Search

Background: Individuals with atrial fibrillation (AF) experience increased hospitalization. Income and education are major social determinants of health, but their contributions to hospitalization risk in AF have had limited investigation. We examined the associations between (1) annual income and (2) educational attainment with hospitalization in a cohort with prevalent AF. Hypothesis: We hypothesized that individuals with lower income or education would have an increased risk of hospitalization. Methods: In an institutional cohort with prevalent AF, we related annual income (≤$19,000/year; $20,000-49,000/year; $50,000-99,000/year; ≥$100,000/year) and educational attainment (high school/vocational; some college; bachelor's; graduate) to hospitalization events. We used the Anderson-Gill model to accommodate multiple events per participant in models adjusted for relevant covariates and co-adjusted for income or education. Results: In 339 individuals with AF (age 72.3±10.1 years; 43% women) followed for a median of 2.6 years (range 0-3.4), we observed 417 hospitalization events. We observed an increase in hospitalization risk as income or education level decreased ( Figure A and B ). Individuals with the lowest annual income had a 2.5-fold increased hospitalization risk compared to the highest (95% Confidence Interval [CI] 1.29-4.71). Individuals with the lowest education had a 2-fold increased hospitalization risk than those with the highest education (95% CI 0.87-3.11). Conclusion: We identified inverse relations between hospitalization risk in individuals with AF and their income or education. Our findings support the consideration of social factors to reduce hospitalization risk in individuals with AF

Background: Reports of left ventricular assist device (LVAD) malfunction have focused on pump thrombosis. However, the device consists of the pump, driveline, and peripherals, all of which are potentially subject to failure. Methods: Prospectively collected data were reviewed for all LVAD device malfunctions (DMs) occurring in rotary LVADs implanted at a single center between April 2004 and May 2016. Durable LVADs included 108 Heartmate II (HM II) and 105 HeartWare VAD (HVAD). DM data were categorized according to device type and into categories related to the component that failed: (1) controller, (2) peripheral components, and (3) implantable blood pump or its integral electric driveline. Pump-related events were analyzed as pump-specific (suspected or confirmed thrombosis) or nonpump-specific (driveline failure). DM rates were reported as events per 1000 patient-days, and Cox proportional hazard models were used for time-to-event analyses. Cumulative rates of malfunction were examined for the main components of each type of LVAD. Results: Types of DM included controller failure (30%), battery failure (19%), or patient cable failure (14%), whereas only 13% were because of pump failure. DMs were more common in the HM II device (3.73 per 1000 patient-days versus 3.06 per 1000 patient-days for the HVAD, P P P P P Conclusions: Device malfunction is much broader than pump failure alone and occurs for different components at different rates based on the type of LVAD.

Objective: Since quadripolar left ventricular (LV) leads allow pacing from multiple electrodes, they are less likely than other leads to be placed in unstable positions in order to optimize electrical pacing parameters. We therefore investigated the rate of lead revision and dislodgement in quadripolar (QUAD) vs. bipolar (BI) LV lead recipients. Methods: We retrospectively collected data for N=545 patients at our institution implanted with QUAD (n=173) vs. BI (n=372) LV leads from 2012-2014 and followed them to the endpoint of LV lead revision or lead dislodgement in the first 6 months after implantation. Time to event was analyzed by lead type using Kaplan-Meier curves, log-rank tests, and Cox proportional-hazards models. Results: The cohort was aged 69.6 ± 11.5 years, 89.3% white, with mean BMI 29.8 ± 6.3 kg/m2. Patients were mostly NYHA Class III heart failure (55.7%), while 47.4% had diabetes, 78.9% had hypertension, and 50.8% had atrial fibrillation. Baseline characteristics were comparable in patients that received QUAD and BI leads. Patients receiving BI leads were more likely to require lead revisions during the index hospitalization (BI: 4.8% vs. QUAD: 1.1%, P=0.03). In the first 6 months of follow-up, patients getting QUAD leads had a significantly lower rate of LV lead dislodgement (7.0% vs. 1.7%, P Conclusions: Quadripolar LV leads are less likely to dislodge or require lead revision during the index hospitalization or follow-up. These results have important clinical implications

Introduction: Lactation is associated with improved maternal blood pressure (BP) in later life and in the postpartum period among normotensive women. However, little is known about whether lactation is also cardio-protective in women with pregnancy-related hypertensive disorders. This study aimed to characterize the relationship between lactation and postpartum BP in women who remained normotensive during pregnancy compared to those who developed preeclampsia or gestational hypertension. Hypothesis: Lactation will be associated with lower postpartum BP, particularly in women with hypertensive disorders of pregnancy. Methods: Data were obtained from a cohort of normotensive women who participated in the Prenatal Exposures & Preeclampsia Prevention study (n=651; 65% African American; 83% overweight or obese prior to pregnancy). Women were enrolled during pregnancy and attended a postpartum visit where data on lactation and BP were collected following a standardized protocol. Analysis of variance (ANOVA) was used to assess the relationship between lactation and postpartum BP in women who remained normotensive during pregnancy, developed gestational hypertension (2 or more BP measurements >140/90), or developed preeclampsia (gestational hypertension plus proteinuria). Further analyses adjusted for age, race, smoking, prepregnancy weight, and time since delivery. Results: A total of 439 women attended the postpartum study visit (mean time since birth 8.5 months); 50 (11%) developed gestational hypertension, and 38 (9%) preeclampsia. Lactation was reported by 246 (56%) with 84 (19%) reporting lactation for ≥ 6 months. Women who lactated were older, wealthier, and more likely to plan to lactate compared to those who did not lactate. There was no association between lactation duration and postpartum systolic BP for women who remained normotensive during pregnancy (never lactated: 111.0 mmHg vs. lactated ≥ 6 months: 112.9 mmHg, p=0.83) nor among women who developed preeclampsia (never lactated: 121.3 mmHg vs. lactated ≥ 6 months: 128.3 mmHg, p=0.35). However, greater lactation duration was associated with lower systolic BP among women who developed gestational hypertension (never lactated: 127.8 mmHg vs. lactated ≥ 6 months: 109.4 mmHg, p=0.04). This relationship remained significant after adjusting for covariates. Similarly, lactation was associated with lower postpartum diastolic BP only for women with a history of gestational hypertension. Conclusions: Lactation appears to lower postpartum BP among women who develop gestational hypertension, but do not develop preeclampsia. Future work should investigate the mechanisms driving the relationship between lactation and postpartum BP in gestational hypertension.

Introduction: Women who deliver preterm births have excess risk for cardiovascular disease and diabetes later in life, perhaps related to metabolic dysregulation. Previous studies, however, have not evaluated how the pre-pregnancy metabolic status, other pregnancy characteristics and post pregnancy weight gain may be involved. Hypothesis: We hypothesized that women who delivered preterm births would have excess risk of incident metabolic syndrome (MetS) compared to women with term births independent of their pre-pregnancy metabolic profile, parity and other risk factors. Methods: We studied 1,246 women (50% Black; 624 of 1,246) in the Coronary Artery Risk Development in Young Adults (CARDIA study) who had at least one singleton birth between baseline (1985-1986) and year 25, and no MetS before pregnancy. Blood pressure, lipids, and anthropometrics were measured at baseline and at up to 7 subsequent exams. We ascertained incident MetS cases using the National Cholesterol Education Program Adult Treatment Panel III criteria and estimated the relative hazards (RH) of MetS in women with 1 or more preterm births ( Results: Of 338 incident MetS cases in 17,212 person years, the crude incidence rate among women with preterm birth was higher than among those with 1, but not 2 or more term births (24.2, 14.4, and 32.2, respectively). After adjustment for covariates, however, including time-varying parity, the adjusted RH (95%CI) for incident MetS was 1.89 (1.24, 2.89) for women with preterm vs. term births. Additional adjustment for GDM or hypertension during pregnancy only modestly affected this estimate, but accounting for time-varying weight gain attenuated it to be non-significant (adj HR 1.42 (0.92, 2.21). Increased waist circumference (18.1 ± 12.3 vs. 15.9 ± 11.9 cm, p Conclusions: In conclusion, women with a history of preterm birth have an almost two-fold increased risk of incident MetS compared to those with term births after 25 years of follow up. This was independent of the pre-pregnancy metabolic status, other complications and time dependent parity. It was explained, in part, by post pregnancy weight gain.

Introduction: Elevated serum C-reactive protein (CRP) can be a marker of disease activity involving inflammation, such as pregnancy complications and cardiovascular disease (CVD). Systemically high levels of CRP in women, including during pregnancy, may indicate higher risk for CVD. It is unknown if CRP measured during the pro-inflammatory state of pregnancy correlates with concentrations assessed 7-13 years after delivery. Hypothesis: Concentrations of CRP assessed during pregnancy will be related to CRP measured several years after pregnancy, independent of weight gain. Methods: We studied the first 252 women enrolled in the follow-up of the Pregnancy Outcomes and Community Health Study (POUCHmoms 2011-2013) with complete CRP data for the pregnancy (mean gestational age: 22.36 [2.22] weeks) and POUCHmoms visits (mean follow-up: 10.76 [1.38] years). The relative risk for high hsCRP (≥ 3.39 μg/ml) at the follow-up visit, related to quartiles of CRP during pregnancy, was examined using stepwise regression models. Results: Median (IQR) levels of pregnancy CRP and hsCRP at the follow-up visit were 5.68 [3.08, 9.76] and 3.39 [0.69, 9.73] μg/ml, respectively. Although absolute values of hsCRP at follow-up were generally lower than pregnancy CRP, 56% of women in the top and bottom quartiles of pregnancy CRP (71 of 126) were in the same quartile for hsCRP at follow-up (figure). The relative risk of having high hsCRP (≥ 3.39 μg/ml) at follow-up ranged from 2.7-5.2 for the 2 nd - 4 th quartiles of pregnancy CRP (vs. the 1st quartile). Controlling for pre-pregnancy BMI and follow-up weight change, the relative risk of having high hsCRP at follow-up was significantly higher for the 2 nd (1.15 [1.02-1.30]),3 rd (1.19 [1.05-1.35), and 4 th (1.22 [1.05-1.41]) quartiles of pregnancy CRP. Conclusions: Pregnancy CRP levels are related to hsCRP levels several years later in this cohort of women, even after adjusting for pre-pregnancy BMI and follow-up weight change. CRP assessed in pregnancy may reflect inflammatory status later in life.