%) showing LVEF < 40%. During mean follow-up of 49.2 months, the risk of HF hospitalization or all-cause mortality was significantly higher in the PICM group (35.3% vs. 19.1%, p = 0.009). LVEDD was independently associated with PICM (HR = 1.10, 95% CI: 1.03-1.17, p = 0.01) and CAD was nearly associated with PICM (HR = 2.19, 95% CI: 0.98-4.90, p = 0.06). 

Conclusions

The incidence of PICM in patients with normal LVEF and AVB is alarmingly high. PICM in patients with a previously normal LVEF is associated with unfavorable outcomes.

Table 1 Characteristics Cohort without PICM (152) n (%) Cohort with PICM (51) n(%) p Age mean ± SD 74.6 ± 10.5 71 ± 13 0.04 Gender (male) 80 (52.6) 29 (56.9) 0.6 Pacing modeDDDVDDVVI 108 (71.1) 38 (25) 6 (3.9) 34 (66.7) 15 (29.4) 2(3.9) 0.83 Hypertension 112 (73.7) 36 (70.6) 0.67 PVD 16 (10.5) 5 (8.9) 0.88 CAD 36 (23.7) 19 (37.3) 0.01 CVA / TIA 17 (11.2) 7 (13.7) 0.63 Atrial fibrillation / flutter 18 (11.8) 9 (17.6) 0.29 COPD 15 (9.9) 2 (3.9) 0.25 Diabetes Mellitus 56 (36.8) 27 (52.9) 0.04 Chronic Kidney Disease 27 (17.9) 14 (27.5) 0.14 Statins 65 (43) 30(60) 0.04 ACE inhibitors / ARBs 52 (34.4) 18 (36) 0.84 Beta Blockers 42 (28) 10 (20) 0.26 LVEDD mm 45.13 ± 5.53 48.46 ± 5.97 <0.001 LVESD mm 25.68 ± 5.28 27.72 ± 4.67 0.02 Baseline characteristics

Abstract Figure. HF and Mortality outcomes

P391Estimated glomerular filtration rate levels and risk of stroke in individuals with diabetes mellitus and atrial fibrillation

Funding Acknowledgements

pfizer

Background

Diabetes mellitus (DM) is associated with increased risk of embolic complications in non-valvular atrial fibrillation (NVAF). Chronic kidney disease (CKD) has been shown in some studies to increase the risk of stroke. This finding is not consistent among all studies. Therefore the relationship between kidney function, diabetes and stroke risk is complex and warrants further investigation.

Purpose

To assess the incidence rates and risk of ischemic stroke and mortality by baseline Estimated Glomerular Filtration Rate (eGFR) levels among individuals with AF and DM.

Methods

A prospective, historical cohort study using our electronic medical records database. The study population included all members 21 years old, with a first diagnosis of NVAF between January 1, 2010 to December 31, 2016 and a minimal follow-up period of 1 year. Among those patients identified as diabetics, we compared three groups of patients according to eGFR levels at the time of AF diagnosis: eGFR ≥ 60, between 30-60 and ≤ 30 or chronic dialysis or kidney transplant.

Results

A total of  17,567 cases were included in the final analysis, of them, 11013 (62.7%) had eGFR ≥ 60, 4930 (28%) with eGFR between 30-60 and 1624 (9.24%) with eGFR ≤30 . The median age was 75 years (IQR 65-83) with a majority of females in all groups, 52.5%, 51.2% and 55.5% respectively. The incidence of stroke per 100 person-years in the three study groups was: 1.88 in patients with eGFR ≥ 60, 2.69 in patients with eGFR between 30-60 and 3.34 in those with eGFR ≤ 30 . Impaired renal function was associated with increased risk of stroke in univariate analysis, but not found in the adjusted model  (Adjusted Hazard Ratio (AHR) = 1.04 {95% 0.89-1.23} for eGFR 30-60  and 1.16 {95% CI 0.88-1.51} for eGFR ≤ 30 compared to GFR ≥ 60). incidence of mortality per 100 person-years was 10.78 in patients with  eGFR ≥ 60, 21.49 in patients with eGFR 30-60 and 41.55 in those with eGFR ≤ 30. In both univariate and multivariate analyses, decreased levels of eGFR were associated with increased mortality risk compared to subjects with normal renal function (AHR 1.22 {95%CI 1.14-1.27} and AHR 2.09 {95%CI 1.95-2.24} for eGFR between 30-60 and for eGFR ≤ 30, respectively).

Conclusion

In this observational prospective cohort of patients with newly diagnosed NVAF, impaired renal function was not found to be associated with increased risk of stroke. Lower eGFR levels were associated with an increased mortality risk.

73Hemoglobin a1c levels and the risk of ischemic stroke and mortality in individuals with diabetes mellitus and atrial fibrillation

Funding Acknowledgements

Pfizer Israel

Background

Diabetes mellitus (DM) is associated with increased risk of embolic complications in non-valvular atrial fibrillation (NVAF). Whether the risk of stroke in AF patients remains the same among the wide spectrum of disease is yet to be determined.

Aim

Among individuals with AF and DM, to assess the incidence rates and risk of ischemic stroke and mortality by baseline HbA1C levels.

Methods

We conducted a prospective, historical cohort study using the Clalit Health Services (CHS) electronic medical records database. The study population included all CHS members ≥ 21 years old, with a first diagnosis of NVAF between January 1, 2010 to December 31, 2016 and a minimal follow-up period of 1 year. Among those patients identified as diabetics, we compared three groups of patients according to HBA1C levels at the time of AF diagnosis: <7.0%, between 7-9% and ≥ 9%.

Results

A total of 44,451 cases were identified. The median age was 75 years (IQR 65-83) and 52.5% were women. During a mean follow up of 38 months, the incidence of stroke per 100 person-years in the three study groups was: 1.9 in patients with HBA1C <7%, 2.37 in the intermediary group and 2.72 in those with HBA1C >9%. In both univariate and multivariate analyses, higher levels of HBA1C were associated with an increased risk of stroke compared with a dose-dependent response when compared to individuals with HBA1C <7% (Adjusted Hazard Ratio (AHR) = 1.32 {95% CI 1.12-1.55}for levels between 7-9% and AHR 1.64 {95% CI 1.28-2.09}) even after adjusting for CHA2DS2-VASC individual risk factors and use of oral anti-coagulants. The risk for overall mortality did not differ significantly between groups, with a slight elevation in the HBA1C >9% group after adjusted analysis {aHR = 1.17 (1.07- 1.28)} Conclusion: In this observational cohort of patients with incident newly diagnosed nonvalvular atrial fibrillation, HBA1C levels were associated with an increased risk of stroke in a dose-dependent manner even after accounting for other recognized risk factors for stroke in this population.

Abstract Figure. Kaplan-Meier for stroke-free survival

P468Pre-diabetes a new risk factor for stroke in non-valvular atrial fibrillation

Funding Acknowledgements

Pfizer Israel

Background

Diabetes mellitus is a well-established independent risk factor for embolic complications in patients with non-valvular atrial fibrillation (NVAF). The association between prediabetes and risk of ischemic stroke, however, has not been studied separately in patients with NVAF.

Purpose

To evaluate whether pre-diabetes is associated with increased risk of stroke and death in patients with NVAF

Methods

We conducted a prospective, historical cohort study using the Clalit Health Services (CHS) electronic medical records database. The study population included all CHS members ≥ 21 years old, with a first diagnosis of NVAF between January 1 2010 to December 31 2016 and a minimal follow-up period of 1 year. We compared three groups of patients:  prediabetes, those with established DM, and normoglycemic individuals

Results

A total of 44,451 cases were identified. The median age was 75 years and 52.5% were women. During a mean follow up of 38 months, the incidence of stroke per 100 person-years in the three study groups was: 1.14 in non-diabetics, 1.40 in pre-diabetics and 2.15 in diabetics. In both univariate and multivariate analyses, pre-diabetes was associated with an increased risk of stroke compared with non-diabetics (Adjusted Hazard Ratio (HR) = 1.19 {95% CI 1.01-1.4}) even after adjusting for CHA2DS2-VASC individual risk factors and use of oral anti-coagulants while diabetes conferred an even higher risk (vs non-diabetics { HR = 1.56, 95% CI ;1.37 - 1.79}). The risk for mortality was higher for diabetics (HR =1.47,  95% CI ;1.41, 1.54}) but not for pre-diabetics (HR = 0.98 ,CI 95%; 0.92 - 1.03). Conclusion: In this observational cohort of patients with incident newly diagnosed patients with NVAF, pre-diabetes was associated with an increased risk of stroke even after accounting for other recognized risk factors.

Abstract Figure. Kaplan-Meier for stroke-free survival

P997Risk of stroke and mortality in patients with atrial fibrillation and insulin dependent versus non-insulin dependent diabetes mellitus

Funding Acknowledgements

Pfizer pharmaceutical corporation

Background

Diabetes is a known risk factor for thromboembolic events in patients with non-valvular atrial fibrillation (NVAF). Whether patients on insulin therapy are at an increased risk for stroke compered to patients treated solely by oral antidiabetic medications is not yet established.

Aim

To assess the risk of ischemic stroke and mortality in patients with NVAF and diabetes mellitus (DM) treated by insulin vs. oral antidiabetic treatment.

Methods

A prospective, historical cohort study based on the Clalit Health Services (CHS) electronic medical records database, including all individuals age ≥ 21 years with a first diagnosis of NVAF between January 2010 to December 2016 and a minimal follow-up period of 1 year. Patients were divided into two groups based on their diabetes therapy regiment (insulin vs. oral antidiabetic medications).

Results

Overall study population included 12,231 patients with AF and DM, of them 3510 (28.7%) had an insulin-requiring diabetes. The median age was 72.4 years (IQR 65-80) in the insulin- treated group and 75.2 (IQR 68-83) in the orally treated group, with a slight majority of women in both groups, 51.6% and 53.5% respectively. Patients in the insulin group had significantly higher co-morbidity rates including hypertension (HTN) (93.6% vs. 91.2%; p < 0.001), congestive heart failure (CHF) (38% vs. 22.2%%; p < 0.001), previous cerebrovascular accident/ transient ischemic attack (CVA/TIA) (23.1% vs.14.5%;  p < 0.001) and vascular diseases (62.1% vs. 46.5%; p < 0.001). Moreover, patient on insulin therapy were significantly less treated with anticoagulation medications at baseline compered to patients not treated with insulin (38.9% vs. 46.6%; p < 0.001). The incidence of stroke per 100 person-years was 2.62 in the insulin-treated group and 2.02 in the oral-treated group. Although, diabetes patients on insulin therapy had a significantly increased risk for stroke compared to patients not treated with insulin in the univariate analysis (HR: 1.34; 95%CI: 1.13- 1.60), this association was not found to be significant after adjusting for confounding variables (HR: 1.17; 95%CI: 0.96- 1.41). The rate of mortality per 100 person-years was 19 in the insulin-treated group and 12.6 in the oral-treated group. The risk for overall mortality was significantly higher in the insulin-treated group compared to the non-insulin group (HR: 1.38; 95%CI: 1.29- 1.48), as found in the multivariate Cox model, adjusted for age, gender, Creatinine clearance, HTN, CHF , CVA/TIA, vascular diseases, duration of diabetes and use of anticoagulation therapy.

Conclusion

In this cohort of patients with newly diagnosed NVAF and DM, patients on insulin are at increased risk of all cause mortality and a have a trend of increased risk of stroke after accounting for other recognized risk factors for stroke and mortality in this population.

Abyss or Shelter? On the Relevance of Web Search Engines' Search Results When People Google for Suicide

Despite evidence that suicide rates can increase after suicides are widely reported in the media, appropriate depictions of suicide in the media can help people to overcome suicidal crises and can thus elicit preventive effects. We argue on the level of individual media users that a similar ambivalence can be postulated for search results on online suicide-related search queries. Importantly, the filter bubble hypothesis (Pariser, 2011) states that search results are biased by algorithms based on a person's previous search behavior. In this study, we investigated whether suicide-related search queries, including either potentially suicide-preventive or -facilitative terms, influence subsequent search results. This might thus protect or harm suicidal Internet users. We utilized a 3 (search history: suicide-related harmful, suicide-related helpful, and suicide-unrelated) × 2 (reactive: clicking the top-most result link and no clicking) experimental design applying agent-based testing. While findings show no influences either of search histories or of reactivity on search results in a subsequent situation, the presentation of a helpline offer raises concerns about possible detrimental algorithmic decision-making: Algorithms "decided" whether or not to present a helpline, and this automated decision, then, followed the agent throughout the rest of the observation period. Implications for policy-making and search providers are discussed.

Clinical implementation of cardiac resynchronization therapy-regional disparities across selected ESC member countries

Background

The present analysis aimed to estimate the penetration of cardiac resynchronization therapy (CRT) on the basis of the prevalence and incidence of eligible patients in selected European countries and in Israel.

Methods and Results

The following countries were considered: Italy, Slovakia, Greece, Israel, Slovenia, Serbia, the Czech Republic, Poland, Romania, Hungary, Ukraine, and the Russian Federation. CRT penetration was defined as the number of patients treated with CRT (CRT patients) divided by the prevalence of patients eligible for CRT. The number of CRT patients was estimated as the sum of CRT implantations in the last 5 years, the European Heart Rhythm Association (EHRA) White Book being used as the source. The prevalence of CRT indications was derived from the literature by applying three epidemiologic models, a synthesis of which indicates that 10% of heart failure (HF) patients are candidates for CRT. HF prevalence was considered to range from 1% to 2% of the general population, resulting in an estimated range of prevalence of CRT indication between 1000 and 2000 patients per million inhabitants. Similarly, the annual incidence of CRT indication, representing the potential target population once CRT has fully penetrated, was estimated as between 100 and 200 individuals per million. The results showed the best CRT penetration in Italy (47–93%), while in some countries it was less than 5% (Romania, Russian Federation, and Ukraine).

Conclusion

CRT penetration differs markedly among the countries analyzed. The main barriers are the lack of reimbursement for the procedure and insufficient awareness of guidelines by the referring physicians.