1,098 research outputs found
sj-docx-1-dst-10.1177_19322968241245654 – Supplemental material for Glucose Color Index: Development and Validation of a Novel Measure of the Shape of Glycemic Variability
No full textSupplemental material, sj-docx-1-dst-10.1177_19322968241245654 for Glucose Color Index: Development and Validation of a Novel Measure of the Shape of Glycemic Variability by Joseph Sartini, Michael Fang, Mary R. Rooney, Elizabeth Selvin, Josef Coresh and Scott Zeger in Journal of Diabetes Science and Technology</p
Supplemental Material - Depression and Health-Related Quality of Life Among Older Adults With Hearing Loss in the ACHIEVE Study
No full textSupplemental Material for Depression and Health-Related Quality of Life Among Older Adults With Hearing Loss in the ACHIEVE Study by Alison R. Huang, Nicholas S. Reed, Jennifer A. Deal, Michelle Arnold, Sheila Burgard, Theresa Chisolm, David Couper, Nancy W. Glynn, Theresa Gmelin, Adele M. Goman, Lisa Gravens-Mueller, Kathleen M. Hayden, Christine Mitchell, James S. Pankow, James Russell Pike, Jennifer A. Schrack, Victoria Sanchez, Josef Coresh, and Frank R. Lin, for the Collaborative Research Group in Journal of Applied Gerontology</p
Evaluation of Risk Data in 4.5 Million Patients for Implementing New Guidelines for Kidney Function Reporting
No full textBackground:
Clinical guidelines recommend reporting estimated glomerular filtration rate (eGFR) from serum creatinine measurements using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation, still organizations report eGFR mainly using alternative equations.
Objective:
To evaluate the risk relationship of eGFR from the CKD-EPI equation relative to the Modification of Diet in Renal Disease (MDRD) and Mayo Clinic Quadratic (MCQ), describe differences in interpretation of eGFR values, and implications associated with switching to the CKD-EPI equation, in a large patient population receiving ambulatory care in the United States.
Results:
Overall, 4.5 million patients aged 18–99 were included in the study, with 37,000 events for ESRD and 195,000 for all-cause mortality. The average eGFR was considerably lower for CKD-EPI (82.7 ml/min/1.73m2) and MDRD (79.7 ml/min/1.73m2), compared to MCQ (94.9 ml/min/1.73m2). Accordingly, the prevalence of GFR category 3–5 (<60 mL/min/1.73 m²) was 15.8% with CKD-EPI, 17.3% with MDRD, and 6.4% with MCQ. The CKD-EPI equation had a similarly steep risk gradient to the MDRD equation in GFR 3-5 range, both steeper than the risk gradient for the MCQ equation. The risk gradient at higher estimates of GFR was steeper for the CKD-EPI equation relative to MDRD, but shallower than MCQ. The CKD-EPI equation, compared to MDRD, reclassified more patients upward to higher categories of eGFR (2.6% downward vs.15.7% upward), and many more patients downward to lower categories compared to the MCQ (39.1% downward vs. 1.3% upward). Net reclassification improvement favored the CKD-EPI to MDRD equation for ESRD (0.12) and all-cause mortality (0.19), and favored the CKD-EPI to MCQ for all-cause mortality (0.06) but not ESRD (‒ 0.07).
Conclusion:
Regarding risk stratification, the recommended CKD-EPI equation is superior to MDRD. Similar estimates of GFR from the two equations, especially in GFR 3–5 range, facilitate transitioning to the CKD-EPI equation from MDRD. MCQ largely shifted the distribution of eGFR and eGFR-risk relationship to higher levels of eGFR, warranting its careful interpretation particularly at referral or transition from or to facilities using other equations
Lower Extremity Peripheral Artery Disease and Quality of Life among Older Individuals in the Community: The Atherosclerosis Risk in Communities (ARIC) Study
No full textBackground: Lower extremity peripheral arterial disease (PAD), commonly identified by an ankle-brachial Index (ABI) <0.9, increases mortality risk and may impair quality of life (QOL). However, most studies assessing reduced QOL in the relation to PAD rely on small clinical studies, leaving uncertainty about the impact of PAD on QOL in the community.
Methods: Using data of 5,115 ARIC visit 5 (2011-2013) participants aged 66-90 years, we assessed the associations of ABI with several QOL parameters, including physical and mental components in SF-12 as well as some other QOL parameters (leisure time exercise/activity/walking, depression, and hopeless feeling. We used linear/logistic regression models to adjust for demographic characteristics, cardiovascular disease (CVD) risk factors, history of CVD, and other comorbidities including lung disease and reduced kidney function.
Results: There were 402 participants with low ABI < 0.90 and 426 participants with borderline low ABI (0.90-0.99). Overall, there were dose-response relationships between lower ABI and poor status of QOL parameters. With ABI 1.10-1.19 as a reference (n=1900), the associations of low ABI (< 0.90) and impaired QOL were much more evident in physical components (Physical Component Summary: -3.27 [95%CI: -5.60 to -0.93]), compared to mental components (Mental Component Summary: -0.07 [95%CI: -2.21 to 2.06]). Regarding each of eight domains in SF-12, low ABI was significantly associated with all four domains for physical components (Physical Functioning, Role Physical, Bodily Pain, and General Health) but only with one of four domains for mental components (vitality). Similarly low ABI was more consistently associated with the other physical QOL parameters than the other mental parameters. Interestingly, a poor status of several QOL parameters was also observed in borderline low ABI. Similar results for lower ABI and physical QOL parameters were observed in subgroups according to sex, race as well as history of CVD, diabetes, and reduced kidney function.
Conclusions: Lower ABI was independently associated with poor status of QOL, especially on physical, with potential important implications on quality-maintained life in older individuals. Further studies are warranted to assess if the PAD-specific management can improve QOL among individuals with lower ABI
EVALUATING BIAS IN LONG-TERM RISK ESTIMATES USING SHORT-TERM FOLLOW-UP
No full textIn lifetime risk methods, long-term risks are estimated by analyzing the survival data on the age time scale. It allows for deriving risk estimates across a wide age range using short-term follow-up by left-truncating study participants and entering them into the risk set at their age of entry to the study. Thus, the follow-up for study participants are connected to provide a survival curve across the sum of their age range during their follow-up. While this provides estimates for the desired risk across a wide age range, it has not been studied to what extent these estimates are valid. We used simulation and analysis of survival data from the NHANES-III study to quantify the bias in long-term risk estimates extrapolated from shorter follow-up. Overall, we found that the bias in the lifetime risk methods occurs when the risk estimates are stratified by a baseline risk factor which varies with age. The stronger the association of the risk factor with age, the stronger the bias. Likewise, the bias is larger at shorter follow-up and at the oldest ages. We confirmed that a bias of the expected direction occurred in real data relating self-reported health status to mortality in NHANES-III. However, the bias was smaller than in our simulation, suggesting that in analyses of real data with limited follow-up, we should examine the extent to which the cohort characteristics and age-related changes in the risk factor play a role in the biased estimates when follow-up is short
SMARTPHONE-BASED TRACKING AND TEXTING INTERVENTIONS FOR PROMOTION OF PHYSICAL ACTIVITY IN CARDIOVASCULAR PREVENTION
No full textIntroduction: The recent advent of smartphone-linked wearable accelerometers offers a novel opportunity to promote physical activity using mobile health (mHealth) technology.
Methods: mActive was a 5-week, blinded, sequentially-randomized, parallel group, pilot trial that enrolled patients at an academic preventive cardiovascular center in Baltimore, Maryland from 1/17/14-5/20/14. Eligible patients were 18-69 year old smartphone users who reported low leisure-time activity by a standardized questionnaire. After establishing baseline activity during a 1-week blinded run-in, we randomized patients 2:1 to unblinded or blinded tracking in phase I (2 weeks), then randomized unblinded patients 1:1 to receive or not receive smart texts in phase II (2 weeks). Smart texts provided fully-automated, personalized, real-time coaching 3 times/day towards a daily goal of 10,000 steps. The primary outcome was daily step count.
Results: Forty-eight patients (22 women, 26 men) enrolled with a mean (SD) age of 58 (8) years, body mass index of 31 (6), and baseline daily step count of 9670 (4350). With 100% uptake of the intervention, the phase I change in activity was non-significantly higher in unblinded patients versus blinded controls by 1024 daily steps (95% CI -580-2628, p=0.21). In phase II, smart text receiving patients increased their daily steps over those not receiving texts by 2534 (1318-3750, p<0.001) and over blinded controls by 3376 (1951-4801, p<0.001).
Conclusion: In present-day adult smartphone users receiving preventive cardiovascular care in the United States, a technologically-integrated mHealth strategy combining digital tracking with fully-automated, personalized, real-time text message coaching resulted in a large increase in physical activity
Two-week continuous monitoring of heart rhythm in chronic kidney disease
No full textIndividuals with chronic kidney disease (CKD) have an alarmingly high rate of sudden cardiac death, largely attributable to arrhythmias. The burden of arrhythmias has been difficult to study because arrhythmias are often transient and asymptomatic, and the current practice is limited by short periods of arrhythmia monitoring. This dissertation therefore predominantly used a new continuous monitoring device in the Atherosclerosis Risk in Communities study to assess the following four aims.
First, we conducted a systematic review and meta-analysis to examine the burden of all types of arrhythmia in CKD. Most studies found that estimated glomerular filtration rate (eGFR) was associated with a higher risk of atrial fibrillation (AF). Some studies also reported a higher incidence of ventricular arrhythmia related to reduced eGFR, but overall, limited number of studies examined albuminuria and other arrhythmias.
Second, we quantified across CKD severity the burden of major arrhythmias (i.e., AF, non-sustained ventricular tachycardia [NSVT], long pause, atrioventricular block [AVB]) and minor arrhythmias (i.e., ventricular ectopy [VE], supraventricular tachycardia [SVT] and ectopy [SVE]). Compared to no-CKD, CKD was associated with higher presence of AF and NSVT, higher frequency of long pause and VE, and a lower frequency of AVB.
Third, we investigated the relationships between several biomarkers representing cardiac overload (i.e., natriuretic peptide [NT-proBNP]), cardiac injury (i.e., high-sensitivity cardiac troponin-T [hs-cTnT]), electrolyte abnormalities (i.e., potassium and magnesium), and anemia (i.e., hemoglobin) with arrhythmias in CKD. NT-proBNP and hs-cTnT were associated with many major arrhythmias. Electrolytes were associated with some arrhythmias, while hemoglobin was not robustly associated with any arrhythmias.
Fourth, we characterized the diurnal patterns of intermittent AF and assessed whether they vary by CKD status. There was a biphasic pattern of AF with a peak occurring around midnight and a nadir around noon.
Taken together, this dissertation provided a broader understanding of the burden of various arrhythmias, their risk factors and markers, and a diurnal pattern of AF in CKD. Our research highlights the relevance of various arrhythmias in CKD and the importance of cardiac overload and injury in the pathophysiology of arrhythmias, while demonstrating a diurnal pattern of AF with potential clinical implications
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