European Journal of Internal Medicine最新文献

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Introduction: Atrial fibrillation (AF) is associated with an increased risk of adverse outcomes. Clinical risk factors have been identified as predictors of such outcomes, but social determinants of health (SDOH) may also play a role. We evaluated the associations between gendered SDOH (unevenly distributed between sexes) and adverse outcomes in AF.

Methods: This is a retrospective cohort study using data from a European registry of AF patients from 250 centers and twenty-seven countries. Gendered SDOH included education, living status, subscales of the EQ-5D-5L questionnaire, behavioral factors, and country-level gender inequality index (GII). The primary outcome was a composite of major adverse cardiovascular events and all-cause mortality. We used multivariate logistic regression models to identify associations between SDOH and the primary outcome.

Results: The study population comprised of 11,096 patients (mean age 69.2 years; 40.7 % females), with 75.6 % of patients having a high-risk CHA₂DS₂-VASc score. Most participants had secondary education, were physically inactive, lived in countries with gender equity and reported at least moderately elevated quality of life measures; they were less likely to live alone, smoke or drink alcohol. After adjustment for clinical factors, not having any post-secondary education (OR:1.17 95 %CI:1.05-1.28), reporting poorer health status (OR:1.08 95 %CI:1.05-1.11), living in a country with a higher GII (higher gender inequity) (OR:1.12 95 %CI:1.03-1.22 each 0.100), reporting reduced mobility (OR:1.18 95 %CI:1.02-1.38) and reduced self-care (OR:1.35;95 %CI:1.14-1.61) were independently associated with worse outcomes.

Conclusions: Gendered SDOH are independently associated with adverse events in patients with AF. These factors should be considered for assessment of risk and as potential targets for interventions to improve outcomes.

Condensed abstract: Atrial fibrillation (AF) is associated with adverse outcomes and social determinants of health (SDOH), which are gendered, may predict adverse outcomes in AF. We used a registry of AF patients from 27 European countries. Multivariate logistic regressions were used to investigate the associations between gendered SDOH and the primary outcome, a composite of major adverse cardiovascular events and all-cause mortality. Several SDOH were independent predictors: no higher education (OR:1.17;95 %CI:1.05-1.28), lower health (OR:1.08;95 %CI:1.05-1.11), higher GII (OR:1.12;95 %CI:1.03-1.22 each 0.100), reduced mobility (OR:1.18;95 %CI:1.02-1.38) and reduced self-care (OR:1.35;95 %CI:1.14-1.61). Gendered SDOH are independently associated with adverse events in AF.

Background: Monitoring is essential in managing acute hypoxemic respiratory failure (AHRF). Nasal pressure swing (P_nose) may predict high-flow nasal oxygen (HFNO) therapy failure and respiratory support dependency. This study investigates P_nose's predictive value for respiratory support needs and clinical outcomes in AHRF patients initially treated with HFNO.

Methods: This post-hoc analysis included 60 AHRF patients treated with HFNO. Respiratory variables, including P_nose, were assessed at baseline and two hours after HFNO initiation. Patients were classified into high (HG) and low (LG) Pnose groups based on a 5.1 cmH2O threshold. The primary outcome was RS-free survival at day 7; HFNO failure, escalation to non-invasive ventilation (NIV) or mechanical ventilation (MV), mortality, and HFNO weaning time were also analyzed. Predictive accuracy of respiratory indices, including P_nose, was evaluated.

Results: Out of the patients enrolled, 35 were in the HG, and 25 in LG group. HG patients showed a lower RS-free survival at day 7 (adjusted HR=0.26, p < 0.0001), and experienced higher failure rates of HFNO (88 % versus 0 %, p < 0.0001), escalation to NIV (84 % versus 0 %, p < 0.0001), endotracheal intubation (36 % versus 0 %, p < 0.0001), and mortality (24 % versus 6 %, p = 0.0001) compared to LG. Accordingly, RS-free days at day 28 were lower in HG (11 days versus 23 days, p < 0.0001). Finally, among the respiratory variables, P_nose resulted independently associated with the primary outcome (OR=0.64 95 %CI [0.42-0.90], p = 0.02).

Conclusions: In patients with AHRF admitted to the ward and treated by HFNO, P_nose is an independent and accurate factor in forecasting the dependency from RS and survival within the first week.