Introduction: Mitral valve (MV) repair (MVr) has superior survival outcomes to MV replacement (MVR) for primary MV diseases. MVr cases has increased in other developed nations but is unknown in Australia. We assessed temporal trends in the total and relative MVr volume and compared MVr and MVR outcomes over 17 years. Method: Patients who had isolated MV surgery (MVSx) between 2001-2017 were identified from the New South Wales statewide Admitted Patient Data Collection registry. Mortality outcome was tracked to Dec 2018. Results: A total of 5693 patients (MVr: n=2020 [35%]; mechanical MVR: n=1656 [29%]; bioprosthetic MVR: n=2017 [35%]) were identified; median age [interquartile range] were 67y [59-75y] vs 64y [55-71y] vs 75y [68-80y], respectively (all P<0.001). Median follow-up for the cohort was 6.3yrs. Annual MVSx cases increased over the study period but relative use of MVr declined from 44% (110/252 MVSx) in 2002 to 27% (165/601 MVSx) in 2017 (Fig1). Crude in-hospital and 1-yr mortality steadily declined for all groups between 2001 and 2017. MVr had the best outcome, with 1.2% in-hospital, 2.5% 1-yr, and 21.6% total cumulative mortality. Compared to MVr, after adjusting for age, sex, referral source, and comorbidities, the adjusted hazard ratios for long-term mortality were 1.41 (95% confidence interval [CI]=1.24-1.61) for mechanical MVR and 1.73 (95% CI=1.53-1.95) for bioprosthetic MVR (Fig 2). Conclusion: In this statewide Australian cohort study, relative use of MVr decreased over 17 years and are lower than reported by other international studies, despite having superior outcome compared to MVR. Factors driving the relatively low use of MVr should be explored.
INTRODUCTION: Haemorrhagic stroke (HS) is an important cardiovascular cause of mortality worldwide. In Australia, long term temporal trends in HS hospitalisation rates and predictors of mortality are unknown. Methods: All New South Wales residents with first-ever HS from 2002-2017 were identified from the Centre-for-Health-Record-Linkage statewide databases. Mortality tracked to 31 Dec 2018 via the death registry were adjusted for age, sex, admission year, referral source, surgical evacuation of HS status, and comorbidities in multivariable regression analyses. Results: There were 35433 patients (51% male) admitted for HS. Age-adjusted mean (±SD) admission rates were higher for males than females (63.6±6.2 vs 49.9±4.4 admissions-per-100,000-persons-per-annum respectively, p<0.001). Annual admission rates declined for both sexes from 2002-2017 (male: 74.4 to 52.5 vs female: 55.2 to 43.6 admissions-per-100,000-persons, both p<0.001 for linear trend). Admission rates were highest in patients ≥60yo but significantly declined from 2002-2017 in both sexes, while admission rates for <60yo patients remained static. Crude in-hospital and 1-year mortality post-HS were 22.5% and 38.2% respectively. Adjusted in-hospital and 1-year mortality post-HS were lower in 2017 compared to 2002 (adjusted odds ratio [aOR]=0.56, 95% confidence interval [CI]=0.49-0.65; adjusted hazard ratio [aHR]=0.73, 95%CI=0.66-0.80, respectively) (all p<0.001). Annual rates of surgical evacuation were static during study period (10.4% per year). Surgical evacuation was associated with better in-hospital and 1-year mortality (aOR=0.47, 95%CI=0.42-0.53; aHR=0.49, 95%CI=0.45-0.53, both p<0.001 respectively). Increasing age and higher Charlson comorbidity index independently predicted greater in-hospital and 1-year mortality. Male sex was associated with lower in-hospital mortality (aOR=0.88, 95%CI=0.83-0.93, p<0.001) but not at 1-year. Conclusion: Age-adjusted admission rates for HS fell between 2002-2017 for both sexes, driven mostly by ≥60 age groups, with adjusted in-hospital and 1-year mortality improving by 43% and 27% respectively. Strategies to improve survival including greater access to surgical evacuation should be further explored.
Background The number of patients with ulcerative colitis (UC) is increasing. As the number of patients increases, patient backgrounds become diverse, and treatment choices that match the background are required. Most UCs are mild, but about 30% are more than moderate. UCs with moderate or higher illness have resistance/dependence to steroids and are difficult to introduce remission. In recent years, many new drugs have appeared for remission induction therapy. However, in UC treatment, maintenance therapy that suppresses relapse after induction of remission is important. Maintaining long-term remission prevents deterioration in the quality of life and reduces the incidence of UC-related colorectal cancer. To that end, it is important to consider remission maintenance therapy. In patients with intractable UC who have been in remission with tacrolimus (TAC) and used vedolizumab (VDZ) as maintenance therapy, patient background, relapse rate (observation period 181.5 ± 25.9 days), (3) safety of TAC and VDZ combination The sex was examined. Methods Seven patients who received remission with TAC and maintained remission with VDZ between November 2018 and June 2019 were included. (1) Patient background at the time of introduction of TAC and VDZ, TAC administration period (day) until the start of VDZ, (2) Relapse rate, (3) AZA use history, side effects, and adverse events caused by the combined use of VED. Results (1) Patient background was age at TAC introduction (age) 44.4 ± 19.7, sex (male / female) 3/4, disease duration (year) 12 ± 11.5, CAI 14.4 ± 2.9, Hb 11 ± 0.8, CRP 5.5 ± 3.6, Endoscopic score (Mayo 3 ± 0, UCEIS 7 ± 1.1), CAI at the time of VDZ introduction 6 ± 3.3, Hb 11.3 ± 2.0, CRP 0.4 ± 0.5, TAC administration period until VDZ start 140 ± It was 155. (2) Six patients had a history of AZA use. 4 out of 6 cases with AZA history side effect due to AZA was observed. The side effects of AZA were leukopenia in 2 cases, headache in 2 cases, and liver injury in 1 case. (There were duplicate cases) (3) No adverse events were observed due to the combined use of TAC and VDZ. Conclusion TAC has clinical remission or symptom improvement for refractory UCVDZ had been administered since then. In cases where administration of AZA was difficult, VDZ was selected as maintenance therapy. There were no serious side effects from the combined use of TAC and VDZ. TAC is a drug that has a rapid effect. However, long-term administration of TAC is at risk for kidney damage. Therefore, we considered that maintenance therapy with VDZ after TAC is effective.
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