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Tran C, Yeap BB, Ball J, Clayton-Chubb D, Hussain SM, Brodtmann A, Tonkin AM, Neumann JT, Schneider HG, Fitzgerald S, Woods RL, McNeil JJ. Testosterone and the risk of incident atrial fibrillation in older men: further analysis of the ASPREE study. EClinicalMedicine 2024; 72:102611. [PMID: 38707912 PMCID: PMC11067494 DOI: 10.1016/j.eclinm.2024.102611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Background A cardiovascular safety trial of testosterone in men with cardiovascular risk factors or disease found no difference in rates of major adverse cardiovascular events (MACE) or death but noted more atrial fibrillation (AF) events in testosterone-treated men. We investigated the relationship between endogenous testosterone concentrations with risk of developing AF in healthy older men. Methods Post-hoc analysis of 4570 male participants in the ASPirin in Reducing Events in the Elderly (ASPREE) study. Men were aged ≥ 70 years, had no history of cardiovascular disease (including AF), thyroid disease, prostate cancer, dementia, or life-threatening illnesses. Risk of AF was modelled using Cox proportional hazards regression. Findings Median (IQR) age was 73.7 (71.6-77.1) years and median (IQR) follow-up 4.4 (3.3-5.5) years, during which 286 men developed AF (15.3 per 1000 participant-years). Baseline testosterone was higher in men who developed incident AF compared men who did not [17.0 (12.4-21.2) vs 15.7 (12.2-20.0) nmol/L]. There was a non-linear association of baseline testosterone with incident AF. The risk for AF was higher in men with testosterone in quintiles (Q) 4&5 (Q4:Q3, HR = 1.91; 95%CI = 1.29-2.83 and Q5:Q3HR = 1.98; 95%CI = 1.33-2.94). Results were similar after excluding men who experienced MACE or heart failure during follow-up. Interpretation Circulating testosterone concentrations within the high-normal range are independently associated with an increased risk of incident AF amongst healthy older men. This suggests that AF may be an adverse consequence of high-normal total testosterone concentrations. Funding National Institute on Aging and National Cancer Institute at the National Institutes of Health; Australian Government (NHMRC, CSIRO); Monash University; and AlfredHealth.
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Affiliation(s)
- Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bu B. Yeap
- Medical School, University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Daniel Clayton-Chubb
- Department of Gastroenterology, The Alfred Hospital, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Johannes T. Neumann
- University Heart and Vascular Center Hamburg, University Medical Center Hamburg – Eppendorf, Hamburg, Germany
- German Center of Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lubeck, Germany
| | - Hans G. Schneider
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Clinical Biochemistry Unit Alfred Pathology Service Alfred Health Melbourne, Victoria, Australia
| | - Sharyn Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Dawson LP, Ball J, Wilson A, Voskoboinik A, Nehme Z, Horrigan M, Emerson L, Kaye D, Stub D. Population trends in the incidence and outcomes of atrial fibrillation presentations to emergency departments in Victoria, Australia. Heart Rhythm 2024; 21:693-695. [PMID: 38219891 DOI: 10.1016/j.hrthm.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Affiliation(s)
- Luke P Dawson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Andrew Wilson
- Department of Health Services, Safer Care Victoria, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- The Alfred Hospital, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Ambulance Victoria, Melbourne, Victoria, Australia
| | - Mark Horrigan
- St Vincent's Health, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia
| | - Lance Emerson
- Department of Health Services, Safer Care Victoria, Melbourne, Victoria, Australia
| | - David Kaye
- The Alfred Hospital, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; The Alfred Hospital, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
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Baxter MA, Denholm M, Kingdon SJ, Kathirgamakarthigeyan S, Parikh S, Shakir R, Johnson R, Martin H, Walton M, Yao W, Swan A, Samuelson C, Ren X, Cooper A, Gray HL, Clifton S, Ball J, Gullick G, Anderson M, Dodd L, Hayhurst H, Salama M, Shotton R, Britton F, Christodoulou T, Abdul-Hamid A, Eichholz A, Evans RM, Wallroth P, Gibson F, Poole K, Rowe M, Harris J. CAnceR IN PreGnancy (CARING) - a retrospective study of cancer diagnosed during pregnancy in the United Kingdom. Br J Cancer 2024; 130:1261-1268. [PMID: 38383704 PMCID: PMC11014900 DOI: 10.1038/s41416-024-02605-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND The incidence of cancer diagnosed during pregnancy is increasing. Data relating to investigation and management, as well as maternal and foetal outcomes is lacking in a United Kingdom (UK) population. METHODS In this retrospective study we report data from 119 patients diagnosed with cancer during pregnancy from 14 cancer centres in the UK across a five-year period (2016-2020). RESULTS Median age at diagnosis was 33 years, with breast, skin and haematological the most common primary sites. The majority of cases were new diagnoses (109 patients, 91.6%). Most patients were treated with radical intent (96 patients, 80.7%), however, gastrointestinal cancers were associated with a high rate of palliative intent treatment (63.6%). Intervention was commenced during pregnancy in 68 (57.1%) patients; 44 (37%) had surgery and 31 (26.1%) received chemotherapy. Live births occurred in 98 (81.7%) of the cases, with 54 (55.1%) of these delivered by caesarean section. Maternal mortality during the study period was 20.2%. CONCLUSIONS This is the first pan-tumour report of diagnosis, management and outcomes of cancer diagnosed during pregnancy in the UK. Our findings demonstrate proof of concept that data collection is feasible and highlight the need for further research in this cohort of patients.
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Affiliation(s)
- M A Baxter
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK.
| | - M Denholm
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
| | - S J Kingdon
- Exeter Oncology Centre, Royal Devon University Hospitals NHS Trust, Exeter, UK
| | | | - S Parikh
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Shakir
- Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Johnson
- Oncology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - H Martin
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Early Cancer Institute, Department of Oncology, University of Cambridge, Cambridge, UK
- Cancer Research UK Cambridge Institute, Cambridge University, Cambridge, UK
| | - M Walton
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - W Yao
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Swan
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - C Samuelson
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - X Ren
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - A Cooper
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - H-L Gray
- Tayside Cancer Centre, Ninewells Hospital and Medical School, NHS Tayside, Dundee, UK
| | - S Clifton
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - J Ball
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - G Gullick
- Oncology Department, Royal United Hospitals NHS Foundation Trust, Bath, UK
| | - M Anderson
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - L Dodd
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - H Hayhurst
- Northern Centre for Cancer Care, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, The Newcastle Upon Tyne, UK
| | - M Salama
- Department of Oncology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Shotton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - F Britton
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - T Christodoulou
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A Abdul-Hamid
- Department of Oncology, Royal Surrey County Hospital NHS Trust, Surrey, UK
| | - A Eichholz
- Department of Oncology, Buckinghamshire Healthcare NHS Trust, Buckinghamshire, UK
| | - R M Evans
- South West Wales Cancer Centre, Swansea Bay NHS Trust, Swansea, UK
| | | | - F Gibson
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - K Poole
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, Belmont, Sutton, Surrey, UK
| | - M Rowe
- Sunrise Oncology Centre, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - J Harris
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Bloom JE, Nehme E, Paratz ED, Dawson L, Nelson AJ, Ball J, Eliakundu A, Voskoboinik A, Anderson D, Bernard S, Burrell A, Udy AA, Pilcher D, Cox S, Chan W, Mihalopoulos C, Kaye D, Nehme Z, Stub D. Healthcare and economic cost burden of emergency medical services treated non-traumatic shock using a population-based cohort in Victoria, Australia. BMJ Open 2024; 14:e078435. [PMID: 38684259 PMCID: PMC11057314 DOI: 10.1136/bmjopen-2023-078435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES We aimed to assess the healthcare costs and impact on the economy at large arising from emergency medical services (EMS) treated non-traumatic shock. DESIGN We conducted a population-based cohort study, where EMS-treated patients were individually linked to hospital-wide and state-wide administrative datasets. Direct healthcare costs (Australian dollars, AUD) were estimated for each element of care using a casemix funding method. The impact on productivity was assessed using a Markov state-transition model with a 3-year horizon. SETTING Patients older than 18 years of age with shock not related to trauma who received care by EMS (1 January 2015-30 June 2019) in Victoria, Australia were included in the analysis. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome assessed was the total healthcare expenditure. Secondary outcomes included healthcare expenditure stratified by shock aetiology, years of life lived (YLL), productivity-adjusted life-years (PALYs) and productivity losses. RESULTS A total of 21 334 patients (mean age 65.9 (±19.1) years, and 9641 (45.2%) females were treated by EMS with non-traumatic shock with an average healthcare-related cost of $A11 031 per episode of care and total cost of $A280 million. Annual costs remained stable throughout the study period, but average costs per episode of care increased (Ptrend=0.05). Among patients who survived to hospital, the average cost per episode of care was stratified by aetiology with cardiogenic shock costing $A24 382, $A21 254 for septic shock, $A19 915 for hypovolaemic shock and $A28 057 for obstructive shock. Modelling demonstrated that over a 3-year horizon the cohort lost 24 355 YLLs and 5059 PALYs. Lost human capital due to premature mortality led to productivity-related losses of $A374 million. When extrapolated to the entire Australian population, productivity losses approached $A1.5 billion ($A326 million annually). CONCLUSION The direct healthcare costs and indirect loss of productivity among patients with non-traumatic shock are high. Targeted public health measures that seek to reduce the incidence of shock and improve systems of care are needed to reduce the financial burden of this syndrome.
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Affiliation(s)
- Jason E Bloom
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Emily Nehme
- Research & Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
| | | | - Luke Dawson
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Adam J Nelson
- Victorian Heart Institute, Clayton, North Carolina, Australia
| | - Jocasta Ball
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Amminadab Eliakundu
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
| | - Aleksandr Voskoboinik
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - David Anderson
- Ambulance Victoria, Doncaster, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | | | | | - Andrew A Udy
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | | | - Shelley Cox
- Research & Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
| | - William Chan
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Western Health, St Albans, Victoria, Australia
| | | | - David Kaye
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Research & Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Dion Stub
- Monash University School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
- Ambulance Victoria, Doncaster, Victoria, Australia
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5
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Zheng WC, Evans N, Dinh D, Bloom JE, Brennan AL, Ball J, Lefkovits J, Shaw JA, Reid CM, Chan W, Stub D. Clinical Outcomes of Renal Transplant Recipients Undergoing Percutaneous Coronary Intervention. Heart Lung Circ 2024:S1443-9506(24)00073-8. [PMID: 38565437 DOI: 10.1016/j.hlc.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Clinical outcomes of patients with renal transplant (RT) undergoing percutaneous coronary intervention (PCI) remain poorly elucidated. METHOD Between 2014 and 2021, data were analysed for the following three groups of patients undergoing PCI enrolled in a multicentre Australian registry: (1) RT recipients (n=226), (2) patients on dialysis (n=992), and (3) chronic kidney disease (CKD) patients (estimated glomerular filtration rate [eGFR], 30‒60 mL/min per 1.73 m2) without previous RT (n=15,534). Primary outcome was 30-day major adverse cardiac and cerebrovascular events (MACCEs)-composite of mortality, myocardial infarction, stent thrombosis, target vessel revascularisation, and stroke. RESULTS RT recipients were younger than dialysis and patients with CKD (61±10 vs 68±12 vs 78±8.2 years, p<0.001). Patients with RT less frequently had severe left ventricular dysfunction compared with dialysis and CKD groups (6.7% vs 14% and 8.5%); however more, often presented with acute coronary syndrome (58% vs 52% and 48%), especially STEMI (all p<0.001). Patients with RT and CKD had lower rates of 30-day MACCE (4.4% and 6.8% vs 11.6%, p<0.001) than the dialysis group. Three-year survival was similar between RT and CKD groups, however was lower in the dialysis group (80% and 83% vs 60%, p<0.001). After adjustment, dialysis was an independent predictor of 30-day MACCE (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.44‒2.50, p<0.001), however RT was not (OR 0.91, CI 0.42‒1.96, p=0.802). Both RT (hazard ratio [HR] 2.07, CI 1.46‒2.95, p<0.001) and dialysis (HR 1.35, CI 1.02‒1.80, p=0.036) heightened the hazard of long-term mortality. CONCLUSIONS RT recipients have more favourable clinical outcomes following PCI compared with patients on dialysis. However, despite having similar short-term outcomes to patients with CKD, the hazard of long-term mortality is significantly greater for RT recipients.
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Affiliation(s)
- Wayne C Zheng
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Nicole Evans
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Jason E Bloom
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Angela L Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - James A Shaw
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; School of Population Health, Curtin University, Perth, WA, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Melbourne, Vic, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, Melbourne, Vic, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
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6
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Ball J, Nehme Z, Stub D. At an intersection of public health crises: Drugs, a pandemic, and out-of-hospital cardiac arrest. Resuscitation 2024; 195:110127. [PMID: 38295897 DOI: 10.1016/j.resuscitation.2024.110127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024]
Affiliation(s)
- J Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Monash Alfred Baker Centre for Cardiovascular Research, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia.
| | - Z Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Moorooduc Highway, Frankston, Victoria, Australia
| | - D Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Monash Alfred Baker Centre for Cardiovascular Research, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
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7
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Bloom JE, Wong N, Nehme E, Dawson LP, Ball J, Anderson D, Cox S, Chan W, Kaye DM, Nehme Z, Stub D. Association of socioeconomic status in the incidence, quality-of-care metrics, and outcomes for patients with cardiogenic shock in a pre-hospital setting. Eur Heart J Qual Care Clin Outcomes 2024; 10:89-98. [PMID: 36808236 DOI: 10.1093/ehjqcco/qcad010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/23/2023] [Accepted: 02/04/2023] [Indexed: 02/19/2023]
Abstract
AIMS The relationship between lower socioeconomic status (SES) and poor cardiovascular outcomes is well described; however, there exists a paucity of data exploring this association in cardiogenic shock (CS). This study aimed to investigate whether any disparities exist between SES and the incidence, quality of care or outcomes of CS patients attended by emergency medical services (EMS). METHODS AND RESULTS This population-based cohort study included consecutive patients transported by EMS with CS between 1 January 2015 and 30 June 2019 in Victoria, Australia. Data were collected from individually linked ambulance, hospital, and mortality datasets. Patients were stratified into SES quintiles using national census data produced by the Australian Bureau of Statistics.A total of 2628 patients were attended by EMS for CS. The age-standardized incidence of CS amongst all patients was 11.8 [95% confidence interval (95% CI), 11.4-12.3] per 100 000 person-years, with a stepwise increase from the highest to lowest SES quintile (lowest quintile 17.0 vs. highest quintile 9.7 per 100 000 person-years, P-trend < 0.001). Patients in lower SES quintiles were less likely to attend metropolitan hospitals and more likely to be received by inner regional and remote centres without revascularization capabilities. A greater proportion of the lower SES groups presented with CS due to non-ST elevation myocardial infarction (NSTEMI) or unstable angina pectoris (UAP), and overall were less likely to undergo coronary angiography. Multivariable analysis demonstrated an increased 30-day all-cause mortality rate in the lowest three SES quintiles when compared with the highest quintile. CONCLUSION This population-based study demonstrated discrepancies between SES status in the incidence, care metrics, and mortality rates of patients presenting to EMS with CS. These findings outline the challenges in equitable healthcare delivery within this cohort.
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Affiliation(s)
- Jason E Bloom
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
- Department of Research and Evaluation, Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Nathan Wong
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Emily Nehme
- Department of Research and Evaluation, Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Luke P Dawson
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
- Department of Research and Evaluation, Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - David Anderson
- Department of Research and Evaluation, Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
- Department of Paramedicine, Monash University, McMahons Road, Frankston, VIC 3199, Australia
- Department of Intensive Care, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
| | - Shelley Cox
- Department of Research and Evaluation, Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Ziad Nehme
- Department of Research and Evaluation, Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
- Department of Paramedicine, Monash University, McMahons Road, Frankston, VIC 3199, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
- Department of Research and Evaluation, Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
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8
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Ball J, Neumann JT, Tonkin AM, Kirchhof P, Freedman B, Brodtmann A, Reid C, Nelson MR, Beilin LJ, Fitzgerald S, Stub D, Woods RL, McNeil JJ. Low-dose aspirin and incident atrial fibrillation in healthy older individuals: a post-hoc analysis of the ASPREE trial. Eur Heart J Cardiovasc Pharmacother 2024; 10:81-82. [PMID: 37951294 PMCID: PMC10766903 DOI: 10.1093/ehjcvp/pvad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 11/13/2023]
Affiliation(s)
- J Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
| | - J T Neumann
- University Heart and Vascular Center Hamburg, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), 10785 Berlin, Germany
| | - A M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - P Kirchhof
- University Heart and Vascular Center Hamburg, University Medical Center Hamburg—Eppendorf, 20251 Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), 10785 Berlin, Germany
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - B Freedman
- Heart Rhythm and Stroke Group, Heart Research Institute, Sydney 2042, Australia
- Charles Perkins Centre, The University of Sydney, Sydney 2050, Australia
| | - A Brodtmann
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Cognitive Health Initiative, Central Clinical School, Monash University, Melbourne 3004, Australia
| | - C Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- School of Population Health, Curtin University, Perth, Western Australia 6102, Australia
| | - M R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania 7000, Australia
| | - L J Beilin
- UWA Medical School, University of Western Australia, Perth 6009, Australia
| | - S Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - D Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia
- Department of Cardiology, Alfred Health, Melbourne, Victoria 3004, Australia
| | - R L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - J J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
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9
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Baldi E, Klersy C, Chan P, Elmer J, Ball J, Counts CR, Rosell Ortiz F, Fothergill R, Auricchio A, Paoli A, Karam N, McNally B, Martin-Gill C, Nehme Z, Drucker CJ, Ruiz Azpiazu JI, Mellett-Smith A, Cresta R, Scquizzato T, Jouven X, Primi R, Al-Araji R, Guyette FX, Sayre MR, Daponte Codina A, Benvenuti C, Marijon E, Savastano S. The impact of COVID-19 pandemic on out-of-hospital cardiac arrest: An individual patient data meta-analysis. Resuscitation 2024; 194:110043. [PMID: 37952575 DOI: 10.1016/j.resuscitation.2023.110043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
AIM Prior studies have reported increased out-of-hospital cardiac arrests (OHCA) incidence and lower survival during the COVID-19 pandemic. We evaluated how the COVID-19 pandemic affected OHCA incidence, bystander CPR rate and patients' outcomes, accounting for regional COVID-19 incidence and OHCA characteristics. METHODS Individual patient data meta-analysis of studies which provided a comparison of OHCA incidence during the first pandemic wave (COVID-period) with a reference period of the previous year(s) (pre-COVID period). We computed COVID-19 incidence per 100,000 inhabitants in each of 97 regions per each week and divided it into its quartiles. RESULTS We considered a total of 49,882 patients in 10 studies. OHCA incidence increased significantly compared to previous years in regions where weekly COVID-19 incidence was in the fourth quartile (>136/100,000/week), and patients in these regions had a lower odds of bystander CPR (OR 0.49, 95%CI 0.29-0.81, p = 0.005). Overall, the COVID-period was associated with an increase in medical etiology (89.2% vs 87.5%, p < 0.001) and OHCAs at home (74.7% vs 67.4%, p < 0.001), and a decrease in shockable initial rhythm (16.5% vs 20.3%, p < 0.001). The COVID-period was independently associated with pre-hospital death (OR 1.73, 95%CI 1.55-1.93, p < 0.001) and negatively associated with survival to hospital admission (OR 0.68, 95%CI 0.64-0.72, p < 0.001) and survival to discharge (OR 0.50, 95%CI 0.46-0.54, p < 0.001). CONCLUSIONS During the first COVID-19 pandemic wave, there was higher OHCA incidence and lower bystander CPR rate in regions with a high-burden of COVID-19. COVID-19 was also associated with a change in patient characteristics and lower survival independently of COVID-19 incidence in the region where OHCA occurred.
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Affiliation(s)
- Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Catherine Klersy
- Biostatistics & Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paul Chan
- Department of Medicine, Saint Luke's Mid America Heart Institute, Kansas City, USA
| | - Jonathan Elmer
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Jocasta Ball
- Centre of Cardiovascular Research & Education in Therapeutics (CCRET), School of Public Health and Preventive Medicine, Monash University, Clayton, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Catherine R Counts
- University of Washington School of Medicine, Seattle, USA; Seattle Fire Department, Seattle, USA
| | - Fernando Rosell Ortiz
- Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Rachael Fothergill
- Clinical Audit & Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Angelo Auricchio
- Fondazione Ticino Cuore, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Andrea Paoli
- Centrale Operativa Provinciale SUEM 118, Azienda ULSS 5 Polesana, Rovigo, Italy
| | - Nicole Karam
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Bryan McNally
- Emory University School of Medicine, Rollins School of Public Health, Atlanta, USA
| | - Christian Martin-Gill
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Ziad Nehme
- Centre of Cardiovascular Research & Education in Therapeutics (CCRET), School of Public Health and Preventive Medicine, Monash University, Clayton, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | | | - José Ignacio Ruiz Azpiazu
- Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Adam Mellett-Smith
- Clinical Audit & Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Ruggero Cresta
- Fondazione Ticino Cuore, Lugano, Switzerland; Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Xavier Jouven
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rabab Al-Araji
- Emory University, Woodruff Health Sciences Center, Atlanta, USA
| | - Francis X Guyette
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Michael R Sayre
- University of Washington School of Medicine, Seattle, USA; Seattle Fire Department, Seattle, USA
| | - Antonio Daponte Codina
- Andalusian School of Public Health, CIBER Epidemiology and Public Health (CIBERESP), Granada, Spain
| | | | - Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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10
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Robb C, Carr PR, Ball J, Owen A, Beilin LJ, Newman AB, Nelson MR, Reid CM, Orchard SG, Neumann JT, Tonkin AM, Wolfe R, McNeil JJ. Association of a healthy lifestyle with mortality in older people. BMC Geriatr 2023; 23:646. [PMID: 37821846 PMCID: PMC10568769 DOI: 10.1186/s12877-023-04247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Unhealthy lifestyle behaviours such as smoking, high alcohol consumption, poor diet or low physical activity are associated with morbidity and mortality. Public health guidelines provide recommendations for adherence to these four factors, however, their relationship to the health of older people is less certain. METHODS The study involved 11,340 Australian participants (median age 7.39 [Interquartile Range (IQR) 71.7, 77.3]) from the ASPirin in Reducing Events in the Elderly study, followed for a median of 6.8 years (IQR: 5.7, 7.9). We investigated whether a point-based lifestyle score based on adherence to guidelines for a healthy diet, physical activity, non-smoking and moderate alcohol consumption was associated with subsequent all-cause and cause-specific mortality. RESULTS In multivariable adjusted models, compared to those in the unfavourable lifestyle group, individuals in the moderate lifestyle group (Hazard Ratio (HR) 0.73 [95% CI 0.61, 0.88]) and favourable lifestyle group (HR 0.68 [95% CI 0.56, 0.83]) had lower risk of all-cause mortality. A similar pattern was observed for cardiovascular related mortality and non-cancer/non-cardiovascular related mortality. There was no association of lifestyle with cancer-related mortality. CONCLUSIONS In a large cohort of initially healthy older people, reported adherence to a healthy lifestyle is associated with reduced risk of all-cause and cause-specific mortality. Adherence to all four lifestyle factors resulted in the strongest protection.
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Affiliation(s)
- Catherine Robb
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia.
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Lawrence J Beilin
- School of Medicine, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Anne B Newman
- Department of Epidemiology, Centre for Aging and Population Health, University of Pittsburgh, Pittsburgh, USA
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Curtin School of Population Health, Curtin University, Perth, WA, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
- German Centre for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road , Melbourne, Victoria, 3004, Australia
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11
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Paratz ED, van Heusden A, Ball J, Smith K, Zentner D, Morgan N, Parsons S, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A. Inconsistent discharge diagnoses for young cardiac arrest episodes: insights from a statewide registry. Intern Med J 2023; 53:1776-1782. [PMID: 36001398 DOI: 10.1111/imj.15918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/18/2022] [Indexed: 10/21/2023]
Abstract
BACKGROUND Administrative coding of out-of-hospital cardiac arrest (OHCA) is heterogeneous, with the prevalence of noninformative diagnoses uncertain. AIM To characterize the prevalence and type of non-informative diagnoses in a young cardiac arrest population. METHODS Hospital discharge diagnoses provided to a statewide OHCA registry were characterised as either 'informative' or 'noninformative.' Informative diagnoses stated an OHCA had occurred or defined OHCA as occurring due to coronary artery disease, cardiomyopathy, channelopathy, definite noncardiac cause, or no known cause. Noninformative diagnoses were blank, stated presenting cardiac rhythm only, provided irrelevant information or presented a complication of the OHCA as the main diagnosis. Characteristics of patients receiving informative versus noninformative diagnoses were compared. RESULTS Of 1479 patients with OHCA aged 1 to 50 years, 290 patients were admitted to 15 hospitals. Ninety diagnoses (31.0%) were noninformative (arrest rhythm = 50, blank = 21, complication = 10 and irrelevant = 9). Two hundred diagnoses (69.0%) were informative (cardiac arrest = 84, coronary artery disease = 54, noncardiac diagnosis = 48, cardiomyopathy = 8, arrhythmia disorder = 4 and unascertained = 2). Only 10 diagnoses (3.5%) included both OHCA and an underlying cause. Patients receiving a noninformative diagnosis were more likely to have survived OHCA or been referred for forensic assessment (P = 0.011) and had longer median length of stay (9 vs 5 days, P = 0.0019). CONCLUSION Almost one third of diagnoses for young patients discharged after an OHCA included neither OHCA nor any underlying cause. Underestimating the burden of OHCA impacts ongoing patient and at-risk family care, data sampling strategies, international statistics and research funding.
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Affiliation(s)
- Elizabeth D Paratz
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Alexander van Heusden
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jocasta Ball
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Research, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- Department of Research, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, Melbourne, Victoria, Australia
| | - Sarah Parsons
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Tina Thompson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Paul James
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Vanessa Connell
- Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Andreas Pflaumer
- Department of Cardiology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Melbourne University, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Jodie Ingles
- Department of Population Genomics, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Dion Stub
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Research, Ambulance Victoria, Melbourne, Victoria, Australia
- Department of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andre La Gerche
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Cardiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
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12
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Knight H, Jia R, Ayling K, Blake H, Morling JR, Villalon AM, Corner J, Denning C, Ball J, Bolton K, Figueredo G, Morris D, Tighe P, Vedhara K. The changing vaccine landscape: rates of COVID-19 vaccine acceptance and hesitancy in young adults during vaccine rollout. Perspect Public Health 2023; 143:220-224. [PMID: 35575215 PMCID: PMC10467000 DOI: 10.1177/17579139221094750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS Development and rollout of vaccines offers the best opportunity for population protection against the SARS-CoV-2 (COVID-19) virus. However, hesitancy towards the vaccines might impede successful uptake in the United Kingdom, particularly in young adults who demonstrate the highest rates of hesitancy. This prospective study explored COVID-19 vaccine hesitancy in young adults and whether the reasons behind these attitudes changed during the initial stages of the United Kingdom's vaccine rollout. METHOD Data on vaccination intention were collected from a British university student cohort at three time points: October 2020, February 2021, and March 2021. This online survey included items on intention to receive a vaccine and a free-text response for the reasons behind this intention. Cochran's Q tests examined changes in rates of hesitancy and acceptance over time and free-text responses were analysed thematically. RESULTS At baseline, 893 students provided data, with 476 participants completing all three time points. Hesitancy declined over time, with 29.4% of participants expressing hesitancy at baseline, reducing to 9.1% at wave 2 and 5.9% at wave 3. The most commonly endorsed themes for those willing to accept a vaccine were self-protection against COVID-19 and pro-social reasons, including protecting the population or unspecific others, and ending the pandemic/returning to normal life. The most commonly endorsed hesitancy themes related to 'confidence' in the vaccines and potential personal risk, including insufficient testing/scientific evidence, concern about side effects, and long-term effects. These reasons remained the most commonly endorsed at both waves 2 and 3. CONCLUSIONS While a decline in hesitancy was observed over time, the key reasons behind both vaccine acceptance and hesitancy remained consistent. Reasons behind hesitancy aligned with those of the general public, providing support for the use of generalist interventions. Pro-social reasons frequently underpinned vaccine acceptance, so cohort-specific interventions targeting those factors may be of benefit.
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Affiliation(s)
- H Knight
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - R Jia
- School of Medicine, University of Nottingham, Nottingham, UK
| | - K Ayling
- School of Medicine, University of Nottingham, UK
| | - H Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - JR Morling
- School of Medicine, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - AM Villalon
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - J Corner
- University Executive Board, University of Nottingham, Nottingham, UK
| | - C Denning
- Biodiscovery Institute, University Park, University of Nottingham, Nottingham, UK
| | - J Ball
- Biodiscovery Institute, University Park, University of Nottingham, Nottingham, UK
| | - K Bolton
- School of Mathematical Sciences, University of Nottingham, Nottingham, UK
| | - G Figueredo
- School of Computer Sciences, University of Nottingham, Nottingham, UK
| | - D Morris
- Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - P Tighe
- School of Life Sciences, University of Nottingham, Nottingham, UK
| | - K Vedhara
- School of Medicine, University of Nottingham, Nottingham, UK
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13
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Azcui Aparicio RE, Carrington MJ, Huynh Q, Ball J, Marwick TH. Association of cardiovascular health and risk prediction algorithms with subclinical atherosclerosis identified by carotid ultrasound. Cardiovasc Digit Health J 2023; 4:91-100. [PMID: 37351332 PMCID: PMC10282005 DOI: 10.1016/j.cvdhj.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Background The requirement for laboratory tests to assess conventional cardiovascular disease (CVD) risk may be a barrier to the early detection and management of atherosclerosis in some population groups. A simpler risk assessment could facilitate detection of CVD. Objectives The association of the Fuster-BEWAT Score (FBS), Framingham Risk Score (FRS), and Pooled Cohort Equation (PCE) with the presence of carotid plaque was investigated, with the intention of developing a stepped screening process for the primary prevention of CVD. Methods Asymptomatic participants with a family history of premature CVD had an absolute cardiovascular disease risk (ACVDR) score calculated using the FBS, FRS, and PCE risk equations. This risk classification was compared with the presence or absence of carotid plaque on ultrasound. Prediction of carotid plaque presence by risk scores and risk factors was assessed by logistic regression and area under the curve (AUC) for discrimination and diagnostic performance. A classification and regression-tree (CART) model was obtained for stratification of risk assessment. Results Risk score calculation and ultrasound scanning were performed in 1031 participants, of whom 51 had carotid plaques. Participants with plaque and male sex showed higher risk (higher PCE and FRS and lower FBS, as higher scores of FBS indicate better cardiovascular health). Participants ≤50 years of age showed the FBS was a significant predictor; there was a reduced likelihood of plaque presence with a higher score (OR 0.54, 95% CI 0.39-0.75, P < .01). Higher ACVDR (evidenced by higher PCE and FRS scores and lower FBS score) was associated with an increased likelihood of carotid plaque; however, the FBS and the addition of risk factors not included in the equation showed the highest AUC (AUC = 0.76, P < .001). CART modeling showed that participants with FBS between 6 and 9 would be recommended for further risk stratification using the PCE, whereupon a PCE score ≥5% conferred an increased risk and greater possibility for plaque. Validation of the model using a different cohort showed similar risk stratification for plaque presence according to level of risk by CART analysis. Conclusion FBS was able to identify the presence of carotid plaque in asymptomatic individuals. Its use for initial risk delineation might improve the selection of patients for more specific and complex assessment, reducing cost and time.
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Affiliation(s)
| | - Melinda J. Carrington
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Torrens University Australia, Melbourne, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Torrens University Australia, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas H. Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Torrens University Australia, Melbourne, Australia
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14
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Abstract
BACKGROUND Nurses working long shifts (≥12 h) experience higher levels of burnout. Yet other shift characteristics, including fixed versus rotating night work, weekly hours and breaks have not been considered. Choice over shift length may moderate the relationship; however, this has not been tested. AIMS To examine the association between shift work characteristics and burnout and exhaustion, and whether choice over shift length influences burnout and exhaustion. METHODS Cross-sectional online survey of nursing staff working in the UK and Ireland. We recruited two large National Health Service Trusts, through trade union membership, online/print nursing magazines and social media. We assessed associations using both univariable and multivariable generalized linear models. RESULTS We had 873 valid responses. Reports of inadequate staffing levels (odds ratio [OR] = 2.84; 95% confidence interval [CI] 2.08-3.90) and less choice over shift length (OR = 0.20; 95% CI 0.06-0.54) were associated with higher burnout in multivariable models. Similar associations were found for exhaustion, where rarely or never taking breaks was also a predictor (OR = 1.61; 95% CI 1.05-2.52). Nurses who worked long shifts had less choice than those working shifts of 8 h or less (66% of 12-h shift nurses versus 44% 8-h shift nurses reporting having no choice), but choice did not moderate the relationship between shift length and burnout and exhaustion. CONCLUSIONS The relationship between long shifts and increased burnout reported previously might have arisen from a lack of choice for those staff working long shifts. Whether limited choice for staff is intrinsically linked to long shifts is unclear.
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Affiliation(s)
- C Dall’Ora
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Applied Research Collaboration, Wessex SO16 7NP, UK
| | - O-Z Ejebu
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Applied Research Collaboration, Wessex SO16 7NP, UK
| | - J Ball
- School of Health Sciences, University of Southampton, Southampton, UK
| | - P Griffiths
- School of Health Sciences, University of Southampton, Southampton, UK
- National Institute for Health Research Applied Research Collaboration, Wessex SO16 7NP, UK
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15
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Hussain SM, Newman AB, Beilin LJ, Tonkin AM, Woods RL, Neumann JT, Nelson M, Carr PR, Reid CM, Owen A, Ball J, Cicuttini FM, Tran C, Wang Y, Ernst ME, McNeil JJ. Associations of Change in Body Size With All-Cause and Cause-Specific Mortality Among Healthy Older Adults. JAMA Netw Open 2023; 6:e237482. [PMID: 37036703 PMCID: PMC10087052 DOI: 10.1001/jamanetworkopen.2023.7482] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/25/2023] [Indexed: 04/11/2023] Open
Abstract
Importance The association between weight change and subsequent cause-specific mortality among older adults is not well described. The significance of changes in waist circumference (WC) has also not been compared with weight change for this purpose. Objective To examine the associations of changes in body weight and WC with all-cause and cause-specific mortality. Design, Setting, and Participants This cohort study is a post hoc analysis of data from the Aspirin in Reducing Events in the Elderly (ASPREE) randomized clinical trial, which recruited participants between March 1, 2010, and December 31, 2014. The study included community-based older adults (16 703 Australian participants aged ≥70 years and 2411 US participants aged ≥65 years) without evident cardiovascular disease (CVD), dementia, physical disability, or life-limiting chronic illness. Data analysis was performed from April to September 2022. Exposures Body weight and WC were measured at baseline and at annual visit 2. Analysis models were adjusted for baseline body mass index because height and weight were measured at baseline, allowing for calculation of body mass index and other variables. Both body weight and WC changes were categorized as change within 5% (stable), decrease by 5% to 10%, decrease by more than 10%, increase by 5% to 10%, and increase by more than 10%. Main Outcomes and Measures All-cause, cancer-specific, CVD-specific, and noncancer non-CVD-specific mortality. Mortality events were adjudicated by an expert review panel. Cox proportional hazards regression and competing risk analyses were used to calculate hazard ratios (HRs) and 95% CIs. Results Among 16 523 participants (mean [SD] age, 75.0 [4.3] years; 9193 women [55.6%]), 1256 deaths were observed over a mean (SD) of 4.4 (1.7) years. Compared with men with stable weight, those with a 5% to 10% weight loss had a 33% higher (HR, 1.33; 95% CI, 1.07-1.66) risk of all-cause mortality, and those with more than a 10% decrease in body weight had a 289% higher (HR, 3.89; 95% CI, 2.93-5.18) risk. Compared with women with stable weight, those with a 5% to 10% weight loss had a 26% higher (HR, 1.26; 95% CI, 1.00-1.60) risk of all-cause mortality, and those with more than a 10% decrease in body weight had a 114% higher (HR, 2.14; 95% CI, 1.58-2.91) risk. Weight loss was associated with a higher cancer-specific mortality (>10% decrease among men: HR, 3.49; 95% CI, 2.26-5.40; 5%-10% decrease among women: HR, 1.44; 95% CI, 1.46-2.04; >10% decrease among women: HR, 2.78; 95% CI, 1.82-4.26), CVD-specific mortality (>10% decrease among men: HR, 3.14; 95% CI, 1.63-6.04; >10% decrease among women: HR, 1.92; 95% CI, 1.05-3.51), and noncancer non-CVD-specific mortality (>10% decrease among men: HR, 4.98; 95% CI, 3.14-7.91). A decrease in WC was also associated with mortality. Conclusions and Relevance This cohort study of healthy older adults suggests that weight loss was associated with an increase in all-cause and cause-specific mortality, including an increased risk of cancer, CVD, and other life-limiting conditions. Physicians should be aware of the significance of weight loss, especially among older men.
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anne B. Newman
- Center for Aging and Population Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lawrence J. Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Johannes T. Neumann
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Mark Nelson
- Discipline of General Practice, University of Tasmania, Hobart, Australia
| | - Prudence R. Carr
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Flavia M. Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Bloom JE, Partovi A, Bernard S, Okyere D, Heritier S, Mahony E, Eliakundu AL, Dawson LP, Voskoboinik A, Anderson D, Ball J, Chan W, Kaye DM, Nehme Z, Stub D. Use of a novel smartphone-based application tool for enrolment and randomisation in pre-hospital clinical trials. Resuscitation 2023; 187:109787. [PMID: 37028747 DOI: 10.1016/j.resuscitation.2023.109787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/11/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
The effective recruitment and randomisation of patients in pre-hospital clinical trials presents unique challenges. Owing to the time critical nature of many pre-hospital emergencies and limited resourcing, the use of traditional methods of randomisation that may include centralised telephone or web-based systems are often not practicable or feasible. Previous technological limitations have necessitated that pre-hospital trialists strike a compromise between implementing pragmatic, deliverable study designs, and robust enrolment and randomisation methodologies. In this commentary piece, we present a novel smartphone-based solution that has the potential to align pre-hospital clinical trial recruitment processes to that of best-in-practice in-hospital and ambulatory care setting studies. Running title: Smartphone application based randomisation in pre-hospital clinical trials.
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Affiliation(s)
- Jason E Bloom
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia; Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
| | | | - Stephen Bernard
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Daniel Okyere
- Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
| | - Stephane Heritier
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Emily Mahony
- Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia
| | - Amminadab L Eliakundu
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Luke P Dawson
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Aleksandr Voskoboinik
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - David Anderson
- Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia; Department of Paramedicine, Monash University, McMahons Road, Frankston, VIC 3199, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - William Chan
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - David M Kaye
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Ziad Nehme
- Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia; Department of Paramedicine, Monash University, McMahons Road, Frankston, VIC 3199, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia; Ambulance Victoria, 31 Joseph Street, Blackburn, VIC 3130, Australia.
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17
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Robb C, Carr P, Ball J, Owen A, Beilin LJ, Newman AB, Nelson MR, Reid CM, Orchard SG, Neumann JT, Tonkin AM, Wolfe R, McNeil JJ. Association of a Healthy Lifestyle with Mortality in Older People. Res Sq 2023:rs.3.rs-2541145. [PMID: 36993471 PMCID: PMC10055537 DOI: 10.21203/rs.3.rs-2541145/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
Background Unhealthy lifestyle behaviours such as smoking, high alcohol consumption, poor diet or low physical activity are associated with morbidity and premature mortality. Public health guidelines provide recommendations for adherence to these four factors, however, their impact on the health of older people is less certain. Methods The study involved 11,340 Australian participants (median age 7.39 [Interquartile Range (IQR) 71.7, 77.3]) from the ASPirin in Reducing Events in the Elderly study, followed for a median of 6.8 years (IQR: 5.7, 7.9). We investigated whether a point-based lifestyle score based on adherence to guidelines for a healthy diet, physical activity, non-smoking and moderate alcohol consumption was associated with all-cause and cause-specific mortality. Results In multivariable adjusted models, compared to those in the unfavourable lifestyle group, individuals in the moderate lifestyle group (Hazard Ratio (HR) 0.73 [95% CI 0.61, 0.88]) and favourable lifestyle group (HR 0.68 [95% CI 0.56, 0.83]) had lower risk of all-cause mortality. A similar pattern was observed for cardiovascular related mortality and non-cancer/non-cardiovascular related mortality. There was no association of lifestyle with cancer-related mortality. Stratified analysis indicated larger effect sizes among males, those ≤ 73 years old and among those in the aspirin treatment group. Conclusions In a large cohort of initially healthy older people, reported adherence to a healthy lifestyle is associated with reduced risk of all-cause and cause-specific mortality.
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18
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Ball J, Mahony E, Ray M, Nehme Z, Stub D, Smith K. No fear: Willingness of smartphone activated first responders to assist with cardiac arrest during the COVID-19 pandemic. Resusc Plus 2023; 13:100341. [PMID: 36530349 PMCID: PMC9747697 DOI: 10.1016/j.resplu.2022.100341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/21/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
Aim To understand the fear and willingness to respond of smartphone activated first responders during the COVID-19 pandemic. Methods We invited smartphone activated first responders registered with the GoodSAM application in Victoria, Australia to take part in an online survey in November 2020. We assessed willingness to respond to an alert and provide CPR during the pandemic and administered the Fear of COVID-19 Scale questionnaire. Regression analysis was conducted to investigate associations between occupation, clinical training, and years of clinical experience with willingness to respond and fear of COVID-19. Results The survey response rate was 5.1%. Responders (n = 348) had a median age (interquartile range) of 46 years (33-55). Most (67%) were aged 30-59 years and 43% were female. Responders spanned several occupations including paramedics (12.6%), registered nurses (14.7%), and non-clinical individuals (21.8%). Most (92%) reported they would feel comfortable responding to a GoodSAM alert during the pandemic. Almost all (>95%) reported they would provide CPR. About 20% reported being afraid of COVID-19 but only 3.2% reported they had a high-level of fear of COVID-19. The odds of paramedics being willing to respond to an alert was reduced by 73% during the pandemic (OR 0.27, 95% CI 0.11 to 0.69). No other associations were found with willingness or fear of COVID-19. Conclusion Although willingness was high and fear of COVID-19 was low, some smartphone activated first responders were less willing to respond to an alert during the pandemic. These findings may inform future pandemic planning and decision-making around pausing first-responder programs.
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Affiliation(s)
- Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia 3004,Corresponding author at: Centre of Cardiovascular Research and Education in Therapeutics (CCRET) School of Public Health and Preventive Medicine Monash University 553 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Emily Mahony
- Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia
| | - Michael Ray
- Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia,Department of Paramedicine, Monash University, Moorooduc Highway, Frankston, Victoria 3199, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Ambulance Victoria, 31 Joseph Street, Blackburn North, Victoria 3004, Australia,Department of Cardiology, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia,Department of Paramedicine, Monash University, Moorooduc Highway, Frankston, Victoria 3199, Australia
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19
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Dawson LP, Nehme E, Nehme Z, Zomer E, Bloom J, Cox S, Anderson D, Stephenson M, Ball J, Zhou J, Lefkovits J, Taylor AJ, Horrigan M, Chew DP, Kaye D, Cullen L, Mihalopoulos C, Smith K, Stub D. Chest Pain Management Using Prehospital Point-of-Care Troponin and Paramedic Risk Assessment. JAMA Intern Med 2023; 183:203-211. [PMID: 36715993 PMCID: PMC9887542 DOI: 10.1001/jamainternmed.2022.6409] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/28/2022] [Indexed: 01/31/2023]
Abstract
Importance Prehospital point-of-care troponin testing and paramedic risk stratification might improve the efficiency of chest pain care pathways compared with existing processes with equivalent health outcomes, but the association with health care costs is unclear. Objective To analyze whether prehospital point-of-care troponin testing and paramedic risk stratification could result in cost savings compared with existing chest pain care pathways. Design, Setting, and Participants In this economic evaluation of adults with acute chest pain without ST-segment elevation, cost-minimization analysis was used to assess linked ambulance, emergency, and hospital attendance in the state of Victoria, Australia, between January 1, 2015, and June 30, 2019. Interventions Paramedic risk stratification and point-of-care troponin testing. Main Outcomes and Measures The outcome was estimated mean annualized statewide costs for acute chest pain. Between May 17 and June 25, 2022, decision tree models were developed to estimate costs under 3 pathways: (1) existing care, (2) paramedic risk stratification and point-of-care troponin testing without prehospital discharge, or (3) prehospital discharge and referral to a virtual emergency department (ED) for low-risk patients. Probabilities for the prehospital pathways were derived from a review of the literature. Multivariable probabilistic sensitivity analysis with 50 000 Monte Carlo iterations was used to estimate mean costs and cost differences among pathways. Results A total of 188 551 patients attended by ambulance for chest pain (mean [SD] age, 61.9 [18.3] years; 50.5% female; 49.5% male; Indigenous Australian, 2.0%) were included in the model. Estimated annualized infrastructure and staffing costs for the point-of-care troponin pathways, assuming a 5-year device life span, was $2.27 million for the pathway without prehospital discharge and $4.60 million for the pathway with prehospital discharge (incorporating virtual ED costs). In the decision tree model, total annual cost using prehospital point-of-care troponin and paramedic risk stratification was lower compared with existing care both without prehospital discharge (cost savings, $6.45 million; 95% uncertainty interval [UI], $0.59-$16.52 million; lower in 94.1% of iterations) and with prehospital discharge (cost savings, $42.84 million; 95% UI, $19.35-$72.26 million; lower in 100% of iterations). Conclusions and Relevance Prehospital point-of-care troponin and paramedic risk stratification for patients with acute chest pain could result in substantial cost savings. These findings should be considered by policy makers in decisions surrounding the potential utility of prehospital chest pain risk stratification and point-of-care troponin models provided that safety is confirmed in prospective studies.
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Affiliation(s)
- Luke P. Dawson
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, The Royal Melbourne Hospital, Victoria, Australia
| | - Emily Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jason Bloom
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- The Baker Institute, Melbourne, Victoria, Australia
| | - Shelley Cox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Australia
| | - David Anderson
- Ambulance Victoria, Melbourne, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Michael Stephenson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Jocasta Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Zhou
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology, The Royal Melbourne Hospital, Victoria, Australia
| | - Andrew J. Taylor
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
- Safer Care Victoria, Melbourne, Australia
| | - Derek P. Chew
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - David Kaye
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- The Baker Institute, Melbourne, Victoria, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women’s Hospital, Queensland, Australia
| | - Cathrine Mihalopoulos
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Ambulance Victoria, Melbourne, Australia
- Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Baker Institute, Melbourne, Victoria, Australia
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Burch RF, Chander H, Saucier D, Ball J. Incorporation of a smart sock with the virtual immersive test for postural stability. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00177-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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21
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Muscente P, Innocente P, Ball J, Gorno S. Analysis of edge transport in L-mode negative triangularity TCV discharges. Nuclear Materials and Energy 2023. [DOI: 10.1016/j.nme.2023.101386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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22
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Renninson E, Channell K, Ball J, Masson S, Challapalli A, Bahl A. Patient Experience and Impact of Rectal Spacers on Dosimetry and Acute Toxicity in Patients Undergoing Radical Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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23
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Sharashova E, Gerdts E, Ball J, Espnes H, Jacobsen BK, Kildal S, Mathiesen EB, Njølstad I, Rosengren A, Schirmer H, Wilsgaard T, Løchen ML. Sex-specific time trends in incident atrial fibrillation and the contribution of risk factors: the Tromsø Study 1994-2016. Eur J Prev Cardiol 2023; 30:72-81. [PMID: 36239184 DOI: 10.1093/eurjpc/zwac234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/02/2022] [Accepted: 10/08/2022] [Indexed: 01/14/2023]
Abstract
AIMS To explore sex-specific time trends in atrial fibrillation (AF) incidence and to estimate the impact of changes in risk factor levels using individual participant-level data from the population-based Tromsø Study 1994-2016. METHODS AND RESULTS A total of 14 818 women and 13 225 men aged 25 years or older without AF were enrolled in the Tromsø Study between 1994 and 2008 and followed up for incident AF throughout 2016. Poisson regression was used for statistical analyses. During follow-up, age-adjusted AF incidence rates in women decreased from 1.19 to 0.71 per 1000 person-years. In men, AF incidence increased from 1.18 to 2.82 per 1000 person-years in 2004, and then declined to 1.94 per 1000 person-years in 2016. Changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), physical activity, smoking and alcohol consumption together accounted for 10.9% [95% confidence interval (CI): -2.4 to 28.6] of the AF incidence decline in women and for 44.7% (95% CI: 19.2; 100.0) of the AF incidence increase in men. Reduction in SBP and DBP had the largest contribution to the decrease in AF incidence in women. Increase in BMI had the largest contribution to the increase in AF incidence in men. CONCLUSION In the population-based Tromsø Study 1994-2016, AF incidence decreased in women and increased following a reverse U-shape in men. Individual changes in SBP and DBP in women and individual changes in BMI in men were the most important risk factors contributing to the AF incidence trends.
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Affiliation(s)
- Ekaterina Sharashova
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway.,University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Jocasta Ball
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hilde Espnes
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway.,Centre for Sami Health Research, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Simon Kildal
- University Hospital of North Norway, Postboks 100, 9038 Tromsø, Norway.,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellisiv B Mathiesen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Schirmer
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Akershus University Hospital, Lørenskog, Oslo, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Community Medicine, UiT The Arctic University of Norway, PO Box 6050 Langnes, N-9037 Tromsø, Norway
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Pironon S, Cantwell-Jones A, Forest F, Ball J, Diazgranados M, Douglas R, Hawkins J, Howes MJR, Ulian T, Vaitla B, Collar D. Towards an action plan for characterizing food plant diversity. Nat Plants 2023; 9:34-35. [PMID: 36543935 DOI: 10.1038/s41477-022-01300-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/31/2022] [Indexed: 06/17/2023]
Affiliation(s)
- S Pironon
- Royal Botanic Gardens, Kew, Richmond, UK.
- UN Environment Programme World Conservation Monitoring Centre, Cambridge, UK.
| | - A Cantwell-Jones
- Science and Solutions for a Changing Planet DTP, Imperial College London, Ascot, UK
- Department of Life Sciences, Imperial College London, Ascot, UK
| | - F Forest
- Royal Botanic Gardens, Kew, Richmond, UK
| | - J Ball
- Royal Botanic Gardens, Kew, Richmond, UK
| | | | | | - J Hawkins
- School of Biological Sciences, University of Reading, Reading, UK
| | | | - T Ulian
- Royal Botanic Gardens, Kew, Richmond, UK
| | - B Vaitla
- Department of Nutrition, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, USA
| | - D Collar
- Department of Organismal and Environmental Biology, Christopher Newport University, Newport News, VA, USA
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Sharwood LN, King V, Ball J, Varma D, Stanford RW, Middleton JW. The influence of initial spinal cord haematoma and cord compression on neurological grade improvement in acute traumatic spinal cord injury: A prospective observational study. J Neurol Sci 2022; 443:120453. [PMID: 36308844 DOI: 10.1016/j.jns.2022.120453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/26/2022] [Accepted: 10/04/2022] [Indexed: 11/21/2022]
Abstract
STUDY DESIGN Prospective observational cohort study linked with administrative data. OBJECTIVES Magnetic Resonance Imaging (MRI) is routinely performed after traumatic spinal cord injury (TSCI), facilitating early, accurate diagnosis to optimize clinical management. Prognosis from early MRI post-injury remains unclear, yet if available could guide early intervention. The aim of this study was to determine the association of spinal cord intramedullary haematoma and/or extent of cord compression evident on initial spine MRI with neurological grade change after TSCI. METHODS Individuals with acute TSCI ≥16 years of age; MRI review. Neurological gradings (American Spinal Injury Association Impairment Scale (AIS)) were compared with initial MRI findings. Various MRI parameters were evaluated for prediction of neurological improvement pre-discharge. RESULTS 120 subjects; 79% male, mean (SD) age 51.0 (17.7) years. Motor vehicle crashes (42.5%) and falls (40.0%) were the most common injury mechanisms. Intramedullary spinal cord haematoma was identified by MRI in 40.0% of patients and was associated with more severe neurologic injury (58.3% initially AIS A). Generalised linear regression showed higher maximum spinal cord compression (MSCC) was associated with lower likelihood of neurological improvement from initial assessment to follow up prior to rehabilitation discharge. Combined thoracic level injury, intramedullary haematoma, and MSCC > 25% resulted in almost 90% probability of pre-discharge AIS (grade A) remaining unchanged from admission assessment. CONCLUSIONS MRI is a vital tool for evaluating the severity and extent of TSCI, assisting in appropriate management decision-making early in TSCI patient care. This study adds to the body of knowledge assisting clinicians in prognostication.
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Affiliation(s)
- L N Sharwood
- University of Sydney, Sydney Medical School, Northern, C/o Kolling Institute, 1 Reserve Road, St Leonards, NSW 2065, Australia; Faculty of Medicine and Health, University of New South Wales, Australia.
| | - V King
- Royal North Shore Hospital, Department of Neurosurgery, Australia
| | - J Ball
- Royal North Shore Hospital, Department of Neurosurgery, Australia.
| | - D Varma
- Radiology, Emergency & Trauma Radiology, The Alfred Health & Monash University, National Trauma Research Institute, Australia; Mission TBI, MRFF Aus Govt., Australia.
| | - R W Stanford
- Prince of Wales Hospital, Department of Orthopedics, Australia
| | - J W Middleton
- Rehabilitation Medicine, University of Sydney, Sydney Medical School, Northern Faculty of Medicine and Health, Australia.
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Ball J, Nehme Z, Stub D. Preventive measures and public education programmes are needed to suck the marrow out of life, but avoid choking on the bone. Resuscitation 2022; 181:170-172. [PMID: 36455703 DOI: 10.1016/j.resuscitation.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- J Ball
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
| | - Z Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Paramedicine, Monash University, Moorooduc Highway, Frankston, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia
| | - D Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Ambulance Victoria, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Health, Melbourne, Victoria, Australia
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Yiallourou SR, Magliano D, Haregu TN, Carrington MJ, Rolnik DL, Rombauts L, Rodrigues A, Ball J, Bruinsma FJ, Da Silva Costa F. Long term all-cause and cardiovascular disease mortality among women who undergo fertility treatment. Med J Aust 2022; 217:532-537. [PMID: 36209740 PMCID: PMC9827840 DOI: 10.5694/mja2.51734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To compare age-adjusted all-cause and CVD mortality, relative to the general female population, for women registered for fertility treatment who received it and those who did not. DESIGN Prospective cohort study; analysis of Monash IVF clinical registries data, 1975-2018, linked with National Death Index mortality data. PARTICIPANTS All women who registered for fertility treatment at Monash IVF (Melbourne, Victoria), 1 January 1975 - 1 January 2014, followed until 31 December 2018. MAIN OUTCOME MEASURES Standardised mortality ratios (SMRs) for all-cause and CVD mortality, for women who did or did not undergo fertility treatment; SMRs stratified by area-level socio-economic disadvantage (SEIFA Index of Relative Socioeconomic Disadvantage [IRSD]) and (for women who underwent treatment), by stimulated cycle number and mean oocytes/cycle categories. RESULTS Of 44 149 women registered for fertility treatment, 33 520 underwent treatment (66.4%), 10 629 did not. After adjustment for age, both all-cause (SMR, 0.58; 95% CI, 0.54-0.62) and CVD mortality (SMR, 0.41; 95% CI, 0.32-0.53) were lower than for the general female population. All-cause mortality was similar for women registered with Monash IVF who did (SMR, 0.55; 95% CI, 0.50-0.60) or did not undergo fertility treatment (SMR, 0.63; 95% CI, 0.56-0.70). The SMR was lowest for both treated and untreated women in the fifth IRSD quintile (least disadvantage), but the difference was statistically significant only for untreated women. CVD mortality was lower for registered women who underwent fertility treatment (SMR, 0.29; 95% CI, 0.19-0.43) than for those who did not (SMR, 0.58; 95% CI, 0.42-0.81). CONCLUSION Fertility treatment does not increase long term all-cause or CVD mortality risk. Lower mortality among women registered for fertility treatment probably reflected their lower socio-economic disadvantage.
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Affiliation(s)
- Stephanie R Yiallourou
- Baker Heart and Diabetes InstituteMelbourneVIC,The Turner Institute for Brain and Mental HealthMonash UniversityMelbourneVIC
| | - Dianna Magliano
- Baker Heart and Diabetes InstituteMelbourneVIC,Monash UniversityMelbourneVIC
| | - Tilahun N Haregu
- Baker Heart and Diabetes InstituteMelbourneVIC,Nossal Institute for Global Healththe University of MelbourneMelbourneVIC
| | | | | | - Luk Rombauts
- Monash HealthMelbourneVIC,Monash IVFMelbourneVIC
| | - Andre Rodrigues
- The Parent–Infant Research Institute, Austin HealthMelbourneVIC
| | | | - Fiona J Bruinsma
- Cancer Council VictoriaMelbourneVIC,Centre for Epidemiology and Biostatisticsthe University of MelbourneVIC
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Espnes H, Ball J, Lochen ML, Wilsgaard T, Njolstad I, Mathiesen EB, Schnabel RB, Gerdts E, Sharashova E. Risk factors and prognosis for heart failure in atrial fibrillation subtypes in women and men. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) and heart failure (HF) are common diseases that often co-exist and substantially impact both morbidity, mortality, and quality of life. Although there has been an increasing amount of research on HF in AF patients, there is limited knowledge on the association of AF subtypes (paroxysmal/persistent, permanent) with HF in women and men.
Purpose
To explore the sex-specific association between incident AF subtypes and HF risk factors and mortality in AF participants in a general population.
Methods
A total of 14,798 women and 13,197 men aged 25 years and older were enrolled from 1994 to 2008 and followed up for incident AF and HF through 2016. Cox proportional hazards regression analysis was conducted to provide sex- and AF subtype-specific hazard ratios (HRs) for the risk of HF, risk factors for HF and joint influence on mortality when AF precedes HF. Participants without AF and HF were used as reference. In the analysis of risk factors for HF we included only those who developed AF, and the follow-up period started at the date of first detected AF. Models were adjusted for systolic blood pressure, body mass index (BMI), total cholesterol, current smoking, physical activity, and history of myocardial infarction, angina pectoris, stroke, and diabetes mellitus, as well as age, with age as the time scale in the regression models.
Results
Over a median follow-up of 21.6 years, incident AF occurred in 856 women (471 with paroxysmal/persistent AF and 385 with permanent AF) and 1,036 men (587 with paroxysmal/persistent AF and 449 with permanent AF). Incident HF occurred in 761 women and 930 men. In both sexes, there was an increased risk of HF when AF was present. For permanent AF, women had a significantly higher risk of HF than men (HR 10.50, 95% CI 8.72–12.66 vs. HR 8.11, 95% CI 6.81–9.67). Permanent AF, current smoking, and prevalent myocardial infarction were significant risk factors for HF in AF participants in both sexes, while hypertension was only associated with increased risk of HF in women and BMI and prevalent stroke in men. Higher physical activity level was associated with reduced risk of AF in both sexes. The risk of death increased when HF succeeded AF. For women the risk of mortality was higher for permanent AF (HR 3.83, 95% CI 3.19–4.61 vs. HR 2.98, 95% CI 2.34–3.80), while in men it was highest for paroxysmal/persistent AF (HR 3.67, 95% CI 2.94–4.58 vs. HR 2.91, 95% CI 2.37–3.57), but there was no significant difference between sexes.
Conclusions
All AF subtypes were associated with an increased risk of HF in both sexes. For permanent AF, women had a significantly higher risk than men. Several risk factors for HF in AF participants were similar between sexes. However, hypertension was only a risk factor in women, whereas BMI and prevalent stroke were only risk factors in men. In AF participants, subsequent development of HF was associated with increased mortality in both sexes.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): UiT The Arctic University of Norway
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Affiliation(s)
- H Espnes
- UiT The Arctic University of Norway, Department of Community Medicine , Tromso , Norway
| | - J Ball
- Monash University, Department of Epidemiology and Preventive Medicine , Melbourne , Australia
| | - M L Lochen
- UiT The Arctic University of Norway, Department of Community Medicine , Tromso , Norway
| | - T Wilsgaard
- UiT The Arctic University of Norway, Department of Community Medicine , Tromso , Norway
| | - I Njolstad
- UiT The Arctic University of Norway, Department of Community Medicine , Tromso , Norway
| | - E B Mathiesen
- UiT The Arctic University of Norway, Department of Clinical Medicine , Tromso , Norway
| | - R B Schnabel
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - E Gerdts
- University of Bergen, Center for research on cardiac disease in women, Department of Clinical Science , Bergen , Norway
| | - E Sharashova
- UiT The Arctic University of Norway, Department of Community Medicine , Tromso , Norway
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Paratz E, Van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Parsons S, La Gerche A. Prevalence of coronary artery anomalies in young sudden cardiac death: insights from a prospective state-wide registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary artery anomalies (CAAs) have been previously implicated as a major cause of young sudden cardiac death (SCD), particularly in exercise-related SCD with a reported prevalence of up to 33%.
Methods
A state-wide prospective out-of-hospital cardiac arrest registry identified all patients aged 1–50 years who experienced an SCD and underwent autopsy from April 2019 to April 2021. Rates of normal anatomy, normal variants and CAAs were identified and circumstances and cause of death for patients with CAAs examined.
Results
Of 1,477 patients who experienced cardiac arrest during the study period, 490 underwent autopsy and were confirmed to have experienced SCD. Of these 490 patients, five (1.0%) had a CAA identified with three having anomalies of coronary origin and two having anomalies of coronary course. In no cases was the CAA deemed responsible for the SCD. In two cases, severe coronary disease and intra-coronary thrombus with histological evidence of acute myocardial infarction were identified, in the third critical coronary disease was found, the fourth had an unrelated thoracic aortic dissection and the fifth had cardiomegaly in the setting of illicit drug use. Of 27 patients who experienced their SCD during exercise, only one had a CAA identified (the patient with thoracic aortic dissection).
Conclusion
In this prospective cohort of consecutive young patients with SCD who underwent autopsy, CAAs occurred in 1.0% of patients and did not cause any deaths. The role of CAAs in causing young SCD appears to be less significant than previously hypothesised.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NHMRC, NHF
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Affiliation(s)
- E Paratz
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - A Van Heusden
- Baker Heart and Diabetes Institute , Melbourne , Australia
| | - D Zentner
- Royal Melbourne Hospital , Melbourne , Australia
| | - N Morgan
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - K Smith
- Ambulance Victoria , Melbourne , Australia
| | - J Ball
- Ambulance Victoria , Melbourne , Australia
| | - T Thompson
- Royal Melbourne Hospital , Melbourne , Australia
| | - P James
- Royal Melbourne Hospital , Melbourne , Australia
| | - V Connell
- Royal Children's Hospital , Melbourne , Australia
| | - A Pflaumer
- Royal Children's Hospital , Melbourne , Australia
| | - C Semsarian
- University of Sydney, Heart Research Institute , Sydney , Australia
| | - J Ingles
- Garvan Institute of Medical Research , Sydney , Australia
| | - D Stub
- The Alfred Hospital , Melbourne , Australia
| | - S Parsons
- Victorian Institute of Forensic Medicine , Melbourne , Australia
| | - A La Gerche
- Baker Heart and Diabetes Institute , Melbourne , Australia
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30
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Paratz ED, van Heusden A, Smith K, Brennan A, Dinh D, Ball J, Lefkovits J, Kaye DM, Nicholls S, Pflaumer A, La Gerche A, Stub D. Factors predicting cardiac arrest in acute coronary syndrome patients under 50: a state-wide angiographic and forensic evaluation of outcomes. Resuscitation 2022; 179:124-130. [PMID: 36031075 DOI: 10.1016/j.resuscitation.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/16/2022] [Accepted: 08/21/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND An uncertain proportion of patients with acute coronary syndrome (ACS) also experience out-of-hospital cardiac arrest (OHCA). Predictors of OHCA in ACS remain unclear and vulnerable to selection bias as pre-hospital deceased patients are usually not included. METHODS Data on patients aged 18-50 years from a percutaneous coronary intervention (PCI) and OHCA registry were combined to identify all patients experiencing OHCA due to ACS (not including those managed medically or who proceeded to cardiac surgery). Clinical, angiographic and forensic details were collated. In-hospital and post-discharge outcomes were compared between OHCA survivors and non-OHCA ACS patients. RESULTS OHCA occurred in 6.0% of ACS patients transported to hospital and 10.0% of all ACS patients. Clinical predictors were non-diabetic status (p=0.015), non-obesity (p=0.004), ST-elevation myocardial infarction (p<0.0001) and left main (p<0.0002) or left anterior descending (LAD) coronary artery (p<0.0001) as culprit vessel. OHCA patients had poorer in-hospital clinical outcomes, including longer length of stay and higher pre-procedural intubation, cardiogenic shock, major adverse cardiovascular events, bleeding, and mortality (p<0.0001 for all). At 30 days, OHCA survivors had equivalent cardiac function and return to premorbid independence but higher rates of anxiety/depression (p=0.029). CONCLUSION OHCA complicates approximately 10% of ACS in the young. Predictors of OHCA are being non-diabetic, non-obese, having a STEMI presentation, and left main or LAD coronary culprit lesion. For OHCA patients surviving to PCI, higher rates of in-hospital complications are observed. Despite this, recovery of pre-morbid physical and cardiac function is equivalent to non-OHCA patients, apart from higher rates of anxiety/depression.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd Prahran VIC 3181; Alfred Hospital, 55 Commercial Rd Prahran VIC 3181; St Vincent's Hospital Melbourne, 41 Victoria Pde Fitzroy VIC 3065.
| | | | - Karen Smith
- Ambulance Victoria, 375 Manningham Rd Doncaster VIC 3108; Department of Paramedicine, Monash University, Melbourne VIC; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - Angela Brennan
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - Diem Dinh
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - Jocasta Ball
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - Jeff Lefkovits
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - David M Kaye
- Alfred Hospital, 55 Commercial Rd Prahran VIC 3181
| | - Steve Nicholls
- Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd Parkville Melbourne VIC 3052; Department of Paediatrics, Melbourne University, Parkville VIC 3010; Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd Parkville VIC 3052
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd Prahran VIC 3181; Alfred Hospital, 55 Commercial Rd Prahran VIC 3181; St Vincent's Hospital Melbourne, 41 Victoria Pde Fitzroy VIC 3065
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd Prahran VIC 3181; Alfred Hospital, 55 Commercial Rd Prahran VIC 3181; Ambulance Victoria, 375 Manningham Rd Doncaster VIC 3108; Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd Melbourne 3004
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31
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Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Parsons S, La Gerche A. Prevalence of Coronary Artery Anomalies in Young and Middle-Aged Sudden Cardiac Death Victims (from a Prospective State-Wide Registry). Am J Cardiol 2022; 175:127-130. [PMID: 35662474 DOI: 10.1016/j.amjcard.2022.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
Abstract
Coronary artery anomalies (CAAs) have been previously implicated as a major cause of young sudden cardiac death (SCD), particularly in exercise-related SCD, with a prevalence of up to 33%. A state-wide prospective out-of-hospital cardiac arrest registry identified all patients aged 1 to 50 years who experienced an SCD and underwent autopsy from April 2019 to April 2021. Rates of normal anatomy, normal variants, and CAAs were identified, and circumstances and causes of death for patients with CAAs examined. Of 1,477 patients who experienced cardiac arrest during the study period, 490 underwent autopsy and were confirmed to have experienced SCD. Of these 490 patients, 5 (1%) had a CAA identified, with 3 having anomalies of coronary origin and 2 having anomalies of coronary course. In no cases were the CAA deemed responsible for the SCD. In 2 cases, severe coronary disease and intra-coronary thrombus with histological evidence of acute myocardial infarction were identified. In the third, critical coronary disease was found, the fourth had an unrelated thoracic aortic dissection, and the fifth had cardiomegaly in the setting of illicit drug use. Of 27 patients who experienced their SCD during exercise, only 1 had a CAA identified (the patient with thoracic aortic dissection). In conclusion, in this prospective cohort of consecutive young patients with SCD who underwent autopsy, CAAs occurred in 1% of patients and did not cause any deaths. The role of CAAs in causing young and middle-aged SCD appears to be less significant than previously hypothesized.
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Logan C, Hemsley C, Fife A, Edgeworth J, Mazzella A, Wade P, Goodman A, Hopkins P, Wyncoll D, Ball J, Planche T, Schelenz S, Bicanic T. A multisite evaluation of antifungal use in critical care: implications for antifungal stewardship. JAC Antimicrob Resist 2022; 4:dlac055. [PMID: 35756574 PMCID: PMC9217759 DOI: 10.1093/jacamr/dlac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background ICUs are settings of high antifungal consumption. There are few data on prescribing practices in ICUs to guide antifungal stewardship implementation in this setting. Methods An antifungal therapy (AFT) service evaluation (15 May-19 November 2019) across ICUs at three London hospitals, evaluating consumption, prescribing rationale, post-prescription review, de-escalation and final invasive fungal infection (IFI) diagnostic classification. Results Overall, 6.4% of ICU admissions (305/4781) received AFT, accounting for 11.41 days of therapy/100 occupied bed days (DOT/100 OBD). The dominant prescribing mode was empirical (41% of consumption), followed by targeted (22%), prophylaxis (18%), pre-emptive (12%) and non-invasive (7%). Echinocandins were the most commonly prescribed drug class (4.59 DOT/100 OBD). In total, 217 patients received AFT for suspected or confirmed IFI; 12%, 10% and 23% were classified as possible, probable or proven IFI, respectively. Hence, in 55%, IFI was unlikely. Proven IFI (n = 50) was mostly invasive candidiasis (92%), of which 48% had been initiated on AFT empirically before yeast identification. Where on-site (1 → 3)-β-d-glucan (BDG) testing was available (1 day turnaround), in those with suspected but unproven invasive candidiasis, median (IQR) AFT duration was 10 (7-15) days with a positive BDG (≥80 pg/mL) versus 8 (5-9) days with a negative BDG (<80 pg/mL). Post-prescription review occurred in 79% of prescribing episodes (median time to review 1 [0-3] day). Where suspected IFI was not confirmed, 38% episodes were stopped and 4% de-escalated within 5 days. Conclusions Achieving a better balance between promptly treating IFI patients and avoiding inappropriate antifungal prescribing in the ICU requires timely post-prescription review by specialist multidisciplinary teams and improved, evidence-based-risk prescribing strategies incorporating rapid diagnostics to guide AFT start and stop decisions.
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Affiliation(s)
- C Logan
- Corresponding author. E-mail:
| | - C Hemsley
- Department of Infectious Diseases, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - A Fife
- Infection Sciences, King’s College Hospital NHS Foundation Trust, London, UK
| | - J Edgeworth
- Department of Infectious Diseases, Guy’s & St Thomas’ NHS Foundation Trust, London, UK,Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King’s College London Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - A Mazzella
- Clinical Infection Group, St George’s University Hospitals NHS Foundation Trust, London, UK,Institute of Infection & Immunity, St George’s University of London, London, UK
| | - P Wade
- Department of Infectious Diseases, Guy’s & St Thomas’ NHS Foundation Trust, London, UK,Directorate of Pharmacy & Medicines Optimisation, Guy’s & St Thomas’s NHS Foundation Trust, London, UK
| | - A Goodman
- Department of Infectious Diseases, Guy’s & St Thomas’ NHS Foundation Trust, London, UK,Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King’s College London Guy’s & St Thomas’ NHS Foundation Trust, London, UK,MRC Clinical Trials Unit at University College London, London, UK
| | - P Hopkins
- Department of Critical Care, King’s College Hospital NHS Foundation Trust, London, UK
| | - D Wyncoll
- Department of Critical Care, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - J Ball
- Department of Critical Care, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - T Planche
- Clinical Infection Group, St George’s University Hospitals NHS Foundation Trust, London, UK,Institute of Infection & Immunity, St George’s University of London, London, UK
| | - S Schelenz
- Infection Sciences, King’s College Hospital NHS Foundation Trust, London, UK
| | - T Bicanic
- Clinical Infection Group, St George’s University Hospitals NHS Foundation Trust, London, UK,Institute of Infection & Immunity, St George’s University of London, London, UK
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Paratz ED, van Heusden A, Smith K, Ball J, Zentner D, Morgan N, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, La Gerche A. Higher rates but similar causes of young out-of-hospital cardiac arrest in rural Australian patients. Aust J Rural Health 2022; 30:619-627. [PMID: 35704685 DOI: 10.1111/ajr.12890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/06/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To determine whether young rural Australians have higher rates or different underlying causes of out-of-hospital cardiac arrest (OHCA). DESIGN A case-control design identified patients experiencing an OHCA, then compared annual OHCA rates and underlying causes in rural versus metropolitan Victoria. OHCA causes were defined as either cardiac or non-cardiac, with specific aetiologies including coronary disease, cardiomyopathy, unascertained cause of arrest, drug toxicity, respiratory event, neurological event and other cardiac and non-cardiac. For OHCAs with confirmed cardiac aetiology, cardiovascular risk profiles were compared. SETTING A state-wide prospective OHCA registry (combining ambulance, hospital and forensic data) in the state of Victoria, Australia (population 6.5 million). PARTICIPANTS Victorians aged 1-50 years old experienced an OHCA between April 2019 and April 2020. MAIN OUTCOME MEASURES Rates and underlying causes of OHCA in young rural and metropolitan Victorians. RESULTS Rates of young OHCA were higher in rural areas (OHCA 22.5 per 100 000 rural residents vs. 13.4 per 100 000 metropolitan residents, standardised incidence ratio 168 (95% CI 101-235); confirmed cardiac cause of arrest 12.1 per 100 000 rural residents versus 7.5 per 100 000 metropolitan residents, standardised incidence ratio 161 (95% CI 71-251). The underlying causation of the OHCA and cardiovascular risk factor burden did not differ between rural and metropolitan areas. CONCLUSION Higher rates of OHCA occur in young rural patients, with standardised incidence ratio of 168 compared to young metropolitan residents. Rural status did not influence causes of cardiac arrest or known cardiovascular risk factor burden in young patients experiencing OHCA.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, Prahran, Vic., Australia.,Alfred Hospital, Prahran, Vic., Australia.,St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
| | | | - Karen Smith
- Ambulance Victoria, Doncaster, Vic., Australia.,Department of Paramedicine, Monash University, Melbourne, Vic., Australia.,Department of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, Prahran, Vic., Australia.,Ambulance Victoria, Doncaster, Vic., Australia
| | - Dominica Zentner
- Royal Melbourne Hospital, Parkville, Vic., Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, Southbank, Vic., Australia
| | - Tina Thompson
- Royal Melbourne Hospital, Parkville, Vic., Australia
| | - Paul James
- Royal Melbourne Hospital, Parkville, Vic., Australia
| | | | - Andreas Pflaumer
- Royal Children's Hospital, Melbourne, Vic., Australia.,Department of Paediatrics, Melbourne University, Parkville, Vic., Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Vic., Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, NSW, Australia
| | - Jodie Ingles
- Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Southbank, Vic., Australia.,Department of Forensic Medicine, Monash University, Southbank, Vic., Australia
| | - Dion Stub
- Alfred Hospital, Prahran, Vic., Australia.,Ambulance Victoria, Doncaster, Vic., Australia.,Department of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Prahran, Vic., Australia.,Alfred Hospital, Prahran, Vic., Australia.,St Vincent's Hospital Melbourne, Fitzroy, Vic., Australia
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Paratz E, van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Parsons S, La Gerche A. PO-712-01 PREDICTORS AND OUTCOMES OF IN-HOSPITAL REFERRALS FOR FORENSIC INVESTIGATION AFTER YOUNG PRESUMED SUDDEN CARDIAC DEATH. Heart Rhythm 2022. [DOI: 10.1016/j.hrthm.2022.03.1135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Turner L, Culliford D, Ball J, Kitson-Reynolds E, Griffiths P. The association between midwifery staffing levels and the experiences of mothers on postnatal wards: Cross sectional analysis of routine data. Women Birth 2022; 35:e583-e589. [DOI: 10.1016/j.wombi.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/08/2022] [Accepted: 02/10/2022] [Indexed: 10/19/2022]
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Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, Parsons S, La Gerche A. Predictors and outcomes of in-hospital referrals for forensic investigation after young sudden cardiac death. Heart Rhythm 2022; 19:937-944. [DOI: 10.1016/j.hrthm.2022.01.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/27/2022]
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Paratz E, van Heusden A, Ball J, Smith K, Thompson T, Zentner D, James P, Parsons S, Morgan N, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A. Inconsistent Discharge Diagnoses for Young Cardiac Arrest Episodes: Insights From a State-wide Registry. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Paratz E, van Heusden A, Ball J, Smith K, Zentner D, James P, Thompson T, Morgan N, Parsons S, Connell V, Pflaumer A, Semsarian C, Ingles J, Stub D, La Gerche A. Predictors and Outcomes of In-Hospital Referrals for Forensic Investigation After Young Sudden Cardiac Death. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Paratz E, van Heusden A, Zentner D, Morgan N, Smith K, Ball J, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, La Gerche A. Prevalence of Coronary Artery Anomalies in Young Sudden Cardiac Death: Insights From a Prospective State-Wide Registry. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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40
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Paratz E, van Heusden A, Smith K, Ball J, Zentner D, Morgan N, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, La Gerche A. Higher Rates But Similar Causes of Young Out-Of-Hospital Cardiac Arrest in Rural Australian Patients. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Azcui Aparicio R, Huynh Q, Ball J, Marwick T, Carrington M. Imaging-Guided and Nurse-Coordinated Disease Management Program for Primary Prevention of Cardiovascular Disease: Findings From the IMPRESS Randomised Controlled Trial. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zisis G, Carrington MJ, Oldenburg B, Whitmore K, Lay M, Huynh Q, Neil C, Ball J, Marwick TH. An m-Health intervention to improve education, self-management, and outcomes in patients admitted for acute decompensated heart failure: barriers to effective implementation. Eur Heart J Digit Health 2021; 2:649-657. [PMID: 36713108 PMCID: PMC9707948 DOI: 10.1093/ehjdh/ztab085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/30/2021] [Indexed: 02/01/2023]
Abstract
Aims Effective and efficient education and patient engagement are fundamental to improve health outcomes in heart failure (HF). The use of artificial intelligence (AI) to enable more effective delivery of education is becoming more widespread for a range of chronic conditions. We sought to determine whether an avatar-based HF-app could improve outcomes by enhancing HF knowledge and improving patient quality of life and self-care behaviour. Methods and results In a randomized controlled trial of patients admitted for acute decompensated HF (ADHF), patients at high risk (≥33%) for 30-day hospital readmission and/or death were randomized to usual care or training with the HF-app. From August 2019 up until December 2020, 200 patients admitted to the hospital for ADHF were enrolled in the Risk-HF study. Of the 72 at high-risk, 36 (25 men; median age 81.5 years; 9.5 years of education; 15 in NYHA Class III at discharge) were randomized into the intervention arm and were offered education involving an HF-app. Whilst 26 (72%) could not use the HF-app, younger patients [odds ratio (OR) 0.89, 95% confidence interval (CI) 0.82-0.97; P < 0.01] and those with a higher education level (OR 1.58, 95% CI 1.09-2.28; P = 0.03) were more likely to enrol. Of those enrolled, only 2 of 10 patients engaged and completed ≥70% of the program, and 6 of the remaining 8 who did not engage were readmitted. Conclusions Although AI-based education is promising in chronic conditions, our study provides a note of caution about the barriers to enrolment in critically ill, post-acute, and elderly patients.
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Affiliation(s)
- Georgios Zisis
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brian Oldenburg
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Kristyn Whitmore
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Maria Lay
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia
| | - Christopher Neil
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC3004, Australia,Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, VIC, Australia,Faculty of Medicine, Nursing and Health Science, University of Melbourne, Melbourne, VIC, Australia,Department of Cardiology, Western Health, Melbourne, VIC, Australia,School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia,Menzies Institute for Medical Research, University of Tasmania, Australia,Corresponding author. Tel: +61 3 8532 1550. Trial registration: Australia New Zealand Clinical Trials Registry (ACTRN): ACTRN12618001273279
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Azcui Aparicio RE, Carrington MJ, Ball J, Abhayaratna W, Stewart S, Haluska B, Marwick TH. Association of traditional risk factors with carotid intima-media thickness and carotid plaque in asymptomatic individuals with a family history of premature cardiovascular disease. Int J Cardiovasc Imaging 2021; 38:10.1007/s10554-021-02459-x. [PMID: 34731395 DOI: 10.1007/s10554-021-02459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
The use of imaging to detect subclinical atherosclerosis helps to inform decision-making in people classified as having intermediate risk for cardiovascular disease (CVD). This study sought to use carotid plaque as an alternative to carotid intima media thickness (cIMT). Carotid ultrasound for assessment of cIMT and plaque was obtained in 1031 people (53 years, 61% female) with a family history of atherosclerotic CVD. The association of baseline characteristics and standard atherosclerotic risk factors (RFs) were sought with abnormal cIMT and plaque. The strongest association of plaque was a history of hypertension (odds ratio [OR] 1.87 (1.02-3.42), followed by age (OR 1.08 [95% CI 1.02-1.13]). For cIMT, the strongest association was smoking history (OR 1.57 [1.13-2.19]). The area under the receiver operator curve for the presence of plaque was 0.74 (95% CI 0.68-0.81, p < 0.001) and 0.65 (95% CI 0.61-0.70, p < 0.001) for cIMT elevation. Isolated elevation of cIMT (n = 178) was associated with increased total cholesterol, body mass index (BMI) and systolic blood pressure (SBP). Plaque only (n = 29) was associated with hypertension, male sex and older age. The presence of both markers abnormal (n = 22) was associated with a history of smoking. The absence of either abnormal cIMT or plaque (n = 773), was inversely associated with current or past smoking, SBP and BMI. Abnormalities in carotid vessels are present in a minority of intermediate risk patients with familial premature disease. The associations with RFs differ and are more closely associated with plaque.
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Affiliation(s)
- Roberto Enrique Azcui Aparicio
- Baker Heart and Diabetes Institute, P.O. Box 6492, Melbourne, VIC, 3004, Australia
- Torrens University Australia, Adelaide, Australia
| | - Melinda J Carrington
- Baker Heart and Diabetes Institute, P.O. Box 6492, Melbourne, VIC, 3004, Australia
- Torrens University Australia, Adelaide, Australia
| | - Jocasta Ball
- Torrens University Australia, Adelaide, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Brian Haluska
- Department of Medicine, University of Queensland, Brisbane, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, P.O. Box 6492, Melbourne, VIC, 3004, Australia.
- Torrens University Australia, Adelaide, Australia.
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Qaderi V, Ball J, Nehme Z, Neumann JT, Wolfe R, Woods R, Tonkin AM, Smith K, McNeil JJ. Out-of-hospital cardiac arrest in elderly individuals. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Out-of-hospital cardiac arrest (OHCA) is associated with poor outcome, particularly in elderly people. Due to the shift in global demographics towards an ageing population, understanding risk factors for OHCA is essential for the development of primary prevention strategies. Thus, we aimed to identify predictors for OHCA in a large, community-dwelling cohort of elderly individuals.
Methods
We analyzed data from 11,156 participants enrolled in a randomized, placebo-controlled primary prevention trial, investigating the effect of low-dose aspirin in individuals aged 70 years or above. At baseline all participants had no prior cardiovascular disease events, dementia or major physical disability. OHCA events occurring within 5 years were identified by probabilistic data-linkage with a state-wide out-of-hospital cardiac arrest registry. Possible predictors included age, sex, anthropometric measures, conventional cardiovascular risk factors, renal function and frailty. To evaluate the association with OHCA, we performed univariable and multivariable Cox regression analyses. In exploratory analyses we also evaluated the effect of low-dose aspirin on OHCA events.
Results
In the cohort 54.7% were female and median age was 74.1 years (Interquartile Range [IQR] 71.8–77.7). During a median follow up time of 4.7 years (IQR 3.4–6.0) we recorded 67 OHCA events with presumed cardiac cause. The incidence rate was 1.07 per 1,000 person-years (95% Confidence-Interval [CI] 0.80–1.40). The mortality rate following OHCA was 91.2% (n=62). Univariable Cox regression analyses identified age, sex, weight, abdominal circumference, serum creatinine, diabetes, arterial hypertension, intake of antihypertensive medication and pre-frailty as predictors for the outcome. In multivariable Cox regression analyses we identified age (Hazard Ratio [HR] 1.06, CI 1.00–1.13), female sex (HR 0.49, CI 0.26–0.94) and pre-frailty (HR 1.92, CI 1.03–3.58) to be independent predictors (Table). In exploratory analyses there was no effect of low-dose aspirin on OHCA (HR 1.52, CI 0.87–2.70).
Conclusion
In a large, contemporary cohort of healthy, elderly individuals we describe a significant incidence of OHCA events associated with a very high mortality. We identified age, sex and pre-frailty, but interestingly not conventional cardiovascular risk factors as independent predictors of OHCA. We could not show a benefit of low-dose aspirin treatment, although the number of events was small. Our findings emphasize the importance of preventive strategies for pre-frailty in elderly individuals.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The ASPREE study was primarily funded by the National Institute of Aging and National Cancer Institute at the National Institutes of Health (grant number U01AG029824), the Australian National Health & Medical Research Council (grants 334047 & 1127060), Monash University (Australia) and the Victorian Cancer Agency (Australia). Multivariable Cox regression analyses
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Affiliation(s)
- V Qaderi
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - J Ball
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - Z Nehme
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - J T Neumann
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - R Wolfe
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - R Woods
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - A M Tonkin
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
| | - K Smith
- Ambulance Victoria, Centre for Research and Evaluation, Melbourne, Australia
| | - J J McNeil
- Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia
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Hook J, Smith K, Andrew E, Ball J, Nehme Z. Daylight savings time transitions and risk of out-of-hospital cardiac arrest: An interrupted time series analysis. Resuscitation 2021; 168:84-90. [PMID: 34571135 DOI: 10.1016/j.resuscitation.2021.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Many studies have reported increases in the risk of acute cardiovascular events following daylight savings time (DST) transitions. We sought to investigate the effect of DST transition on the incidence of out-of-hospital cardiac arrest (OHCA). METHODS Between January 2000 and December 2020, we performed an interrupted time series analysis of the daily number of OHCA cases of medical aetiology from the Victorian Ambulance Cardiac Arrest Registry. The effect of DST transition on OHCA incidence was estimated using negative binomial models, adjusted for temporal trends, population growth, and public holidays. RESULTS A total of 89,409 adult OHCA of medical aetiology were included. Following the spring DST transition (i.e. shorter day), there was an immediate 13% (IRR 1.13, 95% CI: 1.02, 1.25; p = 0.02) increased risk of OHCA on the day of transition (Sunday) and the cumulative risk of OHCA remained higher over the first 2 days (IRR 1.17, 95% CI: 1.02, 1.34; p = 0.03) compared to non-transitional days. Following the autumn DST transition (i.e. longer day), there was a significant lagged effect on the Tuesday with a 12% (IRR 0.88, 95% CI: 0.77, 0.99; p = 0.04) reduced risk of OHCA. The cumulative effect following the autumn DST transition was also significant, with a 30% (IRR 0.70, 95% CI: 0.51, 0.96; p = 0.03) reduction in the incidence of OHCA by the end of the transitional week. CONCLUSION We observed both harmful and protective effects from DST transitions on the risk of OHCA. Strategies to reduce this risk in vulnerable populations should be considered.
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Affiliation(s)
- Jack Hook
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - Emily Andrew
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - Jocasta Ball
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia; Pre-Clinical Disease and Prevention, Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia.
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Case R, Stub D, Mazzagatti E, Pryor H, Mion M, Ball J, Cartledge S, Keeble TR, Bray JE, Smith K. The second year of a second chance: Long-term psychosocial outcomes of cardiac arrest survivors and their family. Resuscitation 2021; 167:274-281. [PMID: 34242735 DOI: 10.1016/j.resuscitation.2021.06.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/11/2021] [Accepted: 06/25/2021] [Indexed: 12/12/2022]
Abstract
AIM Cardiac arrest (CA) survival has diverse psychosocial outcomes for both survivors and their close family, with little known regarding long-term adjustment and recovery experiences. We explored the psychological adjustment and experiential perspectives of survivors and families in the second year after out-of-hospital cardiac arrest (OHCA). METHODS A prospective, mixed-methods study of adult OHCA survivors in Victoria, Australia was conducted. Eighteen survivors and 12 family members completed semi-structured interviews 14-19 months post-arrest. Survivors' cognition, anxiety, depression and post-traumatic stress symptoms were measured using a battery of psychological assessments. A thematic content analysis approach was applied to qualitative interview data by two independent investigators, with data coded and categorised into themes and sub-themes. RESULTS Survivors' cognition, depression, anxiety and post-traumatic stress symptoms were not clinically elevated in the second year post-arrest. Subjective cognitive failures were associated with increased anxiety but not with mental state. Depression was significantly correlated with post-traumatic symptoms. Six primary themes emerged from survivors' recovery stories, focused on: awakening and realisation, barriers to adjustment, psychosocial difficulties, integration, protective factors and unmet needs. Family perspectives revealed four primary themes focused on trauma exposure, survivor adjustment problems, family impact, and areas for service improvement. CONCLUSION Survivors and their family members describe complex recovery journeys characterised by a range of psychosocial adjustment challenges, which are not adequately captured by common psychological measures. Post-arrest care systems are perceived by survivors and their families as inadequate due to a lack of accurate information regarding post-arrest sequalae, limited follow-up and inconsistent access to allied health care.
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Affiliation(s)
- Rosalind Case
- Department of Cardiovascular Medicine, Alfred Health, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Ambulance Victoria, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.
| | - Dion Stub
- Department of Cardiovascular Medicine, Alfred Health, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Ambulance Victoria, Melbourne, Australia
| | - Emilia Mazzagatti
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Holly Pryor
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Marco Mion
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | | | - Susie Cartledge
- Department of Cardiovascular Medicine, Alfred Health, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas R Keeble
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom; School of Medicine, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Janet E Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Parsons S, Paratz ED, van Heusden A, Zentner D, Morgan N, Thompson T, James P, Pflaumer A, Semsarian C, Ingles J, Case R, Ball J, Smith K, Stub D, La Gerche A. The formation of a cardiac arrest registry in Australia [End unexplained cardiac death (EndUCP) registry]. Pathology 2021. [DOI: 10.1016/j.pathol.2021.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nehme Z, Burns S, Ball J, Bernard S, Smith K. The impact of ventricular fibrillation amplitude on successful cardioversion, resuscitation duration, and survival after out-of-hospital cardiac arrest. CRIT CARE RESUSC 2021; 23:202-210. [PMID: 38045517 PMCID: PMC10692559 DOI: 10.51893/2021.2.oa7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: We sought to examine the incidence of low amplitude ventricular fibrillation and its impact on successful cardioversion, duration of resuscitation, and survival to hospital discharge in patients with out-of-hospital cardiac arrest (OHCA). Design: Retrospective analysis from a statewide registry. Setting: Victoria, Australia. Participants: Consecutive initial ventricular fibrillation arrests with an emergency medical service (EMS)-attempted resuscitation between 1 February 2019 and 30 January 2020. Main outcome measures: Survival to hospital discharge, successful cardioversion, and duration of resuscitation. Results: Of the 471 initial ventricular fibrillation arrests, 429 (91.1%) had sufficient electrocardiogram data for review. The median initial and final ventricular fibrillation amplitude did not differ (0.3 mV; interquartile range [IQR], 0.2-0.5 mV). The final pre-shock amplitude was ≤ 0.1 mV (very fine) and ≤ 0.2 mV (fine) in 22.8% and 37.5% of cases respectively. In a multivariable analysis, only the time between emergency call and first defibrillation was associated with a low initial ventricular fibrillation amplitude ≤ 0.2 mV (adjusted odds ratio [aOR], 1.07; 95% CI, 1.02-1.13; P = 0.004). After adjustment for arrest factors, every 0.1 mV increase in final amplitude was independently associated with survival to hospital discharge (aOR, 1.26; 95% CI, 1.14-1.39; P < 0.001) and initial cardioversion success (aOR, 1.19; 95% CI, 1.07-1.32; P = 0.001). The duration of resuscitation also increased by 1.7 minutes (95% CI, 1.03-2.36; P < 0.001) for every 0.1 mV increase in final amplitude. Conclusion: More than one-third of initial ventricular fibrillation OHCA cases were low in amplitude. Comparative international data are needed to better understand how low amplitude ventricular fibrillation rhythms confound the measurement of OHCA interventions and international benchmarks for survival outcomes.
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Affiliation(s)
- Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Paramedicine, Monash University, Melbourne, VIC, Australia
| | - Steffi Burns
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, VIC, Australia
| | - Jocasta Ball
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Stephen Bernard
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Hospital, Melbourne, VIC, Australia
| | - Karen Smith
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Department of Paramedicine, Monash University, Melbourne, VIC, Australia
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Paratz ED, Rowsell L, van Heusden A, Zentner D, Parsons S, Morgan N, Thompson T, James P, Pflaumer A, Semsarian C, Ingles J, Case R, Ball J, Smith K, Stub D, La Gerche A. The End Unexplained Cardiac Death (EndUCD) Registry for Young Australian Sudden Cardiac Arrest. Heart Lung Circ 2021; 30:714-720. [DOI: 10.1016/j.hlc.2020.09.937] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/20/2020] [Indexed: 10/23/2022]
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Fernando H, Milne C, Nehme Z, Ball J, Bernard S, Stephenson M, Myles PS, Bray JE, Lefkovits J, Liew D, Peter K, Brennan A, Dinh D, Andrew E, Taylor AJ, Smith K, Stub D. An open-label, non-inferiority randomized controlled trial of lidocAine Versus Opioids In MyocarDial Infarction study (AVOID-2 study) methods paper. Contemp Clin Trials 2021; 105:106411. [PMID: 33894363 DOI: 10.1016/j.cct.2021.106411] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
Background There is increasing evidence that opioids interfere with the oral bioavailability of P2Y12 inhibitors leading to delayed onset of antiplatelet effects. Several strategies have been proposed to mitigate this interaction including utilizing alternative analgesic agents in the management of ischemic chest pain. Methods The lidocAine Versus Opioids In MyocarDial Infarction (AVOID-2) study is a phase II, pre-hospital, open-label, non-inferiority, randomized controlled trial conducted by Ambulance Victoria and Monash University in metropolitan Melbourne, Victoria, Australia. The purpose of the study is to compare the analgesic effect (reduction in pain by arrival to hospital) and safety (e.g. adverse drug reactions) (co-primary endpoints) of intravenous lidocaine versus intravenous fentanyl in 300 adult patients attended by ambulance with suspected ST-elevation myocardial infarction (STEMI). Secondary endpoints and a cardiac magnetic resonance imaging (MRI) sub-study will also compare infarct size between these two groups. Conclusions The evaluation of alternative analgesic agents in the management of acute coronary syndromes is urgently needed to manage the opioid-P2Y12 inhibitor interaction. The results of this trial will have significant implications on the emergency management of acute coronary syndromes internationally.
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Affiliation(s)
- Himawan Fernando
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Monash University, Melbourne, Australia
| | - Catherine Milne
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Jocasta Ball
- Baker Heart and Diabetes Institute, Melbourne, Australia; Monash University, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Stephen Bernard
- Monash University, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Michael Stephenson
- Monash University, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Paul S Myles
- Monash University, Melbourne, Australia; Department of Anesthesiology and Perioperative Medicine, The Alfred and Monash University, Australia
| | | | - Jeffrey Lefkovits
- Monash University, Melbourne, Australia; Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Karlheinz Peter
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Monash University, Melbourne, Australia
| | | | - Diem Dinh
- Monash University, Melbourne, Australia
| | - Emily Andrew
- Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Andrew J Taylor
- Department of Cardiology, Alfred Hospital, Melbourne, Australia
| | - Karen Smith
- Monash University, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Monash University, Melbourne, Australia; Department of Cardiology, Western Health, Melbourne, Australia.
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