Durvalumab-associated Late-onset Myocarditis Successfully Treated with Corticosteroid Therapy.

We herein report a 66-year-old man with locally advanced non-small-cell lung cancer (NSCLC) who developed durvalumab-associated myocarditis. The patient underwent durvalumab administration every two weeks following concurrent chemoradiotherapy, without any adverse events or apparent disease progression. He presented with fatigue and dyspnea on exertion seven months after the first administration. Myocarditis was suspected based on laboratory data, an electrocardiogram, echocardiography, and magnetic resonance imaging findings. The definitive diagnosis was confirmed by a myocardial biopsy. Myocarditis was alleviated by cessation of durvalumab and corticosteroid therapy. This is a noteworthy case to describe late-onset myocarditis following the administration of durvalumab for NSCLC.

Clinical Significance of Atrial Fibrillation Status in Patients With Percutaneous Coronary Intervention.

BACKGROUND: Patients undergoing percutaneous coronary intervention (PCI) often develop atrial fibrillation (AF). We investigated the clinical effects of AF status on in-hospital mortality and complications in patients with PCI using a recent large-scale nationwide dataset. METHODS: Using a claims-based dataset from 1022 hospitals in Japan for the time period between 2012 and 2016, patients with PCI were identified and classified into 3 groups according to AF status: no AF, prevalent AF before admission, and incident AF after admission. In-hospital mortality, complications, and medical costs were compared in crude and propensity-matched cohorts. RESULTS: In 659,525 hospitalized patients undergoing PCI, prevalent AF and incident AF were observed in 6.0% and 1.3% patients, respectively; the AF rates increased over 5 years. A greater proportion of older patients and patients with comorbidities had both of these categories of AF; undergoing PCI for acute coronary syndrome was common in incident AF. Both prevalent AF and incident AF were associated with worse crude outcomes and complications during hospitalization. In propensity-matched cohorts, incident AF was associated with a higher in-hospital mortality rate, longer length of stay, higher direct costs, and higher rate of complications, including stroke and acute kidney injury, compared with prevalent AF. These outcomes, except length of in-hospital stay, did not change for either AF status over 5 years. CONCLUSIONS: Prevalent AF and incident AF in patients undergoing PCI were both associated with deteriorating crude outcomes and complications; in particular, incident AF was associated with worse adjusted outcomes and complications. Further efforts are needed to improve patient outcomes in an aging society in which the incidence of AF is increasing.

CONTEXTE: Une fibrillation auriculaire (FA) apparaît souvent chez les patients qui subissent une intervention coronarienne percutanée (ICP). Nous avons étudié les effets cliniques de l'état de la FA sur la mortalité à l'hôpital et les complications chez les patients ayant subi une ICP en utilisant un ensemble de données nationales récentes à grande échelle. MÉTHODOLOGIE: À partir d'un ensemble de données basées sur les demandes de règlement de 1022 hôpitaux au Japon pour la période allant de 2012 à 2016, les patients ayant subi une ICP ont été ciblés et classés en 3 groupes selon l'état de la FA : FA absente, FA présente avant l'admission, et nouvelle FA après l'admission. La mortalité à l'hôpital, les complications et les coûts médicaux ont été comparés dans des cohortes brutes et des cohortes appariées par score de propension. RÉSULTATS: Sur 659 525 patients hospitalisés ayant subi une ICP, une FA déjà présente et une nouvelle FA ont été observées chez 6,0 % et 1,3 % des patients, respectivement; les taux de FA ont augmenté sur 5 ans. Une plus grande proportion de patients plus âgés et de patients ayant des comorbidités présentaient ces deux catégories de FA; le fait de subir une ICP pour un syndrome coronarien aigu était fréquent chez les patients présentant une nouvelle FA. La FA déjà présente et la nouvelle FA étaient toutes deux associées à des résultats bruts et à des complications plus graves pendant l'hospitalisation. Dans les cohortes appariées par score de propension, la nouvelle FA était associée à un taux de mortalité à l'hôpital plus élevé, à une durée de séjour plus longue, à des coûts directs plus importants et à un taux plus élevé de complications, notamment d'accidents vasculaires cérébraux et de lésions rénales aiguës, par rapport à la FA déjà présente. Ces résultats, à l'exception de la durée du séjour à l'hôpital, n'ont pas changé pour les deux états de la FA sur 5 ans. CONCLUSIONS: La FA déjà présente et la nouvelle FA chez les patients subissant une ICP étaient toutes deux associées à une détérioration des résultats bruts et à des complications; plus particulièrement, la nouvelle FA était associée à de moins bons résultats ajustés et à de pires complications. Des efforts supplémentaires sont nécessaires pour améliorer les résultats des patients dans une société vieillissante où l'incidence de la FA augmente.

Association between induction of the self-management system for preventing readmission and disease severity and length of readmission in patients with heart failure.

OBJECTIVE: We recently developed the self-management system using the HF points and instructions to visit hospitals or clinics when the points exceed the pre-specified levels. We found that the self-management system decreased the hospitalization for HF with an increase in unplanned visits and early intervention in the outpatient department. However, it is unclear whether we managed severe HF outpatients who should have been hospitalized. In this study, we aimed to compare HF severity in rehospitalized patients with regard to self-management system use. RESULTS: We retrospectively enrolled 306 patients (153 patients each in the system user and non-user groups) using propensity scores (PS). We compared HF severity and length of readmission in rehospitalized patients in both groups. During the 1-year follow-up period, 24 system users and 43 non-system users in the PS-matched cohort were hospitalized. There were no significant differences between the groups in terms of brain natriuretic peptide levels at readmission, maximum daily intravenous furosemide dose, percentage of patients requiring intravenous inotropes, duration of hospital stay and in-hospital mortality. These results suggest that the HF severity in rehospitalized patients was not different between the two groups.

Association of the induction of a self-care management system with 1-year outcomes in patients hospitalized for heart failure.

BACKGROUND: To perform self-care in patients with heart failure (HF), we developed and implemented a new HF point self-care system, which was characterized by 1) the way weight and HF symptoms were scored ("Heart Failure Points") and 2) the timing of consultations defined for both patients and health care providers. We examined the association between the induction of the new system and 1-year outcomes in patients hospitalized for HF. METHODS: We retrospectively enrolled 569 consecutive patients into our study who were admitted for HF treatment at our hospital: 275 patients between November 2011 and October 2013 (before the induction of the self-management system) and 294 patients between November 2015 and October 2017 (after the induction). We sought to compare the clinical outcomes between patients using the self-management system and those not using the system after propensity-score (PS) matching. The primary outcome measure was a composite of all-cause death or HF rehospitalization. RESULTS: The cumulative 1-year incidence of the primary outcome measure in the use group (n = 153) was significantly lower than that in the non-use group (n = 153) (24.5% vs. 34.9%, respectively; p = 0.031; hazard ratio: 0.62; 95% confidence interval: 0.40-0.96), mainly due to a reduction in HF hospitalization. CONCLUSIONS: The induction of the new self-care system was associated with better 1-year outcomes in patients hospitalized for HF. This system may help patients with HF to achieve more efficient self-care.

Temporal trends in prevalence and outcomes of atrial fibrillation in patients undergoing percutaneous coronary intervention.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia in patients undergoing percutaneous coronary intervention (PCI). HYPOTHESIS: Large administrative data may provide further insight into temporal trends in the prevalence and burden of AF in patients who underwent PCI. METHODS: Using the National Inpatient Sample database in the U.S., AF patients ≥18 years who underwent PCI between 2005 and 2014 and were identified by the International Classification of Diseases, ninth revision, Clinical Modification, were examined. In-hospital mortality, morbidity, resource use, and medical costs were evaluated in crude and propensity-matched analyses. RESULTS: Among an estimated 6 272 232 hospitalizations, of patients undergoing PCI, AF prevalence was 9.9% and steadily increased from 8.6% to 12.0% between 2005 and 2014 (P < .001); there was also a greater proportion of comorbidities. There was a marked increase in AF prevalence among those aged ≥65 years and those undergoing elective PCIs. AF was independently associated with higher in-hospital mortality and higher rates of transient ischaemic attack/stroke, bleeding complications, and non-home discharge. Excessive in-hospital mortality, stroke rate, gastrointestinal bleeding, blood transfusion, length of stay, and costs among AF hospitalizations were consistently observed throughout the study period. CONCLUSION: AF becomes more prevalent in patients undergoing PCI, possibly due to a higher comorbidity, particularly in elderly patients with non-acute indications. Less favorable trends in mortality, bleeding, and stroke among AF patients who underwent PCI were consistent over time. Continuous efforts are needed to improve outcomes and manage strategies for AF patients undergoing PCI.