Background:Atrial septal defect(ASD)is a common form of adult congenital heart disease that can lead to long-term adverse outcomes if left untreated.Early closure of ASD has been associated with excellent outcomes and...Background:Atrial septal defect(ASD)is a common form of adult congenital heart disease that can lead to long-term adverse outcomes if left untreated.Early closure of ASD has been associated with excellent outcomes and lower complication rates.However,there is limited evidence regarding the prognosis of ASD closure in older adults.This study aims to evaluate the mortality rates in older ASD patients with and without closure.Methods:A retrospective cohort study was conducted on patients aged 40 years or older with ASD between 2001 and 2017.Patients were followed up to assess all-cause mortality.Univariable and multivariable analyses were performed to identify the predictors of mortality.A p-value of<0.05 was considered statistically significant.Results:The cohort consisted of 450 patients(mean age 56.6±10.4 years,77.3%female),with 66%aged between 40 and 60 years,and 34%over 60 years.Within the cohort,299 underwent ASD closure(201 with transcatheter and 98 with surgical closure).During the median follow-up duration of 7.9 years,51 patients died.The unadjusted cumulative 10-year rate of mortality was 3%in patients with ASD closure,and 28%in patients without ASD closure(log-rank p<0.001).Multivariable analysis revealed that age(hazard ratio[HR]1.04,95%confidence interval[CI]1.006–1.06,p=0.01),NYHA class(HR 2.75,95%CI 1.63–4.62,p<0.001),blood urea nitrogen(BUN)(HR 1.07,95%CI 1.03–1.12,p<0.001),right ventricular systolic pressure(RVSP)(HR 1.07,95%CI 1.003–1.04,p=0.01),and lack of ASD closure(HR 15.12,95%CI 5.63–40.59,p<0.001)were independently associated with mortality.Conclusion:ASD closure demonstrated favorable outcomes in older patients.Age,NYHA class,BUN,RVSP,and lack of ASD closure were identified as independent factors linked to mortality in this population.展开更多
Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients.Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary di...Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients.Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure(ICD-10-TM code:150.9)during 2008-2012 according to three major Thailand reimbursement systems(civil servant,social security,and universal coverage systems).Patients were categorized into either the elderly group(age>65 years)or the non-elderly group(age<65 years).Mortality rate and survival analysis were compared between groups.Demographic,underlying disease and comorbid condition data were collected.Cardiovascular and non-cardiovascular death was also analyzed.Results A total of 201,709 patients were included.The average age of patients was 64.9±14.8 years,and the gender proportion breakdown was 84,155(41.7%)males and 117,554(58.3%)females.Just over half of patients(107,325 patients;53.2%)were elderly.Overall mortality rate was 50.8%.The mortality rate at one month,six months,one year,and three years was 11.0%,24.5%,32.5%,and 46.3%,respectively.Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio(OR)of 1.47(95%CI:1.46-1.49)for all-cause mortality,an OR of 1.25(95%CI:1.23-1.27)for cardiovascular death,and an OR of 1.72(95%CI:1.68-1.75)for non-cardiovascular death(all P<0.001).After adjusting for potential confounders,elderly status remained the second strongest factor associated with increased risk of mortality after heart failure hospitalization following chronic kidney disease.Conclusions The overall mortality rate after heart failure hospitalization was a very high 50.8%.Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization.This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.展开更多
基金This study was approved by the Siriraj Institutional Review Board(SIRB),Faculty of Medicine Siriraj Hospital,Mahidol University(COA no.Si 760/2021).The need for consent was waived by the board due to its retrospective nature and as all personal identifying information was obliterated.The study protocol conforms to the ethical guidelines of the 1975 Declaration of Helsinki.
文摘Background:Atrial septal defect(ASD)is a common form of adult congenital heart disease that can lead to long-term adverse outcomes if left untreated.Early closure of ASD has been associated with excellent outcomes and lower complication rates.However,there is limited evidence regarding the prognosis of ASD closure in older adults.This study aims to evaluate the mortality rates in older ASD patients with and without closure.Methods:A retrospective cohort study was conducted on patients aged 40 years or older with ASD between 2001 and 2017.Patients were followed up to assess all-cause mortality.Univariable and multivariable analyses were performed to identify the predictors of mortality.A p-value of<0.05 was considered statistically significant.Results:The cohort consisted of 450 patients(mean age 56.6±10.4 years,77.3%female),with 66%aged between 40 and 60 years,and 34%over 60 years.Within the cohort,299 underwent ASD closure(201 with transcatheter and 98 with surgical closure).During the median follow-up duration of 7.9 years,51 patients died.The unadjusted cumulative 10-year rate of mortality was 3%in patients with ASD closure,and 28%in patients without ASD closure(log-rank p<0.001).Multivariable analysis revealed that age(hazard ratio[HR]1.04,95%confidence interval[CI]1.006–1.06,p=0.01),NYHA class(HR 2.75,95%CI 1.63–4.62,p<0.001),blood urea nitrogen(BUN)(HR 1.07,95%CI 1.03–1.12,p<0.001),right ventricular systolic pressure(RVSP)(HR 1.07,95%CI 1.003–1.04,p=0.01),and lack of ASD closure(HR 15.12,95%CI 5.63–40.59,p<0.001)were independently associated with mortality.Conclusion:ASD closure demonstrated favorable outcomes in older patients.Age,NYHA class,BUN,RVSP,and lack of ASD closure were identified as independent factors linked to mortality in this population.
文摘Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients.Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure(ICD-10-TM code:150.9)during 2008-2012 according to three major Thailand reimbursement systems(civil servant,social security,and universal coverage systems).Patients were categorized into either the elderly group(age>65 years)or the non-elderly group(age<65 years).Mortality rate and survival analysis were compared between groups.Demographic,underlying disease and comorbid condition data were collected.Cardiovascular and non-cardiovascular death was also analyzed.Results A total of 201,709 patients were included.The average age of patients was 64.9±14.8 years,and the gender proportion breakdown was 84,155(41.7%)males and 117,554(58.3%)females.Just over half of patients(107,325 patients;53.2%)were elderly.Overall mortality rate was 50.8%.The mortality rate at one month,six months,one year,and three years was 11.0%,24.5%,32.5%,and 46.3%,respectively.Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio(OR)of 1.47(95%CI:1.46-1.49)for all-cause mortality,an OR of 1.25(95%CI:1.23-1.27)for cardiovascular death,and an OR of 1.72(95%CI:1.68-1.75)for non-cardiovascular death(all P<0.001).After adjusting for potential confounders,elderly status remained the second strongest factor associated with increased risk of mortality after heart failure hospitalization following chronic kidney disease.Conclusions The overall mortality rate after heart failure hospitalization was a very high 50.8%.Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization.This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.
