Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy

Cardona, Saumeth; Pasquel, Francisco J.; Fayfman, Maya; Peng, Limin; Jacobs, Sol; Vellanki, Priyathama; Weaver, Jeff; Halkos, Michael E.; Guyton, Robert A.; Thourani, Vinod H.

doi:10.1016/j.jdiacomp.2017.01.003

Cited by 26 publications

(17 citation statements)

References 28 publications

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“…Insulin is well recognized to promote adiposity and blood pressure, and we have examined those on insulin and on oral antihyperglycaemic drugs separately. A recent study of patients undergoing coronary bypass graft has shown that compared with patients receiving conservative insulin therapy (HbA1c between 48 and 63 mmol/mol), those receiving intensive insulin treatment (HbA1c between 32 and 48 mmol/mol) had significantly lower hospitalization costs and resource utilization . We have therefore presented diabetic patients treated with oral antihyperglycaemic agents and those with insulin separately to assess any bias introduced to the results among nondiabetic individuals.…”

Section: Discussionmentioning

confidence: 99%

Associations of body fat and skeletal muscle with hypertension

Han

Algindan

Govan

et al. 2018

J of Clinical Hypertension

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Hypertension is known to be associated with obesity, while its relationship to skeletal muscle, SM (SM; a marker of general health and body function), remains uncertain. We analyzed population-based data of 22 591 men (mean age: 51.6 ± 16.9 years) and 27 845 nonpregnant women (50.6 ± 16.9 2595 non-insulin-and 536 insulin-treated diabetic patients. Compared with normotensive individuals (no hypertension history with normal systolic [SBP < 140 mm Hg] and diastolic blood pressure [DBP < 90 mm Hg]), percent body fat (BF%) was significantly higher and percent SM lower (P < 0.001) in undetected (no hypertension history with raised SBP ≥ 140 and/or DBP ≥ 90 mm Hg), controlled (hypertension history with normal BP), uncontrolled (hypertension history with raised BP), and untreated hypertension. The prevalences of hypertension within BF% quintiles were 11.8%, 24.8%, 41.4%, 56.8%, and 71.6% and SM% quintiles were 67.5%, 53.3%, 39.5%, 27.4%, and 18.5%.Compared to referent groups (lowest BF% quintile or highest SM% quintile), odds ratio (age, sex, smoking, ethnicity, country, survey year, and diabetes adjusted) for having all types of hypertension in the highest BF% quintile was 5.5 (95% confidence interval = 5.0-5.9) and lowest SM% quintile was 2.3 (2.2-2.5). Compared with those without diabetes, individuals with diabetes had a 2.3-fold-2.6-fold greater risk of hypertension, independent of confounding factors and BF% or SM%. The associations of hypertension with BF% were higher than those with body mass index (BMI). In conclusion, both BF and SM should be considered when analyzing results from health surveys, rather than relying on BMI which does not discriminate between the two.

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Section: Discussionmentioning

confidence: 99%

Associations of body fat and skeletal muscle with hypertension

Han

Algindan

Govan

et al. 2018

J of Clinical Hypertension

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“…O:E ratios were calculated as previously described and reported with a 95% confidence interval (CI) with significance testing using Pearson c 2 analysis. 11 Statistical significance was defined as a 2-sided P value < .05. Statistical analyses were performed using SAS version 9.4 (SAS institute Inc, Cary, NC) and Prism 7 (GraphPad Software Inc, La Jolla, Calif).…”

Section: Discussionmentioning

confidence: 99%

Current quality reporting methods are not adequate for salvage cardiac operations

Chancellor

Mehaffey

Beller

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Objectives: Outcomes in cardiac surgery are benchmarked against national Society of Thoracic Surgeons (STS) data and include patients undergoing elective, urgent, emergent, and salvage operations. This practice relies on accurate risk adjustment to avoid risk-averse behavior. We hypothesize that the STS risk calculator does not adequately characterize the risk of salvage operations because of their heterogeneity and infrequent occurrence.Methods: Data on all cardiac surgery patients with an STS predicted risk score (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017) were extracted from a regional database of 19 cardiac surgery centers. Patients were stratified according to operative status for univariate analysis. Observed-to-expected (O:E) ratios for mortality and composite morbidity/mortality were calculated and compared among elective, urgent, emergent, and salvage patients.Results: A total of 76,498 patients met inclusion criteria. The O:E mortality ratios for elective, urgent, and emergent cases were 0.96, 0.98, and 0.93, respectively (all P values > .05). However, mortality rate was significantly higher than expected for salvage patients (O:E ratio, 1.41; P ¼ .04). Composite morbidity/mortality rate was lower than expected in elective (O:E ratio, 0.81; P ¼ .0001) and urgent (O:E ratio, 0.93; P ¼ .0001) cases but higher for emergent (O:E ratio, 1.13; P ¼ .0006) and salvage (O:E ratio, 1.24; P ¼ .01). O:E ratios for salvage mortality were highly variable among each of the 19 centers.From the

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“…Most of them were taking oral hypoglycemic agents and only a small percentage of participants were taking insulin (2.5%) [ 12 ]. Therefore, we did not consider the functional role of insulin therapy in the outcome, although insulin therapy might reduce the risk of CVD in elderly people [ 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Walking on Coronary Heart Disease in Elderly Men with Diabetes

2018

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Previous studies have shown that walking is associated with increased longevity and a reduced risk of cardiovascular and age-related diseases. Whether walking benefits individuals with diabetes who are at high risk of coronary heart disease (CHD) remains to be determined. The objective of this study is to examine the association between walking and risk of CHD among elderly men with and without diabetes. Walking data was assessed in 2732 men aged 71 to 93 years participating in the Honolulu Heart Program from 1991–1993. Study participants were initially without disabilities and free of prevalent CHD. Men were then followed for incident CHD for up to 7 years. For men with diabetes who walked <0.25 miles/day, the age-adjusted incidence of CHD was significantly higher than in men without diabetes (27.1 vs. 12.7/1000 person years, p = 0.026). In contrast when distance walked was >1.5 miles/day, incidence of CHD was similar in men with and without diabetes (12.2 vs. 9.1/1000 person-years, p = 0.46). While risk of CHD declined significantly with increasing walking distance in men with diabetes after age and risk factor adjustment (p = 0.043, p = 0.025), associations in those without diabetes were weaker (p = 0.070, p = 0.10). These findings suggest that among elderly men with diabetes who are capable of physical activity, walking reduces CHD risk to levels similar to when diabetes is absent. Walking is an easy, safe and accessible form of physical activity that may have marked health benefits for elderly men with diabetes.

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Hospitalization costs and clinical outcomes in CABG patients treated with intensive insulin therapy

Cited by 26 publications

References 28 publications

Associations of body fat and skeletal muscle with hypertension

Associations of body fat and skeletal muscle with hypertension

Current quality reporting methods are not adequate for salvage cardiac operations

Effects of Walking on Coronary Heart Disease in Elderly Men with Diabetes

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