Objective To investigate the associations between triglyceride (TG) level and its variability with lung related infections, cancer, and mortality outcomes, a retrospective cohort-based was conducted. Methods This was a retrospective cohort study of patients attending the Hospital Authority from 1st January 2000 to 31st December 2003 who were followed up until 31st December 2019 with at least three TG measurements in Hong Kong. Standard deviation (SD), root mean square (RMS), coefficient of variation (CV) were used as measures of variability. The primary outcome was Lung infection related mortality, and the secondary outcomes included lung cancer development, lung infections (bacterial, virus, and influenza infection), and all-cause mortality. Univariate and multivariate Cox regression models were conducted to identify the associations of TG level and its variabilities with the primary and secondary outcomes. Results 47871 patients were included in the study (Median age 65.35 years old, 39.75% male). We found a high triglyceride baseline level is significantly associated with increased risk of all-cause mortality (HR: 1.11, 95% CI [1.104-1.116], p value < 0.0001), respiratory infection (HR: 1.14, 95% CI [1.13-1.15], p value < 0.0001), lung-infection associated mortality (HR: 1.14, 95% CI [1.13-1.15], p value < 0.0001) and lung cancer (HR: 1.10, 95% CI [1.07-1.12], p value < 0.0001). A further sub-analysis on specific respiratory infections revealed that high baseline TG has a similar risk incretion in bacterial, influenza and other viral infection (HR > 1, p value < 0.0001). Conclusion A high serum triglyceride level is associated with increased all-cause mortality, lung cancer, respiratory infections and its associated mortality. Clinicians should be aware of such correlations and offer appropriate lipid control management to minimise these risks. Further studies should be conducted to investigate this relationship in other ethnical groups and whether TG-lowering medications may reduce the aforementioned adverse outcomes.
Background/Introduction Transthyretin amyloidosis (TTR) is a cause of restrictive cardiomyopathy and heart failure predominantly in elderly men. Two main factors have moved TTR amyloidosis from super-specialist centres into mainstream cardiology: We aimed to determine the potential magnitude of referrals to our embryonic cardiac TTR service from patients having routine bone scans for non-cardiac reasons. We planned to estimate the prevalence of cardiac TTR in our local over 65 male population to plan service provision. Methods All HDP bone scans performed at a teaching and research hospital in the UK from the 2017/18 financial year were reviewed (n=1530). Our hospital is the only provider of these scans locally. Of these, 1399 were for oncological and musculoskeletal (oncology/MSK) indications and 37 were referred to specifically “exclude amyloidosis”. We excluded paediatric and duplicate follow-up imaging. There are approximately 140,000 people over aged 65 living within our catchment region. We have assumed approximately 50% are male. Results Myocardial uptake was present in 7/1399 of the oncology/MSK group and 3/7 (43%) of these already had features of heart failure. In these 7 patients bone scans were performed to investigate bony metastases in 6 (1 oesophageal cancer and 5 for prostate cancer) and 1 following an orthopaedic procedure. Cardiac uptake was present in 10/37 of the “exclude amyloid” group. In those with cardiac uptake across both groups (17) 94% were male with a mean age of 83 (sd ±6.59) and 41% were from the oncology/musculoskeletal group. Incidental cardiac uptake was seen in 1:200 routine HDP scans. When looking at males >65 specifically the uptake rate increases to (6 out of 701 scans) i.e. 1:117. Assuming there is no increased risk of TTR in patients with prostate or oesophageal cancer, then an estimate of cardiac TTR in the 75,000 males over the age of 65 locally would be approximately 640 men. Conclusions Bone scans account for 41% of all HDP scans with incidental cardiac uptake and therefore represents a significant potential referral source for a cardiac amyloid service. Our data suggests a potential prevalence of cardiac amyloidosis in 1:117 men over 65 with 43% already having heart failure symptoms and signs. Our age and sex specific prevalence suggests cardiac TTR is neither a rare nor unusual diagnosis. We will use our prevalence estimate to ensure our cardiac TTR service is resourced appropriately. We suggest that cardiac amyloid and cardio-oncology services should include pathways incorporating rapid access routes for suitable patients with incidental cardiac uptake on bone scans performed by non-cardiologists. Funding Acknowledgement Type of funding source: None
Background The patient characteristics, therapy received and outcomes after one or more implantable cardioverter defibrillator (ICD) generator changes from contemporary practice is not well known. Methods We conducted a health service evaluation of patients who underwent ICD implantation and generator change. Patients who had generator changes from February 2016 to October 2019 were identified from our database and electronic records were reviewed for patient characteristics, number of generator changes, receipt of therapy and death. Results Our database included 88 patients with a generator change. A total of 22 patients (25.0%) received dual chamber ICD, 10 patients (11.4%) received single chamber ICD, 54 patients (61.3%) received cardiac resynchronization therapy defibrillator and 2 patients (2.3%) received subcutaneous ICD. A second generator change occurred in 18 patients and a third generator changes was performed in 6 patients. There were 29 deaths and a follow up period of 9.4 ± 2.9 years. From implant to initial generator change 39 patients had appropriate antitachycardia pacing (ATP), 6 patient had inappropriate ATP, 29 patients had appropriate shocks and 5 patients had an inappropriate shock. Between the 1st and 2nd generator change and the 2nd and 3rd there were no cases of inappropriate ATP or shock. Overall, 42 patients out of the 88 had appropriate therapy (47.7%) and 7 patients had inappropriate therapy (8.0%). Conclusions Most patients with ICDs do not receive therapy and a minority have inappropriate therapy which typically occur before the first generator change as we observed no inappropriate therapy beyond the first generator change.
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