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Epidemiology of Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Lampros Papadimitriou, Prabhjot Grewal, Andreas P. Kalogeropoulos
As a disease of older adults, HF is rarely an isolated finding. Over 80% of patients have ≥2 concomitant chronic conditions.9,39,40 The most common comorbidities are hypertension, ischemic heart disease, diabetes mellitus, cerebral and peripheral vascular disease, atrial fibrillation, chronic kidney disease, chronic obstructive lung disease, anemia, and depression. As the average age at HF diagnosis increases over time,9 the number of comorbidities and use of medications in patients with HF increases as well.8,9 In the United Kingdom, the number of comorbidities in patients with HF increased from 3.4±1.9 in 2002 to 5.4±2.5 in 2014 and the percent of patients with ≥3 additional conditions increased from 68% to 87%.9 Overall, there has been a shift from a model where HF was mainly a consequence of coronary artery disease with male predominance toward a disease of older adults equally affecting both sexes and accompanied by a complex medical profile.
Management of Hyperparathyroidism
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
A number of large population-based cohort studies have demonstrated that patients with PHPT appear to be at risk of premature death, predominantly due to cardiovascular disease. A matched cohort study, using hospital episode statistics and mortality data, demonstrated that patients with mild PHPT had significantly worse cardiovascular outcomes, in terms of mortality and nonfatal events. The risk of other comorbidities was also increased. The adverse outcomes were subsequently shown to be linked to high baseline PTH concentration but not baseline calcium.
Measurement Bias, Multiple Indicator Multiple Cause Modeling and Multiple Group Modeling
Published in Douglas D. Gunzler, Adam T. Perzynski, Adam C. Carle, Structural Equation Modeling for Health and Medicine, 2021
Douglas D. Gunzler, Adam T. Perzynski, Adam C. Carle
In Figure 10.2, two observed continuous covariates (age, number of comorbidities) are shown that influence depression in an example of a MIMIC model. We hypothesize the factor mean for depression is different according to the level of age and medical comorbidities. Also, an increased number of comorbidities is hypothesized to lead to an increased level of psychomotor symptoms of depression. Thus, we hypothesize measurement bias in the PHQ-9 in this study population. Individuals with an identical underlying level of depression may have differences in the level of the item for psychomotor symptoms according to the level of the number of comorbidities. We note this is a simplified example to illustrate MIMIC model analysis and that the number of comorbidities can be hypothesized to have an effect on additional items (e.g. anhedonia, sleep, fatigue, appetite and concentration).
Nonalcoholic steatohepatitis diagnosis and treatment from the perspective of patients and primary care physicians: a cross-sectional survey
Published in Annals of Medicine, 2023
Karl Nadolsky, Donna R. Cryer, Amy Articolo, Travis Fisher, Jennifer Schneider, Mary Rinella
The objective of NASH treatment is to delay, halt, or reverse progression of liver disease. However, there are currently no Food and Drug Administration (FDA) approved pharmacological treatments for NASH. Consequently, treatment focuses on managing related comorbidities. Lifestyle therapy is recommended and changes resulting in weight loss can be very effective, with higher degrees of weight loss being associated with greater improvement in NASH and fibrosis [11]. Among patients with NASH who lost ≥10% body weight, 90% had resolution of NASH and 45% had regression of fibrosis, though the majority of patients in that study did not have advanced fibrosis [11]. However, clinical trials set in tertiary centers, community-based interventions and internet-based interventions show that most patients struggle to attain the goal of ≥10% body weight loss and may require additional support [12,13].
Suspected suicides and suicide attempts involving antipsychotic or sedative-hypnotic medications reported to America’s Poison Centers, 2000–2021
Published in Clinical Toxicology, 2023
Larissa Ybanez, Henry A. Spiller, Jaahnavi Badeti, Marcel J. Casavant, Natalie Rine, Nichole L. Michaels, Motao Zhu, Gary A. Smith
Individuals >49 years old were more likely to experience a serious medical outcome or be admitted to a critical care unit or non-critical care unit than younger individuals in this study. The increased prevalence of comorbidities among older individuals may account for some of this increased severity. In addition, the proportion of multiple-substance exposures increased with increasing age group in this study, and multiple-substance exposures were associated with higher proportions of admission to a critical care unit or non-critical care unit and serious medical outcomes (including death) in comparison with single-substance exposures. The increased severity of multiple-substance exposures has been previously reported and may be attributable, in part, to drug-drug interactions [3]. The difference in suicidal intent may be another factor associated with increased severity among older individuals. Increased self-reported suicidal intent following intentional self-poisoning is associated with older age [20,21], with one study showing 64% of older adults admitting suicidal intent compared with 51.3% among adolescents and 40.3% among younger adults [22]. Admitted suicidal intent is associated with higher lethality [22,23]. Another study demonstrated that the mean age of individuals associated with lethal suicide attempts involving psychotropic medications (48.1 years old) was higher than that of individuals associated with nonlethal suicide attempts (35.1 years old) [6].
Respiratory comorbidities in severe asthma: focus on the pediatric age
Published in Expert Review of Respiratory Medicine, 2023
Amelia Licari, Beatrice Andrenacci, Maria Elisa Di Cicco, Maddalena Leone, Gian Luigi Marseglia, Mariangela Tosca
Comorbidities are ‘one or more diseases or disorders occurring concurrently with a primary disease or disorder’ [12]. They are frequent in asthma at all ages, especially in the case of severe asthma. Both pediatric and adult subjects with difficult-to-treat asthma often suffer from concomitant multi-comorbidities, which worsen asthma control and quality of life (QoL), increasing the risk of asthma attacks, hospital admissions, and emergency department visits [13–17]. Since some comorbidities may present with asthma-mimicking symptoms, this could lead to misdiagnosis and subsequent side effects of unnecessary therapies (such as growth issues, osteoporosis, or adrenal suppression in the case of chronic oral steroids or high-dose ICS over-use [12,13,18]. At the same time, the physician’s and pediatrician’s potential unfamiliarity with some less frequent comorbidities – still deeply under-diagnosed – could hinder the access to appropriate add-on therapies, thus preventing optimal asthma control. A recent, cross-sectional, adult-limited study proved that comorbidities might affect more than 60% of asthmatic adults: significantly, about 15% of them may have up to 4 comorbidities simultaneously [19]. Regarding the pediatric population, a newly published, monocentric, cross-sectional Italian study detected comorbidities in up to 87% of the 508 asthmatic children (aged 5 to 17 years). Mainly, respiratory comorbidities alone affected 37% of them, whereas joined respiratory and non-respiratory comorbidities were found in another 40% [16].