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Hearing loss and cognitive decline among older adults with atrial fibrillation:the SAGE-AF study

Journal of Geriatric Cardiology 2020年第4期17卷 177-183页

作者： Wei-Jia WANG Darleen Lessard hawa abu David D.McManus Tanya Mailhot Jerry H.Gurwitz Robert J.Goldberg Jane Saczynski Division of Cardiovascular Medicine Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterMAUSA Department of Population and Quantitative Health Sciences University of Massachusetts Medical SchoolWorcesterMAUSA Department of Pharmacy and Health System Sciences Northeastern UniversityBostonMAUSA Meyers Primary Care Institute University of Massachusetts Medical SchoolWorcesterMAUSA

Objective To examine the association between hearing loss and cognitive function cross-sectionally and prospectively among older adults with atrial fibrillation(AF).Methods Patients with AF≥65-year-old(n=1244)in the SAGE(Systematic Assessment of Geriatric Elements)-AF study were recruited from five internal medicine or cardiology clinics in Massachusetts and *** was assessed by a structured questionnaire at *** function was assessed by Montreal Cognitive Assessment(MoCA)at baseline and one *** impairment was defined as score≤23 on the *** associations between hearing loss and cognitive function were examined by multivariable adjusted logistic *** Participants with hearing loss(n=451,36%)were older,more likely to be male,and have depressive symptoms than patients without hearing *** baseline,528(42%)participants were cognitively *** with hearing loss were significantly more likely to have cognitive impairment at baseline[adjusted odds ratio(OR)=1.37,95%confidence interval(CI):1.05–1.81].Among the 662 participants who did not have cognitive impairment at baseline and attended the one-year follow-up visit,106(16%)developed incident cognitive *** with,versus those without,hearing loss were significantly more likely to develop incident cognitive impairment at one year(adjusted OR=1.68,95%CI:1.07–2.64).Conclusions Hearing loss is a prevalent but under-recognized factor associated with cognitive impairment in patients with *** for hearing loss may be indicated among these patients to identify individuals at high-risk for adverse outcomes.

关键词： Atrial fibrillation Cognitive function Hearing

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Self-reported risk of stroke and factors associated with underestimation of stroke risk among older adults with atrial fibrillation: the SAGE-AF study

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Journal of Geriatric Cardiology 2020年第8期17卷 502-509页

作者： Jordy Mehawej Jane Saczynski Jerry H.Gurwitz hawa O.abu Benita A.Bamgbade Wei-Jia WANG Tenes Paul Katherine Trymbulak Connor Saleeba Zi-Yue WANG Catarina I.Kiefe Robert J.Goldberg David D.Mc Manus Division of Cardiovascular Medicine Department of MedicineUniversity of Massachusetts Medical SchoolWorcesterMAUSA Department of Pharmacy and Health Systems Sciences School of PharmacyNortheastern UniversityBostonMAUSA Department of Population and Quantitative Health Sciences University of Massachusetts Medical SchoolWorcesterMAUSA Division of Geriatric Medicine and Meyers Primary Care Institute University of Massachusetts Medical SchoolWorcesterMAUSA

Background Though engaging patients with atrial fibrillation(AF) in understanding their stroke risk is encouraged by guidelines, little is known regarding AF patients' perceived stroke risk or its relationship with oral anticoagulation(OAC) use. We aim to identify factors associated with underestimation of stroke risk among older patients with AF and relate this to OAC use. Methods Data are from the ongoing SAGE(Systematic Assessment of Geriatric Elements)-AF study, which included older patients(> 65 years) with non-valvular AF and a CHA2 DS2-VASc score of ≥ 2. Participants reported their perceived risk of having a stroke without OAC. We compared the perceived risk to CHA2 DS2-VASc predicted stroke risk and classified participants as "over" or "under" estimators, and identified factors associated with underestimation of risk using multiple logistic regression. Results The average CHA2 DS2-VASc score of 915 participants(average age: 75 years, 47% female, 86% white) was 4.3 ± 1.6, 43% of participants had discordant predicted and self-reported stroke risks. Among the 376 participants at highest risk(CHA2 DS2-VASc score ≥ 5), 46% of participants underestimated their risk. Older participants(≥ 85 years) were more likely and OAC treated patients less likely to underestimate their risk of developing a future stroke than respective comparison groups. Conclusions A significant proportion of study participants misperceived their stroke risk, mostly by overestimating. Almost half of participants at high risk of stroke underestimated their risk, with older patients more likely to do so. Patients on OAC were less likely to underestimate their risk, suggesting that successful efforts to educate patients about their stroke risk may influence treatment choices.

关键词： Anticoagulation Atrial fibrillation Stroke

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内镜下胰管支架置入术用于缓解胰腺癌患者的疼痛:系统综述与meta分析

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Gastroenterology Report 2021年第2期9卷 105-114,I0001页

作者： Pradeep K.Siddappa Fadi hawa Larry J.Prokop MHassan Murad Barham K.abu Dayyeh Vinay Chandrasekhara Mark D.Topazian Fateh Bazerbachi Division of Gastroenterology and Hepatology Stanford University School of MedicineStanfordCAUSA Department of Internal Medicine St.Joseph Mercy Ann Arbor HospitalYpsilantiMIUSA Library Public Services Mayo ClinicRochesterMNUSA Robert D and Patricia E Kern Center for the Science of Health Care Delivery Mayo ClinicRochesterMNUSA Division of Gastroenterology and Hepatology Mayo ClinicRochesterMNUSA Division of Gastroenterology Massachusetts General Hospital and Harvard Medical SchoolBostonMAUSA

背景:腹痛是一种致人衰弱的症状,大约80%的胰腺癌患者都会出现腹痛。胰管减压虽然未被广泛采纳,但有报道该方法能缓解腹痛症状。本研究旨在评估内镜下胰管减压对于缓解胰腺癌患者餐后梗阻型腹痛的作用、效果及安全性。方法:该系统综述... 详细信息

背景:腹痛是一种致人衰弱的症状,大约80%的胰腺癌患者都会出现腹痛。胰管减压虽然未被广泛采纳,但有报道该方法能缓解腹痛症状。本研究旨在评估内镜下胰管减压对于缓解胰腺癌患者餐后梗阻型腹痛的作用、效果及安全性。方法:该系统综述的文献检索时间截至2020年10月7日。由两位研究者独立地筛选文献、提取数据,并对文献质量进行评估。结果:12篇文献共计192例有腹痛症状且尝试胰管减压的胰腺癌患者纳入研究。其中,167例患者成功完成胰管减压(平均年龄62.5岁,58.7%为男性)。159(95.2%)例患者采用塑料支架。所有被纳入的研究均报道了胰管支架置入术后患者疼痛部分或完全缓解,缓解率为93%(95%CI:79%-100%)。平均的疼痛缓解期为94˘16天。内镜逆行性胰胆管造影(ERCP)相关的不良反应包括括约肌切开术后出血(1.8%)、ERCP后胰腺炎(0.6%)和胰管出血(0.6%)。2例行内镜超声引导的胰管减压患者未报道任何不良反应。在成功置入支架的167例患者中,支架移位和支架阻塞的发生率分别为3.6%和3.0%。未报道不良反应相关的死亡病例。文献质量评估提示,绝大部分文献质量较低或难以评价。结论:初步分析结果表明,对于部分经选择的胰腺癌病例,内镜下胰管引流可能是缓解梗阻型疼痛一种安全有效的方法。但该侵入性方法的作用尚需随机对照研究来进一步明确。

关键词： cancer-associated pain Endoscopic retrograde cholangiopancreatography palliative therapy pancreas cancer systematic review meta-analysis

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