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1. The need for increased pragmatism in cardiovascular clinical trials

Author

Usman, Muhammad Shariq, Van Spall, Harriette GC, Greene, Stephen J, Pandey, Ambarish, McGuire, Darren K, Ali, Ziad A, Mentz, Robert J, Fonarow, Gregg C, Spertus, John A, Anker, Stefan D, Butler, Javed, James, Stefan K, and Khan, Muhammad Shahzeb

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Comparative Effectiveness Research, Cardiovascular, Heart Disease, Clinical Trials and Supportive Activities, Prevention, Clinical Research, Good Health and Well Being, Cardiovascular Diseases, Humans, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

The majority of cardiovascular randomized controlled trials (RCTs) test interventions in selected patient populations under explicitly protocol-defined settings. Although these 'explanatory' trial designs optimize conditions to test the efficacy and safety of an intervention, they limit the generalizability of trial findings in broader clinical settings. The concept of 'pragmatism' in RCTs addresses this concern by providing counterbalance to the more idealized situation underpinning explanatory RCTs and optimizing effectiveness over efficacy. The central tenets of pragmatism in RCTs are to test interventions in routine clinical settings, with patients who are representative of broad clinical practice, and to reduce the burden on investigators and participants by minimizing the number of trial visits and the intensity of trial-based testing. Pragmatic evaluation of interventions is particularly important in cardiovascular diseases, where the risk of death among patients has remained fairly stable over the past few decades despite the development of new therapeutic interventions. Pragmatic RCTs can help to reveal the 'real-world' effectiveness of therapeutic interventions and elucidate barriers to their implementation. In this Review, we discuss the attributes of pragmatism in RCT design, conduct and interpretation as well as the general need for increased pragmatism in cardiovascular RCTs. We also summarize current challenges and potential solutions to the implementation of pragmatism in RCTs and highlight selected ongoing and completed cardiovascular RCTs with pragmatic trial designs.

Published
2022

2. Cardiovascular Safety Reporting in Contemporary Breast Cancer Clinical Trials

Author

Hamid, Arsalan, Anker, Markus S, Ruckdeschel, John C, Khan, Muhammad Shahzeb, Tharwani, Arsal, Oshunbade, Adebamike A, Kipchumba, Rodney K, Thigpen, Samuel C, Anker, Stefan D, Fonarow, Gregg C, Hall, Michael E, and Butler, Javed

Subjects
Biomedical and Clinical Sciences, Oncology and Carcinogenesis, Patient Safety, Cardiovascular, Clinical Trials and Supportive Activities, Cancer, Clinical Research, Heart Disease, Breast Cancer, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Good Health and Well Being, Breast Neoplasms, Female, Humans, Troponin, cancer therapy, cardio-oncology, cardiovascular disease, pharmacotherapy, safety, cardio‐oncology, Cardiorespiratory Medicine and Haematology, Cardiovascular medicine and haematology
Abstract

Background Several cancer therapies have been associated with cardiovascular harm in early-phase clinical trials. However, some cardiovascular harms do not manifest until later-phase trials. To limit interdisease variability, we focused on breast cancer. Thus, we assessed the reporting of cardiovascular safety monitoring and outcomes in phase 2 and 3 contemporary breast cancer clinical trials. Methods and Results We searched Embase and Medline records for phase 2 and 3 breast cancer pharmacotherapy trials. We examined exclusion criterion as a result of cardiovascular conditions, adverse cardiovascular event reporting, and cardiovascular safety assessment through cardiovascular imaging, ECG, troponin, or natriuretic peptides. Fisher's exact test was utilized to compare reporting. Fifty clinical trials were included in our study. Patients were excluded because of cardiovascular conditions in 42 (84%) trials. Heart failure was a frequent exclusion criterion (n=31; 62% trials). Adverse cardiovascular events were reported in 43 (86%) trials. Cardiovascular safety assessments were not reported in 23 (46%) trials, whereas natriuretic peptide and troponin assessments were not reported in any trial. Cardiovascular safety assessments were more frequently reported in industry-funded trials (69.2% versus 0.0%; P

Published
2022

3. Robustness of outcomes in trials evaluating sodium–glucose co‐transporter 2 inhibitors for heart failure

Author

Usman, Muhammad Shariq, Khan, Muhammad Shahzeb, Fonarow, Gregg C, Greene, Stephen J, Friede, Tim, Vaduganathan, Muthiah, Filippatos, Gerasimos, Coats, Andrew J Stewart, Anker, Stefan D, and Butler, Javed

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Cardiovascular, Heart Disease, Good Health and Well Being, Glucose, Heart Failure, Humans, Sodium, Sodium-Glucose Transporter 2 Inhibitors, Symporters, Fragility index, Robustness, Sodium-glucose co-transporter 2 inhibitors, Cardiac failure, Cardiorespiratory Medicine and Haematology, Cardiovascular medicine and haematology
Abstract

AimsRecent trials have evaluated sodium-glucose co-transporter 2 inhibitors in patients with heart failure (HF). We sought to assess the robustness of findings from these trials using the fragility index (FI).Methods and resultsFragility index is defined as the minimum number of patients that must be moved from the 'non-event' to the 'event' group to turn a statistically significant result to non-significant. In addition to FI, fragility quotient [(FQ); FI divided by the sample size] was calculated to assess the proportion of events that must be moved to change the significance. For statistically non-significant outcomes, reverse fragility index (RFI) and reverse fragility quotient (RFQ) were calculated. Robustness of findings after pooling data from all three trials was also assessed. A robust reduction in first HF hospitalization or cardiovascular mortality was seen with dapagliflozin (FI = 62 and FQ = 0.013), empagliflozin (FI = 50 and FQ = 0.013), and sotagliflozin (FI = 60 and FQ = 0.049). Dapagliflozin nominally improved all-cause and cardiovascular mortality, with modest FI (n = 8 and 5) and FQ (0.002 and 0.001). Empagliflozin and sotagliflozin did not demonstrate statistically significant reductions in all-cause mortality, with modest RFI (empagliflozin: RFI = 26 and RFQ = 0.007; sotagliflozin: RFI = 6 and RFQ = 0.005). A similar trend was seen with cardiovascular mortality (empagliflozin: RFI = 24 and RFQ = 0.006; sotagliflozin: RFI = 7 and RFQ = 0.006). Upon meta-analysis, the result for first HF hospitalization or cardiovascular mortality was robust (FI = 95 and FQ = 0.010). The reductions in all-cause (FI = 12 and FQ = 0.001) and cardiovascular mortality (FI = 9 and FQ = 0.001), while statistically significant, were fragile.ConclusionImprovement in the composite outcome of first HF hospitalization or cardiovascular death was highly concordant and robust across sodium-glucose co-transporter 2 inhibitor trials. In contrast, secondary endpoints of all-cause and cardiovascular mortality were statistically fragile, underscoring the need to power trials for mortality to fully understand the benefit of therapies on fatal events.

Published
2022

4. Representation of women, older patients, ethnic, and racial minorities in trials of atrial fibrillation

Author

Khan, Muhammad Zia, Munir, Muhammad Bilal, Khan, Safi U, Subramanian, Charumathi Raghu, Khan, Muhammad Usman, Asad, Zain Ul Abideen, Talluri, Swapna, Madhanakumar, Aarthi, Lone, Ahmad Naeem, Khan, Muhammad Shahzeb, Michos, Erin D, and Alkhouli, Mohamad

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Comparative Effectiveness Research, Heart Disease, Clinical Research, Cardiovascular, Clinical Trials and Supportive Activities, American Indian or Alaska Native, Age Factors, Aged, Atrial Fibrillation, Ethnic and Racial Minorities, Female, Humans, Male, Randomized Controlled Trials as Topic, Women, atrial fibrillation, ethnic minorities, racial minorities, randomized controlled trials, women, Biomedical Engineering, Cardiovascular System & Hematology, Cardiovascular medicine and haematology, Clinical sciences
Abstract

BackgroundRepresentation trends of women, older adults, and ethnic/racial minorities in randomized controlled trials (RCTs) of atrial fibrillation (AF) are uncertain.MethodsWe systematically reviewed 134 AF related RCTs (phase II and III) encompassing 149,162 participants using Medline and ClinicalTrials.gov through April 2019 to determine representation trends of women, older patients (≥75 years), and ethnic/racial minorities. Weighted data on the prevalence of AF from epidemiological studies were used to compare the representation of the studied groups of interest in AF RCTs to their expected burden of the disease.ResultsOnly 18.7% of the RCTs reported proportion of older patients, and 12.7% RCTs reported ethnic/racial minorities. The proportions of women in RCTs versus general population were 35.2% and 35.1%, of Hispanics were 11.9% and 5.2%, of Blacks were 1.2% and 5.7%, of American Indian/Alaskans were 0.2% and 0.2%, of Asians were 14.2% and 2.4%, of native Hawaiian/Pacific Islanders were 0.05% and 0.1% and of non-Whites were 19.5% and 22.5%, respectively. The weighted mean age (SD) across the trials was 65.3 (3.2) years which was less than the corresponding weighted mean age of 71.1 (4.5) years in the comparative epidemiological data.ConclusionThe reporting of older patients and ethnic/racial minorities was poor in RCTs of AF. The representation of women and American Indian/Alaskan natives matched their expected population share of disease burden. Hispanics and Asians were over-represented and Blacks, native Hawaiian/Pacific Islanders and non-Whites were under-represented in RCTs of AF.

Published
2021

5. Discontinuation and non‐publication of heart failure randomized controlled trials: a call to publish all trial results

Author

Khan, Muhammad Shahzeb, Shahid, Izza, Asad, Nava, Greene, Stephen J, Khan, Safi U, Doukky, Rami, Metra, Marco, Anker, Stefan D, Filippatos, Gerasimos S, Fonarow, Gregg C, and Butler, Javed

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Heart Disease, Clinical Trials and Supportive Activities, Cardiovascular, Evaluation of treatments and therapeutic interventions, 6.1 Pharmaceuticals, Cross-Sectional Studies, Heart Failure, Humans, Randomized Controlled Trials as Topic, Heart failure, Clinical trials, Discontinuation, Non-publication, Enrolment, Cardiorespiratory Medicine and Haematology, Cardiovascular medicine and haematology
Abstract

AimsDiscontinuation or non-publication of trials may hinder scientific progress and violates the commitment made to research participants. We sought to identify the prevalence of discontinuation and non-publication of heart failure (HF) clinical trials.Methods and resultsWe conducted a cross-sectional search of ClinicalTrials.gov to identify all completed and discontinued HF clinical trials. We limited our search to only include trials that were completed by 31 December 2017. Trials were investigated to identify reasons for discontinuation. Informative termination was defined as trial termination due to safety or efficacy concerns. Data pertaining to the trial phase, funding, intervention, enrolment, and trial completion date were extracted for each trial. A total of 572 trials were included. Of these, 21% (n = 118) were discontinued before completion. Patient accrual was the most frequently cited reason (n = 42; 36%) for trial discontinuation, followed by informative termination (n = 16; 14%) and funding (n = 14; 12%). Overall, 24 780 patients were enrolled in trials that were terminated. Of trials that were completed and not terminated, nearly one-third (n = 131/454; 29%) were not published. Seventy-nine (24%) trials were published within 12 months, 192 (59%) within 24 months, and 252 (78%) trials within 36 months.ConclusionsDiscontinuation and non-publication of HF trials is common. This raises ethical concerns towards participants who volunteer for research and are exposed to potential risks, inconvenience, and discomfort without furthering scientific progress.

Published
2021

6. Reporting and interpretation of subgroup analyses in heart failure randomized controlled trials

Author

Khan, Muhammad Shahzeb, Khan, Muhammad Arbaz Arshad, Irfan, Simra, Siddiqi, Tariq Jamal, Greene, Stephen J, Anker, Stefan D, Sreenivasan, Jayakumar, Friede, Tim, Tahhan, Ayman Samman, Vaduganathan, Muthiah, Fonarow, Gregg C, and Butler, Javed

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Cardiovascular, Clinical Trials and Supportive Activities, Clinical Research, Heart Disease, Heart Failure, Humans, Randomized Controlled Trials as Topic, Subgroup claims, Credibility, Strength of claims, Study characteristics, HF RCTs, Cardiorespiratory Medicine and Haematology, Cardiovascular medicine and haematology
Abstract

AimsThis study aimed to investigate the reporting of subgroup analyses in heart failure (HF) randomized controlled trials (RCTs) and to determine the strength and credibility of subgroup claims.Methods and resultsAll primary HF RCTs published in nine high-impact journals from 1 January 2008 to 31 December 2017 were included. Multivariable regression analysis was used to identify factors that may favour the reporting of results in specific subgroups. Strength of the subgroup effect claimed was classified into (i) strong, (ii) likely, or (iii) suggestive. Credibility of subgroup claim was scored using a pre-specified 10 pointer criteria. Of the 261 HF RCTs studied, 107 (41%) reported subgroup analyses. Twenty-five (23%) RCTs claimed a subgroup effect for the primary outcome of which six (24%) made a strong claim, eight (32%) claimed a likely effect, and 11 (44%) suggested a possible subgroup effect. Seven of the 25 RCTs did not employ interaction testing for subgroup claims of the primary outcome. Three out of 10 pre-specified credibility criteria were satisfied by half of the trials. Fourteen trials justified the choice of subgroups, and 10 explicitly stated they were underpowered to detect differences within subgroups. Source of funding did not influence the frequency of reporting subgroup analyses (OR 0.53, 95% CI 0.78-3.62, P = 0.52).ConclusionsAppropriate credibility criteria were rarely met even by HF RCTs that held strong subgroup claims. Subgroup analyses should be pre-specified, be adequately powered, present interaction terms, and be replicated in independent data before being integrated into clinical decision making.

Published
2021

7. Cardiovascular implications of COVID-19 versus influenza infection: a review.

Author

Khan, Muhammad Shahzeb, Shahid, Izza, Anker, Stefan D, Solomon, Scott D, Vardeny, Orly, Michos, Erin D, Fonarow, Gregg C, and Butler, Javed

Subjects
Humans, Cardiovascular Diseases, Adult, Middle Aged, Female, Male, Influenza, Human, Coinfection, COVID-19, SARS-CoV-2, Influenza, Human, General & Internal Medicine, Medical and Health Sciences
Abstract

BackgroundDue to the overlapping clinical features of coronavirus disease 2019 (COVID-19) and influenza, parallels are often drawn between the two diseases. Patients with pre-existing cardiovascular diseases (CVD) are at a higher risk for severe manifestations of both illnesses. Considering the high transmission rate of COVID-19 and with the seasonal influenza approaching in late 2020, the dual epidemics of COVID-19 and influenza pose serious cardiovascular implications. This review highlights the similarities and differences between influenza and COVID-19 and the potential risks associated with coincident pandemics.Main bodyCOVID-19 has a higher mortality compared to influenza with case fatality rate almost 15 times more than that of influenza. Additionally, a significantly increased risk of adverse outcomes has been noted in patients with CVD, with ~ 15 to 70% of COVID-19 related deaths having an underlying CVD. The critical care need have ranged from 5 to 79% of patients hospitalized due to COVID-19, a proportion substantially higher than with influenza. Similarly, the frequency of vascular thrombosis including deep venous thrombosis and pulmonary embolism is markedly higher in COVID-19 patients compared with influenza in which vascular complications are rarely seen. Unexpectedly, while peak influenza season is associated with increased cardiovascular hospitalizations, a decrease of ~ 50% in cardiovascular hospitalizations has been observed since the first diagnosed case of COVID-19, owing in part to deferred care.ConclusionIn the coming months, increasing efforts towards evaluating new interventions will be vital to curb COVID-19, especially as peak influenza season approaches. Currently, not enough data exist regarding co-infection of COVID-19 with influenza or how it would progress clinically, though it may cause a significant burden on an already struggling health care system. Until an effective COVID-19 vaccination is available, high coverage of influenza vaccination should be of utmost priority.

Published
2020

8. Conducting clinical trials in heart failure during (and after) the COVID-19 pandemic: an Expert Consensus Position Paper from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC)

Author

Anker, Stefan D, Butler, Javed, Khan, Muhammad Shahzeb, Abraham, William T, Bauersachs, Johann, Bocchi, Edimar, Bozkurt, Biykem, Braunwald, Eugene, Chopra, Vijay K, Cleland, John G, Ezekowitz, Justin, Filippatos, Gerasimos, Friede, Tim, Hernandez, Adrian F, Lam, Carolyn SP, Lindenfeld, JoAnn, McMurray, John JV, Mehra, Mandeep, Metra, Marco, Packer, Milton, Pieske, Burkert, Pocock, Stuart J, Ponikowski, Piotr, Rosano, Giuseppe MC, Teerlink, John R, Tsutsui, Hiroyuki, Van Veldhuisen, Dirk J, Verma, Subodh, Voors, Adriaan A, Wittes, Janet, Zannad, Faiez, Zhang, Jian, Seferovic, Petar, and Coats, Andrew JS

Subjects
Clinical Research, Patient Safety, Clinical Trials and Supportive Activities, Cardiovascular, Heart Disease, Prevention, Good Health and Well Being, Betacoronavirus, COVID-19, Clinical Trials as Topic, Coronavirus Infections, Europe, Heart Failure, Humans, Informed Consent, Pandemics, Patient Selection, Pneumonia, Viral, Research Design, SARS-CoV-2, Heart failure, Clinical trials, Coronavirus, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Cardiovascular System & Hematology
Abstract

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has important implications for the safety of participants in clinical trials and the research staff caring for them and, consequently, for the trials themselves. Patients with heart failure may be at greater risk of infection with COVID-19 and the consequences might also be more serious, but they are also at risk of adverse outcomes if their clinical care is compromised. As physicians and clinical trialists, it is our responsibility to ensure safe and effective care is delivered to trial participants without affecting the integrity of the trial. The social contract with our patients demands no less. Many regulatory authorities from different world regions have issued guidance statements regarding the conduct of clinical trials during this COVID-19 crisis. However, international trials may benefit from expert guidance from a global panel of experts to supplement local advice and regulations, thereby enhancing the safety of participants and the integrity of the trial. Accordingly, the Heart Failure Association of the European Society of Cardiology on 21 and 22 March 2020 conducted web-based meetings with expert clinical trialists in Europe, North America, South America, Australia, and Asia. The main objectives of this Expert Position Paper are to highlight the challenges that this pandemic poses for the conduct of clinical trials in heart failure and to offer advice on how they might be overcome, with some practical examples. While this panel of experts are focused on heart failure clinical trials, these discussions and recommendations may apply to clinical trials in other therapeutic areas.

Published
2020

9. Trends in prevalence of comorbidities in heart failure clinical trials

Author

Khan, Muhammad Shahzeb, Tahhan, Ayman Samman, Vaduganathan, Muthiah, Greene, Stephen J, Alrohaibani, Alaaeddin, Anker, Stefan D, Vardeny, Orly, Fonarow, Gregg C, and Butler, Javed

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Trials and Supportive Activities, Clinical Research, Heart Disease, Cardiovascular, Kidney Disease, Chronic Disease, Clinical Trials as Topic, Comorbidity, Heart Failure, Humans, Prevalence, Prognosis, United States, Clinical trials, Comorbidities, Heart failure, Trends, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

AimsThe primary objective of this systematic review was to estimate the prevalence and temporal changes in chronic comorbid conditions reported in heart failure (HF) clinical trials.Methods and resultsWe searched MEDLINE for HF trials enrolling more than 400 patients published between 2001 and 2016.Trials were divided into HF with reduced ejection fraction (HFrEF), HF with preserved ejection fraction (HFpEF), or trials enrolling regardless of ejection fraction. The prevalence of baseline chronic comorbid conditions was categorized according to the algorithm proposed by the Chronic Conditions Data Warehouse, which is used to analyse Medicare data. To test for a trend in the prevalence of comorbid conditions, linear regression models were used to evaluate temporal trends in prevalence of comorbidities. Overall, 118 clinical trials enrolling a cumulative total of 215 508 patients were included. Across all comorbidities examined, data were reported in a mean of 35% of trials, without significant improvement during the study period. Reporting of comorbidities was more common in HFrEF trials (51%) compared with HFpEF trials (27%). Among trials reporting data, hypertension (63%), ischaemic heart disease (44%), hyperlipidaemia (48%), diabetes (33%), chronic kidney disease (25%) and atrial fibrillation (25%) were the major comorbidities. The prevalence of comorbidities including hypertension, atrial fibrillation and chronic kidney disease increased over time while the prevalence of smoking decreased in HFrEF trials.ConclusionMany HF trials do not report baseline comorbidities. A more rigorous, systematic, and standardized framework needs to be adopted for future clinical trials to ensure adequate comorbidity reporting and improve recruitment of multi-morbid HF patients.

Published
2020

10. Renin–angiotensin blockade in heart failure with preserved ejection fraction: a systematic review and meta‐analysis

Author

Khan, Muhammad Shahzeb, Fonarow, Gregg C, Khan, Hassan, Greene, Stephen J, Anker, Stefan D, Gheorghiade, Mihai, and Butler, Javed

Subjects
Clinical Research, Clinical Trials and Supportive Activities, Cardiovascular, Good Health and Well Being, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Heart Failure, Humans, Renin-Angiotensin System, Stroke Volume, Heart failure, Preserved ejection fraction, Angiotensin-converting enzyme inhibitors, Angiotensin receptor blockers, Renin-angiotensin system, Cardiorespiratory Medicine and Haematology
Abstract

Studies with angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) in patients with heart failure with preserved ejection fraction (HFpEF) have yielded inconsistent results. To conduct a systematic review and meta-analysis of all evidence for ACE-I and ARBs in patients with HFpEF, we searched PubMed, Ovid SP, Embase, and Cochrane database to identify randomized trials and observational studies that compared ACE-I or ARBs against placebo or standard therapy in HFpEF patients. Random-effect models were used to pool the data, and I2 testing was performed to assess the heterogeneity of the included studies. A total of 13 studies (treatment arm = 8676 and control arm = 8608) were analysed. Pooled analysis of randomized trials for ACE-I and ARBs (n = 6) did not show any effect on all-cause mortality [relative risk (RR) = 1.02, 95% confidence interval (CI) = 0.93-1.11, P = 0.68, I2  = 0%], while results from observational studies showed a significant improvement (RR = 0.91, 95% CI = 0.87-0.95, P = 0.005, I2  = 81.5%). In pooled analyses of all studies, ACE-I showed a reduction of all-cause mortality (RR = 0.91, 95% CI = 0.87-0.95, P = 0.01). There was no reduction in cardiovascular mortality seen, but in pooled analysis of randomized trials, there was a trend towards reduced HF hospitalization risk (RR = 0.91, 95% CI = 0.83-1.01, I2  = 0%, P = 0.074). These data suggest that ACE-I and ARBs may have a role in improving outcomes of patients with HFpEF, underscoring the need for future research with careful patient selection, and trial design and conduct.

Published
2017

11. Dual Antiplatelet Therapy After Percutaneous Coronary Intervention and Drug-Eluting Stents

Author

Khan, Safi U., Singh, Maninder, Valavoor, Shahul, Khan, Muhammad U., Lone, Ahmad N., Khan, Muhammad Zia, Khan, Muhammad Shahzeb, Mani, Preethi, Kapadia, Samir R., Michos, Erin D., Stone, Gregg W., Kalra, Ankur, and Bhatt, Deepak L.

Subjects
Aspirin, Incidence, percutaneous coronary intervention, Myocardial Infarction, drug-eluting stents, Original Research Articles, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, Purinergic P2Y Receptor Antagonists, Humans, dual anti-platelet therapy, Acute Coronary Syndrome, network meta-analysis, Platelet Aggregation Inhibitors, Randomized Controlled Trials as Topic
Abstract

Supplemental Digital Content is available in the text., Background: The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention with drug-eluting stents remains uncertain. We compared short-term (12-month) DAPT after percutaneous coronary intervention with drug-eluting stents. Methods: Twenty-four randomized, controlled trials were selected using Medline, Embase, Cochrane library, and online databases through September 2019. The coprimary end points were myocardial infarction and major bleeding, which constituted the net clinical benefit. A frequentist network meta-analysis was conducted with a random-effects model. Results: In 79 073 patients, at a median follow-up of 18 months, extended-term DAPT was associated with a reduced risk of myocardial infarction in comparison with 12-month DAPT (absolute risk difference, –3.8 incident cases per 1000 person-years; relative risk, 0.68 [95% CI, 0.54–0.87]), midterm DAPT (absolute risk difference, –4.6 incident cases per 1000 person-years; relative risk, 0.61 [0.45–0.83]), and short-term DAPT followed by aspirin monotherapy (absolute risk difference, –6.1 incident cases per 1000 person-years; relative risk, 0.55 [0.37–0.83]), or P2Y12 inhibitor monotherapy (absolute risk difference, –3.7 incident cases per 1000 person-years; relative risk, 0.69 [0.51–0.95]). Conversely, extended-term DAPT was associated with a higher risk of major bleeding than all other DAPT groups. In comparison with 12-month DAPT, no significant differences in the risks of ischemic end points or major bleeding were observed with midterm or short-term DAPT followed by aspirin monotherapy, with the exception that short-term DAPT followed by P2Y12 inhibitor monotherapy was associated with a reduced risk of major bleeding. There were no significant differences with respect to mortality between the different DAPT strategies. In acute coronary syndrome, extended-term in comparison with 12-month DAPT was associated with a reduced risk of myocardial infarction without a significant increase in the risk of major bleeding. Conclusions: The present network meta-analysis suggests that, in comparison with 12-month DAPT, short-term DAPT followed by P2Y12 inhibitor monotherapy reduces major bleeding after percutaneous coronary intervention with drug-eluting stents, whereas extended-term DAPT reduces myocardial infarction at the expense of more bleeding events.

Published
2020

12. Prevalence of Multiplicity and Appropriate Adjustments Among Cardiovascular Randomized Clinical Trials Published in Major Medical Journals

Author

Khan, Muhammad Shahzeb, Khan, Maaz Shah, Ansari, Zunaira Navid, Siddiqi, Tariq Jamal, Khan, Safi U, Riaz, Irbaz Bin, Asad, Zain Ul Abideen, Mandrola, John, Wason, James, Warraich, Haider J, Stone, Gregg W, Bhatt, Deepak L, Kapadia, Samir R, Kalra, Ankur, Wason, James [0000-0002-4691-126X], and Apollo - University of Cambridge Repository

Subjects
Publishing, Biomedical Research, Cross-Sectional Studies, Cardiovascular Diseases, Prevalence, Humans, Journal Impact Factor, Periodicals as Topic, Randomized Controlled Trials as Topic
Abstract

IMPORTANCE: Multiple analyses in a clinical trial can increase the probability of inaccurately concluding that there is a statistically significant treatment effect. However, to date, it is unknown how many randomized clinical trials (RCTs) perform adjustments for multiple comparisons, the lack of which could lead to erroneous findings. OBJECTIVES: To assess the prevalence of multiplicity and whether appropriate multiplicity adjustments were performed among cardiovascular RCTs published in 6 medical journals with a high impact factor. DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, cardiovascular RCTs were selected from all over the world, characterized as North America, Western Europe, multiregional, and rest of the world. Data were collected from past issues of 3 cardiovascular journals (Circulation, European Heart Journal, and Journal of the American College of Cardiology) and 3 general medicine journals (JAMA, The Lancet, and The New England Journal of Medicine) with high impact factors published between August 1, 2015, and July 31, 2018. Supplements and trial protocols of each of the included RCTs were also searched for multiplicity. Data were analyzed December 20 to 27, 2018. EXPOSURES: Data from the selected RCTs were extracted and verified independently by 2 researchers using a structured data instrument. In case of disagreement, a third reviewer helped to achieve consensus. An RCT was considered to have multiple treatment groups if it had more than 2 arms; multiple outcomes were defined as having more than 1 primary outcome, and multiple analyses were defined as analysis of the same outcome variable in multiple ways. Multiplicity was examined only for the analysis of the primary end point. MAIN OUTCOMES AND MEASURES: Outcomes of interest were percentages of primary analyses that performed multiplicity adjustment of primary end points. RESULTS: Of 511 cardiovascular RCTs included in this analysis, 300 (58.7%) had some form of multiplicity; of these 300, only 85 (28.3%) adjusted for multiplicity. Intervention type and funding source had no statistically significant association with the reporting of multiplicity risk adjustment. Trials that assessed mortality vs nonmortality outcomes were more likely to contain a multiplicity risk in their primary analysis (66.3% [177 of 267] vs 50.4% [123 of 244]; P < .001), and larger trials vs smaller trials were less likely to make any adjustments for multiplicity (35.6% [52 of 146] vs 21.4% [33 of 154]; P = .001). CONCLUSIONS AND RELEVANCE: Findings from this study suggest that cardiovascular RCTs published in medical journals with high impact factors demonstrate infrequent adjustments to correct for multiple comparisons in the primary end point. These parameters may be improved by more standardized reporting.

Published
2020
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13. Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

Author

Kinyoki, Damaris K., Ross, Jennifer M., Lazzar-Atwood, Alice, Munro, Sandra B., Schaeffer, Lauren E., Abbasalizad-Farhangi, Mahdieh, Abbasi, Masoumeh, Abbastabar, Hedayat, Abdelalim, Ahmed, Abdoli, Amir, Abdollahi, Mohammad, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abebe, Nebiyu Dereje, Abebo, Teshome Abuka, Abegaz, Kedir Hussein, Abolhassani, Hassan, Abreu, Lucas Guimarães, Abrigo, Michael R. M., Abushouk, Abdelrahman I., Accrombessi, Manfred Mario Kokou, Acharya, Dilaram, Adabi, Maryam, Adebiyi, Akindele Olupelumi, Adedeji, Isaac Akinkunmi, Adekanmbi, Victor, Adeoye, Abiodun Moshood, Adetokunboh, Olatunji O., Adham, Davoud, Aduroja, Posi Emmanuel, Advani, Shailesh M., Afarideh, Mohsen, Aghaali, Mohammad, Agrawal, Anurag, Ahmad, Tauseef, Ahmadi, Keivan, Ahmadi, Sepideh, Ahmed, Muktar Beshir, Ahmed, Rushdia, Ajumobi, Olufemi, Akal, Chalachew Genet, Akalu, Temesgen Yihunie, Akinyemiju, Tomi, Akombi, Blessing, Al-Aly, Ziyad, Alam, Samiah, Alamene, Genet Melak, Alanzi, Turki M., Rabanal, Jacqueline Elizabeth Alcalde, Alema, Niguse Meles, Ali, Beriwan Abdulqadir, Ali, Muhammad, Alijanzadeh, Mehran, Alinia, Cyrus, Alipour, Vahid, Alizade, Hesam, Aljunid, Syed Mohamed, Almasi, Afshin, Almasi-Hashiani, Amir, Al-Mekhlafi, Hesham M., Al-Raddadi, Rajaa M., Altirkawi, Khalid, Alvis-Guzman, Nelson, Alvis-Zakzuk, Nelson J., Amare, Azmeraw T., Amegah, Adeladza Kofi, Amini, Saeed, Rarani, Mostafa Amini, Amiri, Fatemeh, Amit, Arianna Maever Loreche, Anber, Nahla Hamed, Andrei, Catalina Liliana, Ansari, Fereshteh, Ansari-Moghaddam, Alireza, Anteneh, Zelalem Alamrew, Antonio, Carl Abelardo T., Antriyandarti, Ernoiz, Anvari, Davood, Anwer, Razique, Appiah, Seth Christopher Yaw, Arabloo, Jalal, Arab-Zozani, Morteza, Araya, Ephrem Mebrahtu, Arefi, Zohreh, Aremu, Olatunde, Ärnlöv, Johan, Arzani, Afsaneh, Asadi-Aliabadi, Mehran, Asadi-Pooya, Ali A., Asgari, Samaneh, Asghari, Babak, Ashagre, Alebachew Fasil, Asrat, Anemaw A., Ataeinia, Bahar, Atalay, Hagos Tasew, Atnafu, Desta Debalkie, Atout, Maha Moh’d Wahbi, Ausloos, Marcel, Avokpaho, Euripide F. G. A., Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Ayanore, Martin Amogre, Aynalem, Yared A. Asmare, Azadmehr, Abbas, Azari, Samad, Azarian, Ghasem, Azene, Zelalem Nigussie, Babaee, Ebrahim, Badawi, Alaa, Badiye, Ashish D., Bahrami, Mohamad Amin, Baig, Atif Amin A., Bakhtiari, Ahad, Bakkannavar, Shankar M., Balakrishnan, Senthilkumar, Bali, Ayele Geleto, Banach, Maciej, Banik, Palash Chandra, Baradaran-Seyed, Zahra, Baraki, Adhanom Gebreegziabher, Barboza, Miguel A., Bärnighausen, Till Winfried, Barua, Lingkan, Basaleem, Huda, Basu, Sanjay, Bayati, Mohsen, Bayih, Mulat Tirfie, Baynes, Habtamu Wondifraw, Bedi, Neeraj, Behzadifar, Masoud, Behzadifar, Meysam, Bekele, Yibeltal Alemu, Bennett, Derrick A., Berbada, Dessalegn Ajema, Berhe, Kidanemaryam, Berhe, Abadi Kidanemariam, Berman, Adam E., Bernstein, Robert S., Bhageerathy, Reshmi, Bhandari, Dinesh, Bharadwaj, Pankaj, Bhattacharjee, Natalia V., Bhattacharyya, Krittika, Bijani, Ali, Bikbov, Boris, Bilano, Ver, Bililign, Nigus, Sayeed, Muhammad Shahdaat Bin, Birara, Setognal, Birhane, Minuye Biniam Biniam, Birhanu, Minyichil, Biswas, Raaj Kishore, Bitew, Zebenay Workneh, Bogale, Kassawmar Angaw, Bohlouli, Somayeh, Bolla, Srinivasa Rao, Boloor, Archith, Borzì, Antonio M., Borzouei, Shiva, Brady, Oliver J., Bragazzi, Nicola Luigi, Braithwaite, Dejana, Briko, Nikolay Ivanovich, Britton, Gabrielle, Budhathoki, Shyam S., Nagaraja, Sharath Burugina, Busse, Reinhard, Butt, Zahid A., Cahuana-Hurtado, Lucero, Cámera, Luis Alberto, Campos-Nonato, Ismael R., Cano, Jorge, Car, Josip, Cárdenas, Rosario, Carrero, Juan J., Carvalho, Félix, Castaldelli-Maia, João Mauricio, Castañeda-Orjuela, Carlos A., Castro, Franz, Cerin, Ester, Chansa, Collins, Charan, Jaykaran, Chatterjee, Pranab, Chattu, Vijay Kumar, Chauhan, Bal Govind, Chavshin, Ali Reza, Chehrazi, Mohammad, Chichiabellu, Tesfaye Yitna, Chin, Ken Lee, Christopher, Devasahayam J., Chu, Dinh-Toi, Cicuttini, Flavia M., Collison, Michael L., Cork, Michael A., Cormier, Natalie, Cortesi, Paolo Angelo, Costa, Vera M., Dadi, Abel Fekadu Fekadu, Dagnew, Baye, Dahlawi, Saad M. A., Damiani, Giovanni, Darwish, Amira Hamed, Daryani, Ahmad, Das, Jai K., Gupta, Rajat Das, Dávila-Cervantes, Claudio, Davis Weaver, Nicole, Leo, Diego De, Neve, Jan-Walter De, Demeke, Feleke Mekonnen, Demis, Asmamaw Bizuneh, Demissie, Dereje Bayissa, Demoz, Gebre Teklemariam, Denova-Gutiérrez, Edgar, Deribe, Kebede, Desai, Rupak, Desalegn, Beruk Berhanu, Desalew, Assefa, Deshpande, Aniruddha, Dey, Sagnik, Dharmaratne, Samath Dhamminda, Dhillon, Preeti, Dhimal, Meghnath, Dhungana, Govinda Prasad, Nasab, Mostafa Dianati, Diaz, Daniel, Forooshani, Zahra Sadat Dibaji, Dinsa, Girmaye Deye, Dipeolu, Isaac Oluwafemi, Djalalinia, Shirin, Do, Hoa Thi, Do, Huyen Phuc, Doku, Paul Narh, Dorostkar, Fariba, Doshmangir, Leila, Dubey, Manisha, Adema, Bereket Duko, Dunachie, Susanna J., Duncan, Bruce B., Cousin, Ewerton, Durães, Andre R., Earl, Lucas, Leylabadlo, Hamed Ebrahimzadeh, Eftekhari, Aziz, El Sayed, Iman, El Sayed Zaki, Maysaa, El Tantawi, Maha, Elbarazi, Iffat, Elemineh, Demelash Abewa, El-Jaafary, Shaimaa I., El-Khatib, Ziad, Elsharkawy, Aisha, El-Sherbiny, Yasser Mohamed, Elyazar, Iqbal R. F., Emamian, Mohammad Hassan, Enany, Shymaa, Endalew, Daniel Adane, Endalifer, Melese Linger, Eskandari, Khalil, Eskandarieh, Sharareh, Esmaeilnejad, Saman, Esteghamati, Alireza, Etemadi, Arash, Etisso, Atkilt Esaiyas, Fanzo, Jessica, Farahmand, Mohammad, Faraj, Anwar, Farashi, Sajjad, Fareed, Mohammad, Farioli, Andrea, Faro, Andre, Farzadfar, Farshad, Farzam, Hossein, Fatima, Syeda Sadia, Fattahi, Nazir, Fauk, Nelsensius Klau, Fazaeli, Ali Akbar, Fentahun, Netsanet, Ferede, Tomas Y., Fereshtehnejad, Seyed-Mohammad, Fernandes, Eduarda, Fernandes, João C., Feyissa, Garumma Tolu, Filip, Irina, Fischer, Florian, Flohr, Carsten, Foigt, Nataliya A., Folayan, Morenike Oluwatoyin, Fomenkov, Artem Alekseevich, Foroutan, Masoud, Förster, Jana, Francis, Joel Msafiri, Fukumoto, Takeshi, Gayesa, Reta Tsegaye, Geberemariyam, Biniyam Sahiledengle, Gebrehiwot, Tsegaye Tewelde, Gebremariam, Hadush, Gebremariam, Kidane Tadesse, Gebremedhin, Ketema Bizuwork Bizuwork, Gebremeskel, Gebreamlak Gebremedhn, Gebreslassie, Assefa Ayalew Ayalew, Gebretsadik, Gebretsadkan G. G., Gedefaw, Getnet Azeze, Geramo, Yilma Chisha Dea, Gesesew, Hailay Abrha, Geta, Birhanu, Getenet, Agegnehu Bante, Gezae, Kebede Embaye, Ghaffarifar, Fatemeh, Ghafourifard, Mansour, Ghajar, Alireza, Ghajarzadeh, Mahsa, Ghashghaee, Ahmad, Ghiasvand, Hesam, Gholamian, Asadollah, Gilani, Syed Amir, Gill, Tiffany K., Ginawi, Ibrahim Abdelmageed, Goli, Srinivas, Gomes, Nelson G. M., Gopalani, Sameer Vali, Goudarzi, Houman, Goulart, Alessandra C., Govindakarnavar, Arunkumar, Grada, Ayman, Grivna, Michal, Guimarães, Rafael Alves, Guled, Rashid Abdi, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Hafezi-Nejad, Nima, Haile, Michael Tamene, Haj-Mirzaian, Arvin, Haj-Mirzaian, Arya, Hall, Brian J., Halvaei, Iman, Hamadeh, Randah R., Hamidi, Yadollah, Handiso, Demelash Woldeyohannes, Hankey, Graeme J., Haririan, Hamidreza, Hariyani, Ninuk, Hasaballah, Ahmed I., Hasan, Md. Mehedi, Hasankhani, Milad, Hasanpoor, Edris, Hasanzadeh, Amir, Hashemian, Maryam, Hassanipour, Soheil, Hassen, Hamid Yimam, Havmoeller, Rasmus, Hawkes, Corinna, Hayat, Khezar, Hayelom, Desta Haftu, Heidari, Behnam, Heidari-Soureshjani, Reza, Hendrie, Delia, Henok, Andualem, Henry, Nathaniel J., Herrero, Mario, Herteliu, Claudiu, Heydarpour, Fatemeh, de Hidru, Hagos D., Hoang, Chi Linh, Hoek, Hans W., Hole, Michael K., Holla, Ramesh, Hollerich, Gillian, Rad, Enayatollah Homaie, Hong, Sung Hwi, Hoogar, Praveen, Horino, Masako, Hossain, Naznin, Hosseini, Mostafa, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Hostiuc, Sorin, Househ, Mowafa, Hsairi, Mohamed, Hu, Guoqing, Huda, Tanvir M., Humayun, Ayesha, Hwang, Bing-Fang, Ibitoye, Segun Emmanuel, Ilesanmi, Olayinka Stephen, Ilic, Milena D., Imani-Nasab, Mohammad Hasan, Inbaraj, Leeberk Raja, Iqbal, Usman, Irvani, Seyed Sina Naghibi, Islam, Sheikh Mohammed Shariful, Iwu, Chidozie C. D., Iwu, Chinwe Juliana, Izadi, Neda, Jaafari, Jalil, Jaca, Anelisa, Jadidi-Niaragh, Farhad, Balalami, Nader Jafari, Jafarinia, Morteza, Jahani, Mohammad Ali, Jakovljevic, Mihajlo, Jalali, Amir, Jalilian, Farzad, Jayatilleke, Achala Upendra, Jeemon, Panniyammakal, Jehan, Fyezah, Jenabi, Ensiyeh, Jha, Ravi Prakash, Jha, Vivekanand, Ji, John S., Jia, Peng, John, Oommen, John-Akinola, Yetunde O., Johnson, Kimberly B., Jonas, Jost B., Joseph, Nitin, Joukar, Farahnaz, Jozwiak, Jacek Jerzy, Jungari, Suresh Banayya, Jürisson, Mikk, Kabir, Ali, Kabir, Zubair, Kahsay, Amaha, Kahssay, Molla, Kalani, Hamed, Kalankesh, Leila L., Kalhor, Rohollah, Kamiab, Zahra, Kanchan, Tanuj, Kapil, Umesh, Kapoor, Neeti, Karami, Manoochehr, Matin, Behzad Karami, Karch, André, Karim, Mohd A., Karki, Surendra, Kasaeian, Amir, Kasahun, Gebremicheal Gebreslassie, Kasaye, Habtamu Kebebe, Kassa, Tesfaye Dessale, Kassaye, Hagazi Gebremedhin, Kassebaum, Nicholas J., Karyani, Ali Kazemi, Kengne, Andre Pascal, Ketema, Daniel Bekele, Khader, Yousef Saleh, Khafaie, Morteza Abdullatif, Khaksarian, Mojtaba, Khalid, Nauman, Khalil, Ibrahim A., Khalilov, Rovshan, Khan, Asad, Khan, Ejaz Ahmad, Khan, Md Nuruzzaman, Khan, Mohammad Saud, Khan, Muhammad Shahzeb, Khatab, Khaled, Khater, Amir, Khater, Mona M., Khatib, Mahalqua Nazli, Khayamzadeh, Maryam, Khazaei-Pool, Maryam, Khazaei, Mohammad, Khazaei, Salman, Khodayari, Mohammad Taghi, Khosravi, Mohammad Hossein, Khundkar, Roba, Kiadaliri, Ali, Kianipour, Neda, Kiirithio, Daniel N., Kim, Yun Jin, Kimokoti, Ruth W., Kisa, Adnan, Kisa, Sezer, Kolola, Tufa, Komaki, Hamidreza, Kondlahalli, Shivakumar K. M., Koolivand, Ali, Koul, Parvaiz A., Koyanagi, Ai, Kraemer, Moritz U. G., Krishan, Kewal, Krohn, Kris J., Kugbey, Nuworza, Kumar, Manasi, Kumar, Pushpendra, Kumar, Vivek, Kurmi, Om P., Kuti, Oluwatosin, Vecchia, Carlo La, Lacey, Ben, Lad, Deepesh P., Lal, Aparna, Lal, Dharmesh Kumar, Lami, Faris Hasan, Lamichhane, Prabhat, Lang, Justin J., Lansingh, Van C., Lasrado, Savita, Lebedev, Georgy, Lee, Paul H., Lee, Shaun Wen Huey, Leili, Mostafa, Letourneau, Ian D., Lewycka, Sonia, Li, Shanshan, Lim, Lee-Ling, Linn, Shai, Liu, Shiwei, Liu, Simin, Lodha, Rakesh, Longbottom, Joshua, Lopez, Jaifred Christian F., Lorkowski, Stefan, Macarayan, Erlyn Rachelle King, Madadin, Mohammed, El Razek, Hassan Magdy Abd, El Razek, Muhammed Magdy Abd, Maghavani, Dhaval P., Mahasha, Phetole Walter, Mahotra, Narayan Bahadur, Maled, Venkatesh, Maleki, Afshin, Maleki, Shokofeh, Malta, Deborah Carvalho, Manafi, Ali, Manafi, Farzad, Manafi, Navid, Manohar, Narendar Dawanu, Mansour-Ghanaei, Fariborz, Mansouri, Borhan, Mansournia, Mohammad Ali, Mapoma, Chabila Christopher, Marami, Dadi, Marczak, Laurie B., Arnedo, Carlos Alberto Marrugo, Martins-Melo, Francisco Rogerlândio, Masaka, Anthony, Massenburg, Benjamin Ballard, Maulik, Pallab K., Mayala, Benjamin K., Mazidi, Mohsen, Mehndiratta, Man Mohan, Mehri, Freshteh, Mehta, Kala M., Meitei, Wahengbam Bigyananda, Mekonnen, Fantahun Ayenew, Mekonnen, Teferi, Meles, Gebrekiros Gebremichael, Meles, Hagazi Gebre, Melese, Addisu, Mendoza, Walter, Menezes, Ritesh G., Mengesha, Meresa Berwo, Mensah, George A., Meretoja, Tuomo J., Miazgowski, Tomasz, Kostova, Neda Milevska, Miller, Ted R., Mills, Edward J., Mini, G. K., Mir, Seyed Mostafa, Miri, Mohammad, Mirjalali, Hamed, Mirrakhimov, Erkin M., Mirzaei, Hamed, Mirzaei, Maryam, Mirzaei, Roya, Mirzaei-Alavijeh, Mehdi, Mithra, Prasanna, Moazen, Babak, Mohamadi, Efat, Mohamadi-Bolbanabad, Amjad, Mohammad, Karzan Abdulmuhsin, Mohammad, Yousef, Mohammad, Dara K., Darwesh, Aso Mohammad, Mezerji, Naser Mohammad Gholi, Mohammadian-Hafshejani, Abdollah, Mohammadnia-Afrouzi, Mousa, Mohammadoo-Khorasani, Milad, Mohammadpourhodki, Reza, Mohammed, Salahuddin, Mohammed, Shafiu, Mohammed, Jemal Abdu, Mohammed, Ammas Siraj, Mohebi, Farnam, Mokari, Amin, Mokdad, Ali H., Montañez, Julio Cesar, Montero-Zamora, Pablo A., Moodley, Yoshan, Moossavi, Maryam, Moradi, Ghobad, Moradi, Masoud, Moradi, Yousef, Moradi-Joo, Mohammad, Moradi-Lakeh, Maziar, Moradpour, Farhad, Moradzadeh, Rahmatollah, Moraga, Paula, Morrison, Shane Douglas, Mosapour, Abbas, Mosser, Jonathan F., Mouodi, Simin, Khaneghah, Amin Mousavi, Mozaffarian, Dariush, Mueller, Ulrich Otto, Murray, Christopher J. L., Murthy, G. V. S., Musa, Kamarul Imran, Mustafa, Ghulam, Muthupandian, Saravanan, Nabavizadeh, Behnam, Naderi, Mehdi, Nadkarni, Girish N., Nagarajan, Ahamarshan Jayaraman, Naghavi, Mohsen, Naheed, Aliya, Naik, Gurudatta, Najafi, Farid, Nansseu, Jobert Richie, Narayan, K. M. Venkat, Nascimento, Bruno Ramos, Nayak, Vinod, Nazari, Javad, Ndwandwe, Duduzile Edith, Negoi, Ionut, Negoi, Ruxandra Irina, Ngunjiri, Josephine W., Nguyen, Cuong Tat, Nguyen, Huong Lan Thi, Nigatu, Dabere, Nigatu, Yeshambel T., Nikbakhsh, Rajan, Ningrum, Dina Nur Anggraini, Nnaji, Chukwudi A., Nong, Vuong Minh, Noubiap, Jean Jacques, Nowak, Christoph, Oancea, Bogdan, Ofori-Asenso, Richard, Oghenetega, Onome Bright, Oh, In-Hwan, Oladimeji, Olanrewaju, Oladnabi, Morteza, Olagunju, Andrew T., Olagunju, Tinuke O., Olusanya, Bolajoko Olubukunola, Olusanya, Jacob Olusegun, Oluwasanu, Mojisola Morenike, Omer, Muktar Omer, Onwujekwe, Obinna E., Asante, Kwaku Oppong, Oren, Eyal, Orisakwe, Orish Ebere, Ortiz, Alberto, Osarenotor, Osayomwanbo, Osgood-Zimmerman, Aaron E., Owolabi, Mayowa Ojo, P. A., Mahesh, Padubidri, Jagadish Rao, Pakshir, Keyvan, Pana, Adrian, Panda-Jonas, Songhomitra, Parsian, Hadi, Pashaei, Tahereh, Pasupula, Deepak Kumar, Patel, Sangram Kishor, Pathak, Ashish, Pathak, Mona, Pati, Sanghamitra, Patle, Ajay, Patton, George C., Paulos, Kebreab, Toroudi, Hamidreza Pazoki, Pepito, Veincent Christian Filipino, Perico, Norberto, Petri, William A., Pickering, Brandon V., Pigott, David M., Pirestani, Majid, Piroozi, Bakhtiar, Pirsaheb, Meghdad, Pokhrel, Khem Narayan, Postma, Maarten J., Pourjafar, Hadi, Pourmalek, Farshad, Kalhori, Reza Pourmirza, Pourshams, Akram, Poustchi, Hossein, Prada, Sergio I., Preotescu, Liliana, Pribadi, Dimas Ria Angga, Syed, Zahiruddin Quazi, Rabiee, Mohammad, Rabiee, Navid, Radfar, Amir, Rafiei, Alireza, Rahim, Fakher, Rahimi-Movaghar, Vafa, Rahman, Muhammad Aziz, Rahman, Sajjad ur, Rai, Rajesh Kumar, Rajabpour-Sanati, Ali, Rajati, Fatemeh, Ramezanzadeh, Kiana, Rana, Saleem Muhammad, Ranabhat, Chhabi Lal, Rao, Sowmya J., Rasella, Davide, Rashedi, Vahid, Rastogi, Prateek, Rathi, Priya, Rawaf, Salman, Rawaf, David Laith, Rawal, Lal, Ray, Sarah E., Remuzzi, Giuseppe, Renjith, Vishnu, Renzaho, Andre M. N., Resnikoff, Serge, Rezaei, Nima, Rezaeian, Shahab, Rezai, Mohammad Sadegh, Rezapour, Aziz, Riahi, Seyed Mohammad, Ribeiro, Ana Isabel, Rickard, Jennifer, Rodriguez, Alina, Roever, Leonardo, Roro, Elias Merdassa, Roshandel, Gholamreza, Rostami, Ali, Rubagotti, Enrico, Saad, Anas M., Saadatagah, Seyedmohammad, Sabde, Yogesh Damodar, Sabour, Siamak, Sadeghi, Ehsan, Sadeghi, Masoumeh, Safari, Saeed, Safari, Yahya, Safarpour, Hamid, Sagar, Rajesh, Sahebkar, Amirhossein, Sahraian, Mohammad Ali, Sajadi, S. Mohammad, Salahshoor, Mohammad Reza, Salam, Nasir, Salehi, Farkhonde, Zahabi, Saleh Salehi, Salem, Hosni, Salem, Marwa R. Rashad, Salimi, Yahya, Salimzadeh, Hamideh, Kafil, Hossein Samadi, Sambala, Evanson Zondani, Samy, Abdallah M., Santos, Itamar S., Jose, Bruno Piassi Sao, Saraswathy, Sivan Yegnanarayana Iyer, Sarker, Abdur Razzaque, Sartorius, Benn, Sarveazad, Arash, Sathian, Brijesh, Satpathy, Maheswar, Saxena, Sonia, Sayyah, Mehdi, Sbarra, Alyssa N., Schipp, Megan F., Schmidt, Maria Inês, Schutte, Aletta Elisabeth, Schwebel, David C., Senbeta, Anbissa Muleta, Senthilkumaran, Subramanian, Seyedmousavi, Seyedmojtaba, Shaahmadi, Faramarz, Shafaat, Omid, Shahabi, Saeed, Shaikh, Masood Ali, Shalash, Ali S., Shams-Beyranvand, Mehran, Shamshirian, Amir, Shamsizadeh, Morteza, Shannawaz, Mohammed, Sharafi, Kiomars, Sharif, Mehdi, Sharma, Rajesh, Shehata, Hatem Samir, Sheikhtaheri, Abbas, Shibuya, Kenji, Shiferaw, Wondimeneh Shibabaw, Shigematsu, Mika, Shin, Jae Il, Shiri, Rahman, Shirkoohi, Reza, Shiue, Ivy, Shuval, Kerem, Siabani, Soraya, Siddiqi, Tariq J., Sigfusdottir, Inga Dora, Silva, Diego Augusto Santos, Simonetti, Biagio, Singh, Ambrish, Singh, Pushpendra, Singh, Virendra, Singh, Jasvinder A., Singh, Pankaj Kumar, Sinha, Dhirendra Narain, Sintayehu, Yitagesu, Sisay, Malede Mequanent M., Soheili, Amin, Soleymani, Bija, Soltani, Farzaneh, Soltani, Shahin, Soriano, Joan B., Sorrie, Muluken Bekele, Soshnikov, Sergey, Soyiri, Ireneous N., Spotin, Adel, Sreeramareddy, Chandrashekhar T., Srivastava, Rajni Kant Kant, Starodubova, Antonina, Sudaryanto, Agus, Sufiyan, Mu’awiyyah Babale, Suleria, Hafiz Ansar Rasul, Sulo, Gerhard, Sunguya, Bruno F., Sykes, Bryan L., Tabarés-Seisdedos, Rafael, Tabuchi, Takahiro, Tadesse, Birkneh Tilahun, Taherkhani, Amir, Tamirat, Koku Sisay, Tassew, Segen Gebremeskel, Taveira, Nuno, Teklehaimanot, Berhane Fseha, Tekulu, Gebretsadkan Hintsa, Temsah, Mohamad-Hani, Terkawi, Abdullah Sulieman, Tessema, Zemenu Tadesse, Thomas, Nihal, Titova, Mariya Vladimirovna, Tlaye, Kenean Getaneh, Tohidinik, Hamid Reza, Tonelli, Marcello, Tovani-Palone, Marcos Roberto, Traini, Eugenio, Tran, Khanh Bao, Tripathi, Manjari, Uddin, Riaz, Ullah, Irfan, Unnikrishnan, Bhaskaran, Upadhyay, Era, Useh, Ushotanefe, Usman, Muhammad Shariq, Uthman, Olalekan A., Vacante, Marco, Vaezghasemi, Masoud, Valdez, Pascual R., VanderHeide, John, Varavikova, Elena, Varughese, Santosh, Vasankari, Tommi Juhani, Vasseghian, Yasser, Veisani, Yousef, Venkatesh, Srinivasaraghavan, Venketasubramanian, Narayanaswamy, Verma, Madhur, Vidale, Simone, Violante, Francesco S., Vlassov, Vasily, Vollmer, Sebastian, Vukovic, Rade, Waheed, Yasir, Wang, Haidong, Wang, Yafeng, Wang, Yuan-Pang, Weldesamuel, Girmay Teklay, Werdecker, Andrea, Wiangkham, Taweewat, Wiens, Kirsten E., Wijeratne, Tissa, Wolde, Haileab Fekadu, Wondafrash, Dawit Zewdu, Wonde, Tewodros Eshete, Wondmieneh, Adam Belay, Wu, Ai-Min, Xu, Gelin, Yadegar, Abbas, Yadollahpour, Ali, Jabbari, Seyed Hossein Yahyazadeh, Yamada, Tomohide, Yano, Yuichiro, Yaya, Sanni, Yazdi-Feyzabadi, Vahid, Yeshaneh, Alex, Yeshaw, Yigizie, Yeshitila, Yordanos Gizachew, Yilma, Mekdes Tigistu, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Youm, Yoosik, Younis, Mustafa Z., Yousefi, Zabihollah, Yousof, Hebat-Allah Salah A., Yu, Chuanhua, Yusefzadeh, Hasan, Moghadam, Telma Zahirian, Zaki, Leila, Zaman, Sojib Bin, Zamani, Mohammad, Zamanian, Maryam, Zandian, Hamed, Zarafshan, Hadi, Zepro, Nejimu Biza, Zerfu, Taddese Alemu, Zewale, Taye Abuhay, Zhang, Yunquan, Zhang, Zhi-Jiang, Zhao, Xiu-Ju, Zodpey, Sanjay, Zomorodian, Kamiar, Zotor, Francis Bruno, Afshin, Ashkan, Hay, Simon I., LBD Double Burden of Malnutrition Collaborator, Violante FS, Adema, Bereket Duko, Yeshaw, Yigizie, LBD Double Burden of Malnutrition Collaborators, Instituto de Saúde Pública da Universidade do Porto, 10922180 - Schutte, Aletta Elisabeth, UAM. Departamento de Medicina, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD), Instituto de Investigación Sanitaria Hospital Universitario de La Princesa (IIS-IP), Veritati - Repositório Institucional da Universidade Católica Portuguesa, Biosciences, University of Helsinki, Clinicum, HUS Comprehensive Cancer Center, Institute for Molecular Medicine Finland, Department of Earth Observation Science, UT-I-ITC-ACQUAL, Faculty of Geo-Information Science and Earth Observation, Sálfræðideild (HR), Department of Psychology (RU), Samfélagssvið (HR), School of Social Sciences (RU), Háskólinn í Reykjavík, Reykjavik University, Instituto de Investigación Sanitaria Fundación Jiménez Díaz (ISS-FJD), Kinyoki, D, Ross, J, Lazzar-Atwood, A, Munro, S, Schaeffer, L, Abbasalizad-Farhangi, M, Abbasi, M, Abbastabar, H, Abdelalim, A, Abdoli, A, Abdollahi, M, Abdollahpour, I, Abdulkader, R, Abebe, N, Abebo, T, Abegaz, K, Abolhassani, H, Abreu, L, Abrigo, M, Abushouk, A, Accrombessi, M, 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S, Kasaeian, A, Kasahun, G, Kasaye, H, Kassa, T, Kassaye, H, Kassebaum, N, Karyani, A, Kengne, A, Ketema, D, Khader, Y, Khafaie, M, Khaksarian, M, Khalid, N, Khalil, I, Khalilov, R, Khan, A, Khan, E, Khan, M, Khatab, K, Khater, A, Khater, M, Khatib, M, Khayamzadeh, M, Khazaei-Pool, M, Khazaei, M, Khazaei, S, Khodayari, M, Khosravi, M, Khundkar, R, Kiadaliri, A, Kianipour, N, Kiirithio, D, Kim, Y, Kimokoti, R, Kisa, A, Kisa, S, Kolola, T, Komaki, H, Kondlahalli, S, Koolivand, A, Koul, P, Koyanagi, A, Kraemer, M, Krishan, K, Krohn, K, Kugbey, N, Kumar, M, Kumar, P, Kumar, V, Kurmi, O, Kuti, O, Vecchia, C, Lacey, B, Lad, D, Lal, A, Lal, D, Lami, F, Lamichhane, P, Lang, J, Lansingh, V, Lasrado, S, Lebedev, G, Lee, P, Lee, S, Leili, M, Letourneau, I, Lewycka, S, Li, S, Lim, L, Linn, S, Liu, S, Lodha, R, Longbottom, J, Lopez, J, Lorkowski, S, Macarayan, E, Madadin, M, El Razek, H, El Razek, M, Maghavani, D, Mahasha, P, Mahotra, N, Maled, V, Maleki, A, Maleki, S, Malta, D, Manafi, A, Manafi, 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Mosser, J, Mouodi, S, Khaneghah, A, Mozaffarian, D, Mueller, U, Murray, C, Murthy, G, Musa, K, Mustafa, G, Muthupandian, S, Nabavizadeh, B, Naderi, M, Nadkarni, G, Nagarajan, A, Naghavi, M, Naheed, A, Naik, G, Najafi, F, Nansseu, J, Narayan, K, Nascimento, B, Nayak, V, Nazari, J, Ndwandwe, D, Negoi, I, Negoi, R, Ngunjiri, J, Nguyen, C, Nguyen, H, Nigatu, D, Nigatu, Y, Nikbakhsh, R, Ningrum, D, Nnaji, C, Nong, V, Noubiap, J, Nowak, C, Oancea, B, Ofori-Asenso, R, Oghenetega, O, Oh, I, Oladimeji, O, Oladnabi, M, Olagunju, A, Olagunju, T, Olusanya, B, Olusanya, J, Oluwasanu, M, Omer, M, Onwujekwe, O, Asante, K, Oren, E, Orisakwe, O, Ortiz, A, Osarenotor, O, Osgood-Zimmerman, A, Owolabi, M, P. A, M, Padubidri, J, Pakshir, K, Pana, A, Panda-Jonas, S, Parsian, H, Pashaei, T, Pasupula, D, Patel, S, Pathak, A, Pathak, M, Pati, S, Patle, A, Patton, G, Paulos, K, Toroudi, H, Pepito, V, Perico, N, Petri, W, Pickering, B, Pigott, D, Pirestani, M, Piroozi, B, Pirsaheb, M, Pokhrel, K, Postma, M, Pourjafar, H, Pourmalek, F, Kalhori, R, Pourshams, A, Poustchi, H, Prada, S, Preotescu, L, Pribadi, D, Syed, Z, Rabiee, M, Rabiee, N, Radfar, A, Rafiei, A, Rahim, F, Rahimi-Movaghar, V, Rahman, M, Rahman, S, Rai, R, Rajabpour-Sanati, A, Rajati, F, Ramezanzadeh, K, Rana, S, Ranabhat, C, Rao, S, Rasella, D, Rashedi, V, Rastogi, P, Rathi, P, Rawaf, S, Rawaf, D, Rawal, L, Ray, S, Remuzzi, G, Renjith, V, Renzaho, A, Resnikoff, S, Rezaei, N, Rezaeian, S, Rezai, M, Rezapour, A, Riahi, S, Ribeiro, A, Rickard, J, Rodriguez, A, Roever, L, Roro, E, Roshandel, G, Rostami, A, Rubagotti, E, Saad, A, Saadatagah, S, Sabde, Y, Sabour, S, Sadeghi, E, Sadeghi, M, Safari, S, Safari, Y, Safarpour, H, Sagar, R, Sahebkar, A, Sahraian, M, Sajadi, S, Salahshoor, M, Salam, N, Salehi, F, Zahabi, S, Salem, H, Salem, M, Salimi, Y, Salimzadeh, H, Kafil, H, Sambala, E, Samy, A, Santos, I, Jose, B, Saraswathy, S, Sarker, A, Sartorius, B, Sarveazad, A, Sathian, B, Satpathy, M, Saxena, S, Sayyah, M, Sbarra, A, Schipp, M, Schmidt, M, Schutte, A, Schwebel, D, Senbeta, A, Senthilkumaran, S, Seyedmousavi, S, Shaahmadi, F, Shafaat, O, Shahabi, S, Shaikh, M, Shalash, A, Shams-Beyranvand, M, Shamshirian, A, Shamsizadeh, M, Shannawaz, M, Sharafi, K, Sharif, M, Sharma, R, Shehata, H, Sheikhtaheri, A, Shibuya, K, Shiferaw, W, Shigematsu, M, Shin, J, Shiri, R, Shirkoohi, R, Shiue, I, Shuval, K, Siabani, S, Siddiqi, T, Sigfusdottir, I, Silva, D, Simonetti, B, Singh, A, Singh, P, Singh, V, Singh, J, Sinha, D, Sintayehu, Y, Sisay, M, Soheili, A, Soleymani, B, Soltani, F, Soltani, S, Soriano, J, Sorrie, M, Soshnikov, S, Soyiri, I, Spotin, A, Sreeramareddy, C, Srivastava, R, Starodubova, A, Sudaryanto, A, Sufiyan, M, Suleria, H, Sulo, G, Sunguya, B, Sykes, B, Tabares-Seisdedos, R, Tabuchi, T, Tadesse, B, Taherkhani, A, Tamirat, K, Tassew, S, Taveira, N, Teklehaimanot, B, Tekulu, G, Temsah, M, Terkawi, A, Tessema, Z, Thomas, N, Titova, M, Tlaye, K, Tohidinik, H, Tonelli, M, Tovani-Palone, M, Traini, E, Tran, K, Tripathi, M, Uddin, R, Ullah, I, Unnikrishnan, B, Upadhyay, E, Useh, U, Usman, M, Uthman, O, Vacante, M, Vaezghasemi, M, Valdez, P, Vanderheide, J, Varavikova, E, Varughese, S, Vasankari, T, Vasseghian, Y, Veisani, Y, Venkatesh, S, Venketasubramanian, N, Verma, M, Vidale, S, Violante, F, Vlassov, V, Vollmer, S, Vukovic, R, Waheed, Y, Wang, H, Wang, Y, Weldesamuel, G, Werdecker, A, Wiangkham, T, Wiens, K, Wijeratne, T, Wolde, H, Wondafrash, D, Wonde, T, Wondmieneh, A, Wu, A, Xu, G, Yadegar, A, Yadollahpour, A, Jabbari, S, Yamada, T, Yano, Y, Yaya, S, Yazdi-Feyzabadi, V, Yeshaneh, A, Yeshaw, Y, Yeshitila, Y, Yilma, M, Yip, P, Yonemoto, N, Yoon, S, Youm, Y, Younis, M, Yousefi, Z, Yousof, H, Yu, C, Yusefzadeh, H, Moghadam, T, Zaki, L, Zaman, S, Zamani, M, Zamanian, M, Zandian, H, Zarafshan, H, Zepro, N, Zerfu, T, Zewale, T, Zhang, Y, Zhang, Z, Zhao, X, Zodpey, S, Zomorodian, K, Zotor, F, Afshin, A, Hay, S, Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Value, Affordability and Sustainability (VALUE), and Microbes in Health and Disease (MHD)

Subjects
Male, Local patterns, Double burden, Börn, Research & Experimental Medicine, Sjúkdómseinkenni, DOUBLE BURDEN, Childhood overweight, Lífefnafræði, Læknisfræði, 0302 clinical medicine, Syndemic, Child, 11 Medical and Health Sciences, under 5 years of age, General Medicine, 3. Good health, Geography, Medicine, Research & Experimental, Child, Preschool, Income, GROWTH, AFRICA, medicine.medical_specialty, Biochemistry & Molecular Biology, RJ, Medicina, Immunology, education, MODELS, wa_395, General Biochemistry, Genetics and Molecular Biology, Article, 03 medical and health sciences, Humans, Author Correction, Developing Countries, Poverty, Biology, LBD Double Burden of Malnutrition Collaborators, Demography, Science & Technology, Wasting Syndrome, Public health, MORTALITY, Infant, Næringarskortur, medicine.disease, Obesity, TRENDS, signs and symptoms, Social Class, Risk factors, Sameindalíffræði, ITC-ISI-JOURNAL-ARTICLE, UNDERNUTRITION, Human medicine, Clinical Medicine, 030217 neurology & neurosurgery, Pediatric Obesity, obesity, Offita, Áhættuþættir, Geographic Mapping, Overweight, RA0421, Global health, risk factors, 030212 general & internal medicine, Signs and symptoms, Wasting, Malnutrition, Global Burden of Diseases, Global Nutrition, low- and middle-income countries, 2. Zero hunger, 1. No poverty, Public Health, Global Health, Social Medicine and Epidemiology, A900 Others in Medicine and Dentistry, Childhood wasting, PREVALENCE, Chemistry, Mapping, Female, Lýðheilsa, medicine.symptom, Life Sciences & Biomedicine, GROWTH FAILURE, Nutritional Status, malnutrition, ITC-HYBRID, ws_115, children, Environmental health, medicine, Erfðafræði, wd_200, Malnutrition, Infant, Newborn, Klinisk medicin, Cell Biology, Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi, 3121 General medicine, internal medicine and other clinical medicine, NA
Abstract

Artículo con numerosos autores, sólo se mencionan el primero, los de la UAM y grupo colectivo, A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of, This work was primarily supported by grant OPP1132415 from the Bill & Melinda Gates Foundation awarded to S.I.H.

Published
2020

14. Association of Maternal Lactation With Diabetes and Hypertension

Author

Rameez, Rabel Misbah, Sadana, Divyajot, Kaur, Simrat, Ahmed, Taha, Patel, Jay, Khan, Muhammad Shahzeb, Misbah, Sarah, Simonson, Marian T., Riaz, Haris, and Ahmed, Haitham M.

Subjects
Online Only, Breast Feeding, Time Factors, Research, Hypertension, Diabetes Mellitus, Obstetrics and Gynecology, Humans, Lactation, Female, Protective Factors, Original Investigation
Abstract

Key Points Question Is breastfeeding associated with lower risk of maternal diabetes or hypertension? Findings This meta-analysis of 6 studies including more than 200 000 participants found that breastfeeding was associated with a relative risk reduction of 30% for diabetes and 13% for hypertension in the mothers studied. Meaning These findings suggest that breastfeeding is associated with long-term cardiovascular health benefits for women., This systematic review and meta-analysis examines the association between breastfeeding and maternal risk of diabetes and hypertension., Importance Lactation has been shown to be associated with lower rates of diabetes and hypertension in mothers. However, the strength of association has varied between studies, and sample sizes are relatively small. Objective To conduct a systematic review and meta-analysis to determine whether lactation is associated with a lower risk of diabetes and hypertension. Data Sources Ovid MEDLINE, Ovid Embase, Cochrane CENTRAL, and CINAHL databases were searched from inception to July 2018 with manual search of the references. Study Selection Studies of adult women that specified duration of breastfeeding for at least 12 months, evaluated primary hypertension and diabetes as outcomes, were full-text articles in English, and reported statistical outcomes as odds ratios were included. Data Extraction and Synthesis Study characteristics were independently extracted using a standard spreadsheet template and the data were pooled using the random-effects model. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline for reporting was followed. Main Outcomes and Measures Diabetes and hypertension. Results The search yielded 1558 articles, from which a total of 6 studies met inclusion criteria for association between breastfeeding and diabetes and/or hypertension. The 4 studies included in the meta-analysis for the association between lactation and diabetes had a total of 206 204 participants, and the 5 studies included in the meta-analysis for the association between lactation and hypertension had a total of 255 271 participants. Breastfeeding for more than 12 months was associated with a relative risk reduction of 30% for diabetes (pooled odds ratio, 0.70 [95% CI, 0.62-0.78]; P

Published
2019

15. Use of Balloon Atrial Septostomy in Patients With Advanced Pulmonary Arterial Hypertension: A Systematic Review and Meta-Analysis

Author

Khan, Muhammad Shahzeb, Memon, Muhammad Mustafa, Amin, Emaan, Yamani, Naser, Khan, Safi U., Figueredo, Vincent M., Deo, Salil, Rich, Jonathan D., Benza, Raymond L., and Krasuski, Richard A.

Subjects
Pulmonary Vascular Disease, Cardiac Catheterization, Pulmonary Arterial Hypertension, Palliative Care, Heart Septum, Hemodynamics, Humans, Cardiac Surgical Procedures
Abstract

BACKGROUND: Despite the use and purported benefits of balloon atrial septostomy (BAS), its safety, efficacy, and therapeutic role in the setting of advanced pulmonary arterial hypertension (PAH) are not well defined. OBJECTIVE: The goal of this study was to conduct a systematic review and meta-analysis to better determine the evidence supporting the use of BAS in PAH. METHODS: MEDLINE, Scopus, Cochrane Library, and Clinicaltrials.gov were searched from inception through May 2018 for original studies reporting outcomes with PAH prior to and following BAS. Studies comparing BAS vs other septostomy procedures were excluded. Weighted mean differences and 95% CIs were pooled by using a random effects model. RESULTS: Sixteen studies comprising 204 patients (mean age, 35.8 years; 73.1% women) were included. Meta-analysis revealed significant reductions in right atrial pressure (–2.77 mm Hg [95% CI, –3.50, –2.04]; P < .001) and increases in cardiac index (0.62 L/min/m(2) [95% CI, 0.48, 0.75]; P < .001) and left atrial pressure (1.86 mm Hg [95% CI, 1.24, 2.49]; P < .001) following BAS, along with a significant reduction in arterial oxygen saturation (–8.45% [95% CI, –9.93, –6.97]; P < .001). The pooled incidence of procedure-related (48 h), short-term (≤ 30 day), and long-term (> 30 days up to a mean follow-up of 46.5 months) mortality was 4.8% (95% CI, 1.7%, 9.0%), 14.6% (95% CI, 8.6%, 21.5%), and 37.7% (95% CI, 27.9%, 47.9%), respectively. CONCLUSIONS: The present analysis suggests that BAS is relatively safe in advanced PAH, with beneficial hemodynamic effects. The relatively high postprocedural and short-term survival with less impressive long-term survival suggest a bridging role for BAS; its contribution to this change needs to be verified by using a comparator group.

Published
2019

16. Global, regional, and national burden of suicide mortality 1990 to 2016:Systematic analysis for the Global Burden of Disease Study 2016

Author

Orpana, Heather M., Marczak, Laurie B., Arora, Megha, Abbasi, Nooshin, Abdulkader, Rizwan Suliankatchi, Abebe, Zegeye, Abraha, Haftom Niguse, Afarideh, Mohsen, Afshari, Mahdi, Ahmadi, Alireza, Aichour, Amani Nidhal, Aichour, Ibtihel, Aichour, Miloud Taki Eddine, Akseer, Nadia, Al‐raddadi, Rajaa M., Alahdab, Fares, Alkerwi, Ala'a, Allebeck, Peter, Alvis‐guzman, Nelson, Anber, Nahla Hamed, Anjomshoa, Mina, Antonio, Carl Abelardo T., Arora, Amit, Aryal, Krishna K., Asgedom, Solomon Weldegebreal, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Badali, Hamid, Barker‐collo, Suzanne Lyn, Bärnighausen, Till Winfried, Bazargan‐hejazi, Shahrzad, Benjet, Corina, Bensenor, Isabela M., Berfeld, Noami, Beuran, Mircea, Bhutta, Zulfiqar A., Biadgo, Belete, Bililign, Nigus, Borges, Guilherme, Borschmann, Rohan, Brazinova, Alexandra, Breitborde, Nicholas J.K., Brugha, Traolach, Butt, Zahid A., Carrero, Juan J., Carvalho, Félix, Malta, Deborah Carvalho, Castañeda‐orjuela, Carlos A., Catalá‐lópez, Ferrán, Ciobanu, Liliana G., Dachew, Berihun Assefa, Dandona, Lalit, Dandona, Rakhi, Dargan, Paul I., Daryani, Ahmad, Davitoiu, Dragos Virgil, Davletov, Kairat, Degenhardt, Louisa, Demoz, Gebre Teklemariam, Jarlais, Don C.Des, Dharmaratne, Samath Dhamminda, Djalalinia, Shirin, Doan, Linh, Doku, David Teye, Dubey, Manisha, El‐khatib, Ziad, Eskandarieh, Sharareh, Esteghamati, Alireza, Esteghamati, Sadaf, Faro, Andre, Farzadfar, Farshad, Fekadu, Wubalem, Fernandes, Eduarda, Ferrari, Alize J., Filip, Irina, Fischer, Florian, Foreman, Kyle J., Fukumoto, Takeshi, Gebre, Abadi Kahsu, Grosso, Giuseppe, Gupta, Rahul, Haagsma, Juanita A., Bidgoli, Hassan Haghparast, Haj‐mirzaian, Arvin, Hamidi, Samer, Hankey, Graeme J., Haro, Josep Maria, Hassen, Hamid Yimam, Hay, Simon I., Heidari, Behnam, Hendrie, Delia, Rad, Enayatollah Homaie, Hosseini, Seyed Mostafa, Hostiuc, Sorin, Irvani, Seyed Sina Naghibi, Islam, Sheikh Mohammed Shariful, Jakovljevic, Mihajlo, James, Spencer, Jayatilleke, Achala Upendra, Jha, Ravi Prakash, Jonas, Jost B., Jozwiak, Jacek Jerzy, Kadel, Rajendra, Kahsay, Amaha, Kasaeian, Amir, Kassa, Getachew Mullu, Kawakami, Norito, Kefale, Adane Teshome, Kemp, Grant Rodgers, Khader, Yousef Saleh, Khafaie, Morteza Abdullatif, Khalil, Ibrahim A., Khan, Ejaz Ahmad, Khan, Muhammad Ali, Khan, Muhammad Shahzeb, Khang, Young Ho, Khubchandani, Jagdish, Kiadaliri, Aliasghar A., Kieling, Christian, Kim, Young Eun, Kisa, Adnan, Knudsen, Ann Kristin Skrindo, Kokubo, Yoshihiro, Koyanagi, Ai, Krish, Varsha Sarah, Defo, Barthelemy Kuate, Kumar, G. Anil, Kumar, Manasi, Lamichhane, Prabhat, Lang, Justin J., Latifi, Arman, Lee, Paul H., Leung, Janni, Lim, Lee Ling, Lopez, Alan D., Lorkowski, Stefan, Lotufo, Paulo A., Lozano, Rafael, Lunevicius, Raimundas, Mahesh, P. A., Majdan, Marek, Majdzadeh, Reza, Malekzadeh, Reza, Manda, Ana Laura, Mansournia, Mohammad Ali, Mantovani, Lorenzo Giovanni, Maravilla, Joemer C., Martinez‐raga, Jose, Mathur, Manu Raj, Maulik, Pallab K., McGrath, John J., Mehrotra, Ravi, Mekonen, Tesfa, Mendoza, Walter, Meretoja, Tuomo J., Mestrovic, Tomislav, Miller, Ted R., Mini, G. K., Mirrakhimov, Erkin M., Mitchell, Philip B., Moazen, Babak, Mohammad, Karzan Abdulmuhsin, Mohammadi, Moslem, Mohammed, Shafiu, Mokdad, Ali H., Monasta, Lorenzo, Moosazadeh, Mahmood, Moradi, Ghobad, Moradi‐lakeh, Maziar, Moradinazar, Mehdi, Velásquez, Ilais Moreno, Morisaki, Naho, Morrison, Shane Douglas, Moschos, Marilita M., Mousavi, Seyyed Meysam, Mustafa, Ghulam, Nagel, Gabriele, Naheed, Aliya, Naik, Gurudatta, Najafi, Farid, Negoi, Ionut, Negoi, Ruxandra Irina, Nguyen, Huong Lan Thi, Nguyen, Long Hoang, Nixon, Molly R., Ofori‐asenso, Richard, Ogbo, Felix Akpojene, Oh, In Hwan, Olagunju, Andrew T., Olagunju, Tinuke O., Øverland, Simon, Owolabi, Mayowa Ojo, Panda‐jonas, Songhomitra, Parry, Charles D.H., Pati, Sanghamitra, Patten, Scott B., Patton, George C., Petzold, Max, Phillips, Michael R., Plana‐ripoll, Oleguer, Postma, Maarten J., Pourshams, Akram, Poustchi, Hossein, Qorbani, Mostafa, Radfar, Amir, Rafay, Anwar, Rafiei, Alireza, Rahim, Fakher, Rahimi‐movaghar, Afarin, Rahimi‐movaghar, Vafa, Rahman, Muhammad Aziz, Rai, Rajesh Kumar, Rezaeian, Shahab, Roever, Leonardo, Ronfani, Luca, Roshandel, Gholamreza, Rostami, Ali, Sachdev, Perminder S., Safari, Hosein, Safiri, Saeid, Salamati, Payman, Salimi, Yahya, Salomon, Joshua A., Samy, Abdallah M., Santos, Itamar S., Santric‐milicevic, Milena M., Sartorius, Benn, Sarvi, Shahabeddin, Satpathy, Maheswar, Sawhney, Monika, Schwebel, David C., Sepanlou, Sadaf G., Shaikh, Masood Ali, Sharif, Mehdi, Shibuya, Kenji, Shigematsu, Mika, Shiri, Rahman, Shiue, Ivy, Siabani, Soraya, Siddiqi, Tariq J., Sigfusdottir, Inga Dora, Silva, João Pedro, Singh, Jasvinder A., Filho, Adauto Martins Soares, Sobhani, Soheila, Stein, Dan J., Stein, Murray B., Sufiyan, Mu'awiyyah Babale, Sunguya, Bruno F., Tabarés‐seisdedos, Rafael, Tabb, Karen M., Tavakkoli, Mohammad, Tehrani‐banihashemi, Arash, Temsah, Mohamad Hani, Topor‐madry, Roman, Tran, Bach Xuan, Tran, Khanh Bao, Ullah, Irfan, Unutzer, Jurgen, Usman, Muhammad Shariq, Uthman, Olalekan A., Valdez, Pascual R., Yonemoto, Naohiro, Vasconcelos, Cintia, Vlassov, Vasily, Vos, Theo, Vujcic, Isidora S., Waheed, Yasir, Wang, Yuan Pang, Weiderpass, Elisabete, Werdecker, Andrea, Westerman, Ronny, Whiteford, Harvey A., Wyper, Grant M.A., Yaseri, Mehdi, Yimer, Ebrahim M., Yisma, Engida, Yoon, Seok Jun, Yotebieng, Marcel, Yousefifard, Mahmoud, Yu, Chuanhua, Zaidi, Zoubida, Zamani, Mohammad, Murray, Christopher J.L., Naghavi, Mohsen, Orpana, H, Marczak, L, Arora, M, Abbasi, N, Abdulkader, R, Abebe, Z, Abraha, H, Afarideh, M, Afshari, M, Ahmadi, A, Aichour, A, Aichour, I, Aichour, M, Akseer, N, Al‐raddadi, R, Alahdab, F, Alkerwi, A, Allebeck, P, Alvis‐guzman, N, Anber, N, Anjomshoa, M, Antonio, C, Arora, A, Aryal, K, Asgedom, S, Awasthi, A, Quintanilla, B, Badali, H, Barker‐collo, S, Bärnighausen, T, Bazargan‐hejazi, S, Benjet, C, Bensenor, I, Berfeld, N, Beuran, M, Bhutta, Z, Biadgo, B, Bililign, N, Borges, G, Borschmann, R, Brazinova, A, Breitborde, N, Brugha, T, Butt, Z, Carrero, J, Carvalho, F, Malta, D, Castañeda‐orjuela, C, Catalá‐lópez, F, Ciobanu, L, Dachew, B, Dandona, L, Dandona, R, Dargan, P, Daryani, A, Davitoiu, D, Davletov, K, Degenhardt, L, Demoz, G, Jarlais, D, Dharmaratne, S, Djalalinia, S, Doan, L, Doku, D, Dubey, M, El‐khatib, Z, Eskandarieh, S, Esteghamati, A, Esteghamati, S, Faro, A, Farzadfar, F, Fekadu, W, Fernandes, E, Ferrari, A, Filip, I, Fischer, F, Foreman, K, Fukumoto, T, Gebre, A, Grosso, G, Gupta, R, Haagsma, J, Bidgoli, H, Haj‐mirzaian, A, Hamidi, S, Hankey, G, Haro, J, Hassen, H, Hay, S, Heidari, B, Hendrie, D, Rad, E, Hosseini, S, Hostiuc, S, Irvani, S, Islam, S, Jakovljevic, M, James, S, Jayatilleke, A, Jha, R, Jonas, J, Jozwiak, J, Kadel, R, Kahsay, A, Kasaeian, A, Kassa, G, Kawakami, N, Kefale, A, Kemp, G, Khader, Y, Khafaie, M, Khalil, I, Khan, E, Khan, M, Khang, Y, Khubchandani, J, Kiadaliri, A, Kieling, C, Kim, Y, Kisa, A, Knudsen, A, Kokubo, Y, Koyanagi, A, Krish, V, Defo, B, Kumar, G, Kumar, M, Lamichhane, P, Lang, J, Latifi, A, Lee, P, Leung, J, Lim, L, Lopez, A, Lorkowski, S, Lotufo, P, Lozano, R, Lunevicius, R, Mahesh, P, Majdan, M, Majdzadeh, R, Malekzadeh, R, Manda, A, Mansournia, M, Mantovani, L, Maravilla, J, Martinez‐raga, J, Mathur, M, Maulik, P, Mcgrath, J, Mehrotra, R, Mekonen, T, Mendoza, W, Meretoja, T, Mestrovic, T, Miller, T, Mini, G, Mirrakhimov, E, Mitchell, P, Moazen, B, Mohammad, K, Mohammadi, M, Mohammed, S, Mokdad, A, Monasta, L, Moosazadeh, M, Moradi, G, Moradi‐lakeh, M, Moradinazar, M, Velásquez, I, Morisaki, N, Morrison, S, Moschos, M, Mousavi, S, Mustafa, G, Nagel, G, Naheed, A, Naik, G, Najafi, F, Negoi, I, Negoi, R, Nguyen, H, Nguyen, L, Nixon, M, Ofori‐asenso, R, Ogbo, F, Oh, I, Olagunju, A, Olagunju, T, Øverland, S, Owolabi, M, Panda‐jonas, S, Parry, C, Pati, S, Patten, S, Patton, G, Petzold, M, Phillips, M, Plana‐ripoll, O, Postma, M, Pourshams, A, Poustchi, H, Qorbani, M, Radfar, A, Rafay, A, Rafiei, A, Rahim, F, Rahimi‐movaghar, A, Rahimi‐movaghar, V, Rahman, M, Rai, R, Rezaeian, S, Roever, L, Ronfani, L, Roshandel, G, Rostami, A, Sachdev, P, Safari, H, Safiri, S, Salamati, P, Salimi, Y, Salomon, J, Samy, A, Santos, I, Santric‐milicevic, M, Sartorius, B, Sarvi, S, Satpathy, M, Sawhney, M, Schwebel, D, Sepanlou, S, Shaikh, M, Sharif, M, Shibuya, K, Shigematsu, M, Shiri, R, Shiue, I, Siabani, S, Siddiqi, T, Sigfusdottir, I, Silva, J, Singh, J, Filho, A, Sobhani, S, Stein, D, Stein, M, Sufiyan, M, Sunguya, B, Tabarés‐seisdedos, R, Tabb, K, Tavakkoli, M, Tehrani‐banihashemi, A, Temsah, M, Topor‐madry, R, Tran, B, Tran, K, Ullah, I, Unutzer, J, Usman, M, Uthman, O, Valdez, P, Vasankari, T, Vasconcelos, C, Vlassov, V, Vos, T, Vujcic, I, Waheed, Y, Wang, Y, Weiderpass, E, Werdecker, A, Westerman, R, Whiteford, H, Wyper, G, Yaseri, M, Yimer, E, Yisma, E, Yonemoto, N, Yoon, S, Yotebieng, M, Yousefifard, M, Yu, C, Zaidi, Z, Zamani, M, Murray, C, and Naghavi, M

Subjects
Suicide Prevention, Adult, Cross-Cultural Comparison, Male, Data Interpretation, Adolescent, Outcome Assessment, Age Distribution, Age Factors, Aged, Cause of Death, Data Interpretation, Statistical, Female, Global Health, Humans, Life Expectancy, Mortality, Outcome Assessment, Health Care, Sex Distribution, Sex Factors, Socioeconomic Factors, Global Burden of Disease, Suicide, Medicine (all), Research, Statistical, Health Care
Abstract

Objectives To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016. Design Systematic analysis. Main outcome measures Crude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education). Results The total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%). Conclusions Age standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates.

Published
2019

17. Catheter Ablation Versus Medical Therapy for Atrial Fibrillation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Author

Asad, Zain Ul Abideen, Yousif, Ali, Khan, Muhammad Shahzeb, Al-Khatib, Sana M., and Stavrakis, Stavros

Subjects
ATRIAL fibrillation treatment, MYOCARDIAL depressants, RESEARCH, CLINICAL trials, META-analysis, RESEARCH methodology, CATHETER ablation, EVALUATION research, MEDICAL cooperation, TREATMENT effectiveness, COMPARATIVE studies
Abstract

Background: Despite the publication of several randomized clinical trials comparing catheter ablation (CA) with medical therapy (MT) in patients with atrial fibrillation (AF), the superiority of one strategy over another is still questioned by many. In this meta-analysis of randomized controlled trials, we compared the efficacy and safety of CA with MT for AF.Methods: We systematically searched MEDLINE, EMBASE, and other online sources for randomized controlled trials of AF patients that compared CA with MT. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular hospitalizations and recurrence of atrial arrhythmia. Subgroup analyses stratified by the presence of heart failure with reduced ejection fraction, type of AF, age, and sex were performed. Risk ratios (RRs) with 95% CIs were calculated using a random effects model, and Mantel-Haenszel method was used to pool RR.Results: Eighteen randomized controlled trials comprising 4464 patients (CA, n=2286; MT, n=2178) were included. CA resulted in a significant reduction in all-cause mortality (RR, 0.69; 95% CI, 0.54-0.88; P=0.003) that was driven by patients with AF and heart failure with reduced ejection fraction (RR, 0.52; 95% CI, 0.35-0.76; P=0.0009). CA resulted in significantly fewer cardiovascular hospitalizations (hazard ratio, 0.56; 95% CI, 0.39-0.81; P=0.002) and fewer recurrences of atrial arrhythmias (RR, 0.42; 95% CI, 0.33-0.53; P<0.00001). Subgroup analyses suggested that younger patients (age, <65 years) and men derived more benefit from CA compared with MT.Conclusions: CA is associated with all-cause mortality benefit, that is driven by patients with AF and heart failure with reduced ejection fraction. CA reduces cardiovascular hospitalizations and recurrences of atrial arrhythmia for patients with AF. Younger patients and men appear to derive more benefit from CA. [ABSTRACT FROM AUTHOR]

Published
2019
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18. Mapping 123 million neonatal, infant and child deaths between 2000 and 2017

Author

Burstein, Roy, Henry, Nathaniel J, Collison, Michael L, Marczak, Laurie B, Sligar, Amber, Watson, Stefanie, Marquez, Neal, Abbasalizad-Farhangi, Mahdieh, Abbasi, Masoumeh, Abd-Allah, Foad, Abdoli, Amir, Abdollahi, Mohammad, Abdollahpour, Ibrahim, Abdulkader, Rizwan Suliankatchi, Abrigo, Michael RM, Acharya, Dilaram, Adebayo, Oladimeji M, Adekanmbi, Victor, Adham, Davoud, Afshari, Mahdi, Aghaali, Mohammad, Ahmadi, Keivan, Ahmadi, Mehdi, Ahmadpour, Ehsan, Ahmed, Rushdia, Akal, Chalachew Genet, Akinyemi, Joshua O, Alahdab, Fares, Alam, Noore, Alamene, Genet Melak, Alene, Kefyalew Addis, Alijanzadeh, Mehran, Alinia, Cyrus, Alipour, Vahid, Aljunid, Syed Mohamed, Almalki, Mohammed J, Al-Mekhlafi, Hesham M, Altirkawi, Khalid, Alvis-Guzman, Nelson, Amegah, Adeladza Kofi, Amini, Saeed, Amit, Arianna Maever Loreche, Anbari, Zohreh, Androudi, Sofia, Anjomshoa, Mina, Ansari, Fereshteh, Antonio, Carl Abelardo T, Arabloo, Jalal, Arefi, Zohreh, Aremu, Olatunde, Armoon, Bahram, Arora, Amit, Artaman, Al, Asadi, Anvar, Asadi-Aliabadi, Mehran, Ashraf-Ganjouei, Amir, Assadi, Reza, Ataeinia, Bahar, Atre, Sachin R, Quintanilla, Beatriz Paulina Ayala, Ayanore, Martin Amogre, Azari, Samad, Babaee, Ebrahim, Babazadeh, Arefeh, Badawi, Alaa, Bagheri, Soghra, Bagherzadeh, Mojtaba, Baheiraei, Nafiseh, Balouchi, Abbas, Barac, Aleksandra, Bassat, Quique, Baune, Bernhard T, Bayati, Mohsen, Bedi, Neeraj, Beghi, Ettore, Behzadifar, Masoud, Behzadifar, Meysam, Belay, Yared Belete, Bell, Brent, Bell, Michelle L, Berbada, Dessalegn Ajema, Bernstein, Robert S, Bhattacharjee, Natalia V, Bhattarai, Suraj, Bhutta, Zulfiqar A, Bijani, Ali, Bohlouli, Somayeh, Breitborde, Nicholas JK, Britton, Gabrielle, Browne, Annie J, Nagaraja, Sharath Burugina, Busse, Reinhard, Butt, Zahid A, Car, Josip, Cárdenas, Rosario, Castañeda-Orjuela, Carlos A, Cerin, Ester, Chanie, Wagaye Fentahun, Chatterjee, Pranab, Chu, Dinh-Toi, Cooper, Cyrus, Costa, Vera M, Dalal, Koustuv, Dandona, Lalit, Dandona, Rakhi, Daoud, Farah, Daryani, Ahmad, Das Gupta, Rajat, Davis, Ian, Davis Weaver, Nicole, Davitoiu, Dragos Virgil, De Neve, Jan-Walter, Demeke, Feleke Mekonnen, Demoz, Gebre Teklemariam, Deribe, Kebede, Desai, Rupak, Deshpande, Aniruddha, Desyibelew, Hanna Demelash, Dey, Sagnik, Dharmaratne, Samath Dhamminda, Dhimal, Meghnath, Diaz, Daniel, Doshmangir, Leila, Duraes, Andre R, Dwyer-Lindgren, Laura, Earl, Lucas, Ebrahimi, Roya, Ebrahimpour, Soheil, Effiong, Andem, Eftekhari, Aziz, Ehsani-Chimeh, Elham, El Sayed, Iman, El Sayed Zaki, Maysaa, El Tantawi, Maha, El-Khatib, Ziad, Emamian, Mohammad Hassan, Enany, Shymaa, Eskandarieh, Sharareh, Eyawo, Oghenowede, Ezalarab, Maha, Faramarzi, Mahbobeh, Fareed, Mohammad, Faridnia, Roghiyeh, Faro, Andre, Fazaeli, Ali Akbar, Fazlzadeh, Mehdi, Fentahun, Netsanet, Fereshtehnejad, Seyed-Mohammad, Fernandes, João C, Filip, Irina, Fischer, Florian, Foigt, Nataliya A, Foroutan, Masoud, Francis, Joel Msafiri, Fukumoto, Takeshi, Fullman, Nancy, Gallus, Silvano, Gebre, Destallem Gebremedhin, Gebrehiwot, Tsegaye Tewelde, Gebremeskel, Gebreamlak Gebremedhn, Gessner, Bradford D, Geta, Birhanu, Gething, Peter W, Ghadimi, Reza, Ghadiri, Keyghobad, Ghajarzadeh, Mahsa, Ghashghaee, Ahmad, Gill, Paramjit Singh, Gill, Tiffany K, Golding, Nick, Gomes, Nelson GM, Gona, Philimon N, Gopalani, Sameer Vali, Gorini, Giuseppe, Goulart, Bárbara Niegia Garcia, Graetz, Nicholas, Greaves, Felix, Green, Manfred S, Guo, Yuming, Haj-Mirzaian, Arvin, Haj-Mirzaian, Arya, Hall, Brian James, Hamidi, Samer, Haririan, Hamidreza, Haro, Josep Maria, Hasankhani, Milad, Hasanpoor, Edris, Hasanzadeh, Amir, Hassankhani, Hadi, Hassen, Hamid Yimam, Hegazy, Mohamed I, Hendrie, Delia, Heydarpour, Fatemeh, Hird, Thomas R, Hoang, Chi Linh, Hollerich, Gillian, Rad, Enayatollah Homaie, Hoseini-Ghahfarokhi, Mojtaba, Hossain, Naznin, Hosseini, Mostafa, Hosseinzadeh, Mehdi, Hostiuc, Mihaela, Hostiuc, Sorin, Househ, Mowafa, Hsairi, Mohamed, Ilesanmi, Olayinka Stephen, Imani-Nasab, Mohammad Hasan, Iqbal, 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Konstantinovitch, Vlassov, Vasily, Vos, Theo, Vu, Giang Thu, Vujcic, Isidora S, Waheed, Yasir, Wakefield, Jon, Wang, Haidong, Wang, Yafeng, Wang, Yuan-Pang, Ward, Joseph L, Weintraub, Robert G, Weldegwergs, Kidu Gidey, Weldesamuel, Girmay Teklay, Westerman, Ronny, Wiysonge, Charles Shey, Wondafrash, Dawit Zewdu, Woyczynski, Lauren, Wu, Ai-Min, Xu, Gelin, Yadegar, Abbas, Yamada, Tomohide, Yazdi-Feyzabadi, Vahid, Yilgwan, Christopher Sabo, Yip, Paul, Yonemoto, Naohiro, Lebni, Javad Yoosefi, Younis, Mustafa Z, Yousefifard, Mahmoud, Yousof, Hebat-Allah Salah A, Yu, Chuanhua, Yusefzadeh, Hasan, Zabeh, Erfan, Moghadam, Telma Zahirian, Bin Zaman, Sojib, Zamani, Mohammad, Zandian, Hamed, Zangeneh, Alireza, Zerfu, Taddese Alemu, Zhang, Yunquan, Ziapour, Arash, Zodpey, Sanjay, Murray, Christopher JL, and Hay, Simon I

Subjects
Geography, United Nations, 1. No poverty, Infant, Newborn, Infant, Global Health, 3. Good health, Socioeconomic Factors, Child Mortality, Infant Mortality, Humans, Organizational Objectives, Public Health, 10. No inequality, Child
Abstract

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

19. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

Author

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Subjects
Male, Health Status, health statu, HALE, mortality rate, communicable disease, DALYs, Global Burden of Disease, Risk Factors, Prevalence, Medicine and Health Sciences, Singapore, OUTCOMES, disability-adjusted life year, international cooperation, Medicine (all), 11 Medical And Health Sciences, Central African Republic, newborn disease, IRON-DEFICIENCY, AIDS, priority journal, Bahrain, disease severity, Female, Quality-Adjusted Life Years, cerebrovascular accident, Ukraine, Life Sciences & Biomedicine, INTERVENTIONS, Slovakia, DISORDERS, Burundi, WEIGHTS, GBD 2017 DALYs and HALE Collaborators, Communicable Diseases, Article, STYLE, Medicine, General & Internal, Life Expectancy, General & Internal Medicine, Humans, Disabled Persons, human, Healthy Lifestyle, HALE, DALYs, global burden of disease, Mortality, Aged, Science & Technology, Mortality, Premature, HIV, ischemic heart disease, major clinical study, PREVENTION, non communicable disease, GBD, disability-adjusted life-years, age, sex factor, Socioeconomic Factors, Algeria, Federation of Bosnia and Herzegovina, lower respiratory tract infection, Wounds and Injuries, GENDER, Human medicine, trend study, chronic obstructive lung disease
Abstract

Background How long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years. Methods We used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Sociodemographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males. Findings Globally, from 1990 to 2017, life expectancy at birth increased by 7.4 years (95% uncertainty interval 74-7.8), from 65.6 years (65.3-65- 8) in 1990 to 73.0 years (72.7-73.3) in 2017. The increase in years of life varied from 5.1 years (5.0-5.3) in high SDI countries to 12.0 years (11.3-12.8) in low SDI countries. Of the additional years of life expected at birth, 26.3% (20.1-33.1) were expected to be spent in poor health in high SDI countries compared with 11.7% (8.8-15.1) in low-middle SDI countries. HALE at birth increased by 6.3 years (5.9-6.7), from 57.0 years (54.6-59.1) in 1990 to 63.3 years (60.5-65.7) in 2017. The increase varied from 3.8 years (3.4-4.1) in high SDI countries to 10.5 years (9.8-11.2) in low SDI countries. Even larger variations in HALE than these were observed between countries, ranging from 1.0 year (0.4-1.7) in Saint Vincent and the Grenadines (62.4 years [59.9-64.7] in 1990 to 63.5 years [60.9-65.8] in 2017) to 23.7 years (21.9-25.6) in Eritrea (30.7 years [28.9-32.2] in 1990 to 54.4 years [51.5-57.1] in 2017). In most countries, the increase in HALE was smaller than the increase in overall life expectancy, indicating more years lived in poor health. In 180 of 195 countries and territories, females were expected to live longer than males in 2017, with extra years lived varying from 1.4 years (0.6-2.3) in Algeria to 11.9 years (10.9-12.9) in Ukraine. Of the extra years gained, the proportion spent in poor health varied largely across countries, with less than 20% of additional years spent in poor health in Bosnia and Herzegovina, Burundi, and Slovakia, whereas in Bahrain all the extra years were spent in poor health. In 2017, the highest estimate of HALE at birth was in Singapore for both females (75.8 years [72.4-78.7]) and males (72.6 years [69 " 8-75.0]) and the lowest estimates were in Central African Republic (47.0 years [43.7-50.2] for females and 42.8 years [40.1-45.6] for males). Globally, in 2017, the five leading causes of DALYs were neonatal disorders, ischaemic heart disease, stroke, lower respiratory infections, and chronic obstructive pulmonary disease. Between 1990 and 2017, age-standardised DALY rates decreased by 41.3% (38.8-43.5) for communicable diseases and by 49"8% (47.9-51.6) for neonatal disorders. For non-communicable diseases, global DALYs increased by 40.1% (36.8-43.0), although age-standardised DALY rates decreased by 18.1% (16.0-20.2). Interpretation With increasing life expectancy in most countries, the question of whether the additional years of life gained are spent in good health or poor health has been increasingly relevant because of the potential policy implications, such as health-care provisions and extending retirement ages. In some locations, a large proportion of those additional years are spent in poor health. Large inequalities in HALE and disease burden exist across countries in different SDI quintiles and between sexes. The burden of disabling conditions has serious implications for health system planning and health-related expenditures. Despite the progress made in reducing the burden of communicable diseases and neonatal disorders in low S DI countries, the speed of this progress could be increased by scaling up proven interventions. The global trends among non-communicable diseases indicate that more effort is needed to maximise HALE, such as risk prevention and attention to upstream determinants of health. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd.

Published
2018

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