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Alcohol Abuse and Cardiac Disease
The Journal of Emergency Medicine, Vol. 52, No. 4, pp. 595–600, 2017 0736-4679/$ - see front matter
Abstracts , ALCOHOL ABUSE AND CARDIAC DISEASE. Whitman IR, Agarwal V, Nah G, et al. JACC. 2017;69:13-24 Alcohol abuse is a prevalent issue in the United States and may be amenable to change. Conversely, although not modifiable, cardiovascular disease is the greatest cause of mortality in the world. The relationship between alcohol abuse and cardiovascular disease is not well elucidated but may provide insight into preventing cardiovascular disease. The objective of this study was to investigate the relationship between clinical alcohol abuse and incident atrial fibrillation (AF), myocardial infarction (MI) and congestive heart failure (CHF) overall and in populations with cardiovascular disease risk factors. California residents 21 years of age or older treated in California emergency departments, ambulatory surgery units or inpatient units between January 2005 and December 2009 per the Healthcare Cost and Utilization Project database without a prior diagnosis of AF, MI or CHF were enrolled in the study. Patient demographic data was collected to determine its impact on the risks and to evaluate population-attributable risk. Ultimately, 14,727,591 patients were included in the study and, of those, 268,084 (1.8%) were diagnosed with alcohol abuse. There were 358,887 incident AF events (2.5%). Alcohol abuse was associated with a higher risk of incident AF (hazard ratio [HR] 1.93; 95% confidence interval [CI] 1.99-1.98). Following adjustment for patient demographics and comorbid conditions, alcohol abuse still predicted a more than doubled risk of AF (HR 2.14; 95% CI 2.08-2.19). A total of 157,254 patients had MI (1.1%). The risk of incident MI was higher in those with alcohol abuse before (HR 2.03; CI 1.95-2.11) and after (HR 1.45; CI 1.40-1.51) adjustment for demographics and comorbid conditions. Lastly, there were 411,983 incident CHF events (2.9%). Alcohol abuse predicted a higher risk of incident CHF (2.23; CI 2.19-2.28) and was unchanged after adjustment. For all three conditions, patients without risk factors for cardiovascular disease were at a particularly increased risk in the setting of alcohol abuse. The authors concluded that alcohol abuse imposes a higher risk of AF, MI and CHF comparable to known risk factors and that the absence of risk factors predicts a disproportionately increased risk in alcohol abusers. [Brittany Catanach, MD Denver Health Medical Center, Denver, CO]
ease. Additional investigations into the relationship between a quantified amount of alcohol intake and cardiac conditions while controlling for cardiovascular risk factors would be beneficial. , ABNORMALITIES IN FIBRINOLYSIS AT THE TIME OF ADMISSION ARE ASSOCIATED WITH DEEP VEIN THROMBOSIS, MORTALITY AND DISABILITY IN PEDIATRIC TRAUMA POPULATION. Leeper CM, Neal MD, McKenna C, et al. J Trauma Acute Care Surg. 2017;82:27-34 It has been shown that derangements in fibrinolysis are related to mortality in adult trauma patients. While thromboelastography (TEG) has been shown to be a useful diagnostic tool to evaluate clotting kinetics in adult trauma patients, little is known about how abnormalities in fibrinolysis, specifically hyperfibrinolysis (HF) and fibrinolysis shutdown (SD), impact morbidity and mortality in pediatric trauma patients. The goal of this observational study was to define SD, evaluate the range of fibrinolysis in pediatric trauma patients and to investigate the relationship between abnormalities in fibrinolysis and poor outcomes. The prospective cohort included Level I activation patients between the ages of zero to eighteen years old receiving care at one academic pediatric trauma center from June 2015 to July 2016. Patients who were enrolled had a TEG completed in the first 2 hours of admission. The primary outcomes for the study were mortality, disability, packed red blood cell (PRBC) transfusion during the first 24-hours and incidence of deep vein thrombosis (DVT). Additional factors evaluated for comparison included patient demographics, specific injuries, vital signs and laboratory studies. One hundred thirty three patients were enrolled in the study. There was a male predominance and median age of 10 years old. Blunt trauma accounted for 68.4% of injuries, followed by penetrating trauma (18.4%), non-accidental head trauma (7.9%) and hanging/drowning (5.3%). Based on survivability and good functional outcome, SD was determined to be lysis 30 minutes after maximum amplitude (LY30) of 0.8% or less and HF was LY30 of 3.0% or higher. HF was shown in 19.6% and SD in 38.4%. The reference range was 42.1%. Mortality was 9% overall with higher mortality in HF patients (11.5%, p=0.021) and SD patients (15.7%, p=0.014) with a reference range of 1.8%. The SD patients had a higher level of functional disability (40.5%, p<0.001) and DVT. Both HF and SD groups required blood transfusions (HF p<0.001, SD p=0.014) and were associated with elevated INR greater than 1.3 (SD p=0.001, HF p=0.036). The authors concluded that derangements in fibrinolysis, which are prevalent in pediatric patient following injury, are
Comment: This study contributes important evidence regarding an association between two significant problems in the healthcare system—alcohol abuse and cardiovascular dis595
Abstracts , ALCOHOL ABUSE AND CARDIAC DISEASE. Whitman IR, Agarwal V, Nah G, et al. JACC. 2017;69:13-24 Alcohol abuse is a prevalent issue in the United States and may be amenable to change. Conversely, although not modifiable, cardiovascular disease is the greatest cause of mortality in the world. The relationship between alcohol abuse and cardiovascular disease is not well elucidated but may provide insight into preventing cardiovascular disease. The objective of this study was to investigate the relationship between clinical alcohol abuse and incident atrial fibrillation (AF), myocardial infarction (MI) and congestive heart failure (CHF) overall and in populations with cardiovascular disease risk factors. California residents 21 years of age or older treated in California emergency departments, ambulatory surgery units or inpatient units between January 2005 and December 2009 per the Healthcare Cost and Utilization Project database without a prior diagnosis of AF, MI or CHF were enrolled in the study. Patient demographic data was collected to determine its impact on the risks and to evaluate population-attributable risk. Ultimately, 14,727,591 patients were included in the study and, of those, 268,084 (1.8%) were diagnosed with alcohol abuse. There were 358,887 incident AF events (2.5%). Alcohol abuse was associated with a higher risk of incident AF (hazard ratio [HR] 1.93; 95% confidence interval [CI] 1.99-1.98). Following adjustment for patient demographics and comorbid conditions, alcohol abuse still predicted a more than doubled risk of AF (HR 2.14; 95% CI 2.08-2.19). A total of 157,254 patients had MI (1.1%). The risk of incident MI was higher in those with alcohol abuse before (HR 2.03; CI 1.95-2.11) and after (HR 1.45; CI 1.40-1.51) adjustment for demographics and comorbid conditions. Lastly, there were 411,983 incident CHF events (2.9%). Alcohol abuse predicted a higher risk of incident CHF (2.23; CI 2.19-2.28) and was unchanged after adjustment. For all three conditions, patients without risk factors for cardiovascular disease were at a particularly increased risk in the setting of alcohol abuse. The authors concluded that alcohol abuse imposes a higher risk of AF, MI and CHF comparable to known risk factors and that the absence of risk factors predicts a disproportionately increased risk in alcohol abusers. [Brittany Catanach, MD Denver Health Medical Center, Denver, CO]
ease. Additional investigations into the relationship between a quantified amount of alcohol intake and cardiac conditions while controlling for cardiovascular risk factors would be beneficial. , ABNORMALITIES IN FIBRINOLYSIS AT THE TIME OF ADMISSION ARE ASSOCIATED WITH DEEP VEIN THROMBOSIS, MORTALITY AND DISABILITY IN PEDIATRIC TRAUMA POPULATION. Leeper CM, Neal MD, McKenna C, et al. J Trauma Acute Care Surg. 2017;82:27-34 It has been shown that derangements in fibrinolysis are related to mortality in adult trauma patients. While thromboelastography (TEG) has been shown to be a useful diagnostic tool to evaluate clotting kinetics in adult trauma patients, little is known about how abnormalities in fibrinolysis, specifically hyperfibrinolysis (HF) and fibrinolysis shutdown (SD), impact morbidity and mortality in pediatric trauma patients. The goal of this observational study was to define SD, evaluate the range of fibrinolysis in pediatric trauma patients and to investigate the relationship between abnormalities in fibrinolysis and poor outcomes. The prospective cohort included Level I activation patients between the ages of zero to eighteen years old receiving care at one academic pediatric trauma center from June 2015 to July 2016. Patients who were enrolled had a TEG completed in the first 2 hours of admission. The primary outcomes for the study were mortality, disability, packed red blood cell (PRBC) transfusion during the first 24-hours and incidence of deep vein thrombosis (DVT). Additional factors evaluated for comparison included patient demographics, specific injuries, vital signs and laboratory studies. One hundred thirty three patients were enrolled in the study. There was a male predominance and median age of 10 years old. Blunt trauma accounted for 68.4% of injuries, followed by penetrating trauma (18.4%), non-accidental head trauma (7.9%) and hanging/drowning (5.3%). Based on survivability and good functional outcome, SD was determined to be lysis 30 minutes after maximum amplitude (LY30) of 0.8% or less and HF was LY30 of 3.0% or higher. HF was shown in 19.6% and SD in 38.4%. The reference range was 42.1%. Mortality was 9% overall with higher mortality in HF patients (11.5%, p=0.021) and SD patients (15.7%, p=0.014) with a reference range of 1.8%. The SD patients had a higher level of functional disability (40.5%, p<0.001) and DVT. Both HF and SD groups required blood transfusions (HF p<0.001, SD p=0.014) and were associated with elevated INR greater than 1.3 (SD p=0.001, HF p=0.036). The authors concluded that derangements in fibrinolysis, which are prevalent in pediatric patient following injury, are
Comment: This study contributes important evidence regarding an association between two significant problems in the healthcare system—alcohol abuse and cardiovascular dis595