BackgroundAtrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions.Methods and ResultsIn the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P<0.0001) and age ≥75 years (hazard ratio 1.69, 95% CI 1.51–1.90, P<0.0001) were associated with higher all‐cause mortality. Multiple additional characteristics were independently associated with higher mortality, with decreasing creatinine clearance, chronic obstructive pulmonary disease, male sex, peripheral vascular disease, and diabetes being among the most strongly associated (model C‐index 0.677).ConclusionsIn a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas <1 in 10 deaths were caused by nonhemorrhagic stroke or systemic embolism. Optimal prevention and treatment of heart failure, renal impairment, chronic obstructive pulmonary disease, and diabetes may improve survival.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT00403767.

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OBJECTIVE: Obesity is associated with a high mortality rate due to cardiovascular disease. Left ventricular (LV) hypertrophy has been described in relation to obesity. The aim of this study was to evaluate echocardiographically the LV mass and function in young obese women as compared to lean women with similar characteristics. DESIGN: Prospective study. SUBJECTS: Eighty-two young women ( 40 y), with obesity degree varying from I to III (BMI from 30 to 50 kgam 2 ) were compared to eighty young lean women. All of them were normotensive, none had cardiovascular complaints or any previous history of pulmonary disease, and none were taking any medication. The LV mass was calculated by the Devereux and Reichek formula. RESULTS: The LV mass was strongly increased in all obese groups (P`0.00003 to 0.000005) compared to lean subjects. LV mass adjusted indexes for height, BMI or volume were also increased compared to lean subjects and when adjusted for weight it was decreased. However when comparing LV massabody surface area index this difference was not statistically signi®cant. The linear regression analysis showed a strong association between the degree of obesity and LV mass, (r 0.52, P`0.001). Systolic and diastolic function in obese patients were similar to lean subjects, except for a lower EaA ratio in the obese group (P 0.005). CONCLUSION: In asymptomatic young obese women, there are some echocardiographic ®ndings suggesting early cardiac involvement that seems to be related to the degree of obesity.

Nine patients with severe sepsis were studied to determine causes for any alterations in oxygen dissociation. Seven of the patients had oxyhemoglobin curves shifted to the left of expected and diminished DPG levels. These deficiences were not corrected in one case. The other eight patients survived or expired with normal to elevated P(50T) and DPG levels. In this study, three factors occurring either individually, in concordance, or in sequence were present when P(50T) was decreased. Correction of these deficiencies lead to normalization and, in one case, exceedingly high P(50T) and DPG levels. Where hypophosphatemia, acidosis, and transfusion of DPG deficient blood were avoided, no such change occurred. Hypophosphatemia is a common occurrence in the seriously ill patient whether or not hyperalimentation is used and may occur in spite of phosphate supplementation. Blood transfusions with CPD as the preservative are effective in reducing the severity of this disorder by the addition of an inorganic phosphate load. Septic shock itself had no untoward effect on oxygen dissociation. This held true even in the terminal stages of the disease process.

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Purpose -To assess differences in the in-hospital mortality (HM) rate between men and women with unstable angina pectoris (UA) according to age, depression of the ST segment, history of previous acute myocardial infarction (AMI), and risk factors for coronary heart disease. =1.02-9.27. In logistic regression models, the association between sex and death was not significantly altered when the following parameters were considered: age, depression of the ST segment, history of previous AMI and risk factors for coronary heart disease. The nonadjusted and adjusted odds ratio (OR) for the distinct covariables were 3.28 , respectively. Numerous studies have consistently shown that mortality in acute myocardial infarction (AMI) is higher in women than in men [1][2][3][4][5][6][7][8][9] . There is evidence that some factors related to the female gender, such as advanced age at the time of hospital admission, a higher frequency of heart failure, a larger interval between symptom onset and hospital admission, and lesser access to medical care partially explain the higher mortality in women with AMI. In regard to unstable angina pectoris (UA), there are few studies comparing the prognosis between men and women, which is particularly amazing considering the large number of hospital admissions due to UA at cardiology services 10 . In addition, the risk of death during hospital admission for this group of patients can reach 5% to 10% 11 . These points motivated the present study, whose main purpose was to assess the possible association between sex and in-hospital mortality (HM) due to UA in a cardiology service in the city of Salvador in the Brazilian state of Bahia. Methods Conclusion MethodsAll patients in this study (n=261) were admitted to the Cardiology and Cardiovascular Surgery Unit of the Fundação Bahiana de Cardiologia (FBC), at the Hospital Universitário Prof. Edgar Santos, of the Federal University of Bahia. This hospital has a 24-hour emergency unit and is a referral service for the entire state of Bahia. Patients were prospectively and consecutively selected at the time of hospital admission to the Coronary Unit, from October 96 to March 98. Patients with one of the following characteristics were excluded from the study: those with elevated levels of CKMB in the first 12 hours after admission (these patients were considered to have evolving AMI); those patients remaining in the hospital for less than 48 hours free from events because the period of observation was considered too short; and those with diagnosis on hospital discharge different from UA because they did not have angiographic documentation of coronary heart disease (CHD) or objective evidence of spontaneous or provoked ischemia.Data collected were from the hospital phase of the UA, 674Passos et al In-hospital mortality of unstable angina in men and women Arq Bras Cardiol volume 72, (nº 6), 1999which is defined as precordial pain compatible with myocardial ischemia at rest (with or without electrocardiographic alteration) or progressive angina (i. e.,...