Background Benefits of patients with end‐stage renal disease and atrial fibrillation undergoing peritoneal dialysis (PD) or hemodialysis are unknown. Methods and Results Patients undergoing dialysis were retrieved from Taiwan National Health Insurance Research Database during 2001 to 2013 and separated into PD or hemodialysis. Primary outcomes were ischemic stroke/systemic embolism, major bleeding, and intracranial hemorrhage (ICH). An inverse probability of treatment weighting based on propensity score was used to reduce the confounding. The risk of outcomes between PD and hemodialysis was compared using Cox proportional hazard model for fatal outcomes or Fine and Gray subdistribution hazard model which considered death a competing risk, respectively. A total of 7916 patients with end‐stage renal disease with atrial fibrillation undergoing PD or hemodialysis during 2001 to 2013 were identified. After exclusion criteria, 363 patients receiving PD and 5302 patients receiving hemodialysis were analyzed. At 1‐year follow‐up, the risk of ICH was significantly lower in the PD group compared with the hemodialysis group (0.2% versus 0.9%; subdistribution hazard ratio [SHR], 0.31; 95% CI, 0.17–0.57). At 3‐year follow‐up, the risks of major bleeding and ICH were significantly lower in the PD group compared with the hemodialysis group (major bleeding: 1.8% versus 3.2%; SHR, 0.68; 95% CI, 0.53–0.87; ICH: 0.5% versus 2%; SHR, 0.32; 95% CI, 0.21–0.48). At 5‐year follow‐up, ischemic stroke/systemic embolism, major bleeding, and ICH were significantly lower in the PD group compared with the hemodialysis group (ischemic stroke/systemic embolism: 12.4% versus 17.7%, SHR, 0.87; 95% CI, 0.79–0.96; major bleeding: 2.6% versus 4.1%; SHR, 0.79; 95% CI, 0.64–0.97; ICH: 0.5% versus 2.6%; SHR, 0.25; 95% CI, 0.17–0.37). Conclusions In patients with end‐stage renal disease and atrial fibrillation, dialytic modalities by PD or hemodialysis impacted these patients differently. There were overall reduced ischemic stroke/systemic embolism, major bleeding, and ICH at 5‐year follow‐up in patients undergoing PD compared with hemodialysis.
Objective: There is limited evidence regarding the association between myocardial function and long-term survival rate in patients who reach hospital discharge. This study aimed to investigate the association between myocardial function parameters collected at different times from weaning to long-term follow-up and the long-term mortality rate. Method: A cohort of 403 patients successfully weaned from VA-ECMO was identified from a total of 1300 patients who underwent VA-ECMO between 2000-2018 after applying exclusion criteria for age and indications not of interest in the Chang Gung Memorial Hospital Research Database. A retrospective analysis was performed to investigate the effect of ejection fraction timing on long-term mortality. Results: Percentile improvement in EF between ECMO placement and successful weaning is significantly associated with lower cumulative mortality, while the EF value before discharge was significantly associated with better survival. Lastly, the association of lower long-term mortality with EF change from discharge to midterm follow-up and the maximum EF at midterm follow-up was found to be non-significant. Conclusions: This is the first study to provide a comprehensive analysis of echo-cardiographic parameters collected at different times and long-term cumulative mortality in patients who survived VA-ECMO. Improvements in cardiac function and better baseline cardiac function are associated with lower long-term mortality.
Background: Scrub typhus is an infectious disease that affects multiple organs. However, the long-term cardiovascular (CV) risk in survivors remains unknown. Method: A retrospective cohort study used administrative claims data from the National Health Insurance Research Database (NHIRD) to investigate the CV risk of scrub typhus survivors from January 1, 2010, to December 31, 2015. People who had prior CV events before the diagnosis of scrub typhus were excluded. The CV outcomes of interest were acute myocardial infarction (AMI), heart failure hospitalization (HFH), hemorrhagic or ischemic stroke, new-onset atrial fibrillation (AF), aneurysm or dissection of aorta, venous thromboembolism (VTE), and CV death. Result: A total of 2,269 patients with scrub typhus and without a prior CV event were identified (mean age 47.8±16.1 years, 38.0% female). The health control cohort (n=2,264) was selected to compare by the frequency matching with age, gender, and co-morbidities with patients with scrub typhus. The incidence of HFH, new-onset AF, and total events was significantly higher among patients with scrub typhus than the control cohort with an adjusted hazard ratio (aHR) of 1.97, 95% confidence interval (CI) 1.13-3.42 for HFH; 2.48, 95% CI: 1.23-5.0 for new-onset AF; 1.43, 95% CI: 1.08-1.91 for total CV events, respectively. The event rates of other outcomes were similar between the two groups. Conclusion: In the cohort study, survivors of scrub typhus are at heightened risk of subsequent CV events, especially for HFH and new-onset AF. These findings serve as an important reminder to physicians regarding the significant CV risk that remains present following acute scrub typhus infection.
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