73 (0.66-0.81) and 0.75 (0.64-0.88), respectively, in men and 0.83 (0.78-0.89) and 0.81 (0.72-0.92) in women.

Diabetic patients receiving metformin treatment, and individuals without diabetes were at lower risk for cancer incidence than diabetic patients without metformin treatment.

Diabetic patients receiving metformin treatment, and individuals without diabetes were at lower risk for cancer incidence than diabetic patients without metformin treatment.We aimed to evaluate the feasibility of interventional treatment of atrial septal defect (ASD) in low weight infants under 2-year-old. Seven hundred and ninety-three secundum ASD patients were divided into 2 groups 665 were above 2-year-old and 128 were under 2-year-old. JHU395 The basic conditions before the operation, postoperative complications within 24 hours, and adverse outcomes during a three-year follow-up were compared between the 2 groups using multivariate analysis. There were significant differences in age, weight, and the diameter of the ASD between the 2 groups (p 0.05). Similarly, we found no association between age ≤2-year-old and any adverse outcomes postprocedure within 24 hours, including procedure failure (OR = 0.35; 95%CI 0.04 to 2.93), residual shunt (OR = 1.07; 95%CI 0.54 to 2.14), arrhythmia (OR = 0.68; 95%CI 0.32 to 1.43), or procedure-related arrhythmia (OR = 0.34; 95%CI 0.04 to 2.87). In the follow-up data, we found no association between age ≤2-year-old and arrhythmia (HR = 0.95; 95%CI 0.50 to 1.80) and procedure-related arrhythmia (HR = 0.96;95%CI0.25 to 3.64). Kaplan-Meier survival curves indicated no significant difference in the occurrence of arrhythmia between the 2 groups (log-rank test p = 0.776). In conclusion, percutaneous ASD closure in young and low weight infants has a high success and low complication rate, along with reliable effects.It is unclear if patients with paroxysmal atrial fibrillation (AF) and persistent AF have different outcomes following electrical cardioversion (ECV). ENSURE-AF-a multicenter, prospective, randomized, open-label, blinded-endpoint evaluation trial-compared once-daily edoxaban 60 mg with enoxaparin-warfarin in 2,199 subjects undergoing ECV of nonvalvular AF (NCT02072434). Patients received ≥3 weeks of proper anticoagulation or transesophageal echocardiogram before ECV paroxysmal AF was defined as AF with spontaneous conversion of duration of 2 52.0% vs 49.5%, p = 0.4375) and prior myocardial infarction (6.5% vs 6.8%, p = 0.91) did not significantly differ between groups. After ECV, primary endpoint events were numerically higher in paroxysmal AF versus persistent AF (1.5% vs 0.6%, p = 0.0571), approaching statistical significance. Of note, myocardial infarction was observed in paroxysmal AF (n = 4 vs 0), whereas persistent AF was accompanied by stroke (n = 0 vs 5; p less then 0.05). In conclusion, patients with paroxysmal AF had more frequent major cardiovascular events than patients with persistent AF. Composite event rates were driven mainly by myocardial infarction in patients with paroxysmal AF and by stroke in those with persistent AF. Overall, the absolute number of events was low after ECV under anticoagulation.Valvular heart disease is common among left ventricular assist device (LVAD) recipients. However, its management at the time of LVAD implantation remains controversial. Patients who underwent LVAD implantation and concomitant aortic (AVR), mitral (MVR), or tricuspid valve (TVR) repair or replacement from 2010 to 2017 were identified using the national inpatient sample. End points were in-hospital outcomes, length of stay, and cost. Procedure-related complications were identified via ICD-9 and ICD-10 coding and analysis was performed via mixed effect models. A total of 25,171 weighted adults underwent LVAD implantation without valvular surgery, 1,329 had isolated TVR, 1,021 AVR, 377 MVR, and 615 had combined valvular surgery (411 had TVR + AVR, 115 TVR + MVR, 62 AVR + MVR, 25 AVR + MVR + TVR). During the study period, rates of AVR decreased and combined valvular surgeries increased. Patients who underwent TVR or combined valvular surgery had overall higher burden of co-morbidities than LVAD recipients with or without other valvular procedures. Postoperative bleeding was higher with AVR whereas acute kidney injury requiring dialysis was higher with TVR or combined valvular surgery. In-hospital mortality was higher with AVR, MVR, or combined surgery without differences in the rates of stroke. Length of stay did not differ significantly among groups but cost of hospitalization and nonroutine discharge rates were higher for cases of TVR and combined surgery. Approximately 1 in 9 LVAD recipients underwent concomitant valvular surgery and TVR was the most frequently performed procedure. In-hospital mortality and cost were lower among those who did not undergo valvular surgery.

Several medications are likely to be potentially inappropriate medications for patients with heart failure (PIMHF) as they may worsen heart failure (HF). A screening tool inclusive of PIMHF is lacking.

To develop an extensive list of PIMHF for HF patients.

A list of PIMHF was developed using reviews of recent HF guidelines and literature and validated through a survey study of HF experts using a modified Delphi technique. The study participants were Thai HF experts with ≥ 5 years of practice experience in Thailand. To create an initial list of PIMHF, medications likely to be PIMHF were gathered from both HF guidelines and HF-related explicit criteria. A 3-round Delphi survey was conducted for 9 months, from January 1, 2019 to September 30, 2019. In the first round, medication items that ≥ 60% of the participants rated as “not PIMHF” were excluded. The two subsequent rounds were conducted to measure an agreement on PIMHF. To reach consensus, medication items in the PIMHF list had to meet the following pre-determined criteria convergence (median≥3.5 and interquartile range≤1.5) and stability (marginal changes of medians between round 2 and round 3<15%).

Seventeen eligible HF experts, including 10 cardiologists, 3 hospital pharmacists and 4 academic pharmacists, participated in the study. The initial list of PIMHF consisted of 100 medication items. From round 1, 8 medication items were excluded from the initial list. Thus, 92 medication items were considered in the second and the third round, respectively. After 3 surveys, 47 medication items reached the consensus and agreed as PIMHF.

This Delphi survey on opinion about PIMHF among an HF expert panel produced a list of 47 medication items as PIMHF which may be used as a screening tool for PIMHF in Thai HF patients.

This Delphi survey on opinion about PIMHF among an HF expert panel produced a list of 47 medication items as PIMHF which may be used as a screening tool for PIMHF in Thai HF patients.