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Rheumatic heart disease (RHD), caused by Streptococcus pyogenes infections, is driven by social determinants of health and disproportionately affects Aboriginal and Torres Strait Islanders in Australia (hereafter Indigenous Australians), causing [...]

Introduction: Survivors of stroke are at risk of experiencing subsequent major adverse cardiovascular events (MACE). We aimed to determine the incidence of, and risk factors for, MACE after first-ever ischemic stroke, by age group (18–64 years vs. ≥65 years). Methods: Observational cohort study using patient-level data from the Australian Stroke Clinical Registry (2009–2013), linked with hospital administrative data. We included adults with first-ever ischemic stroke who had no previous acute cardiovascular admissions and followed these patients for 2 years post-discharge, or until the first post-stroke MACE event. A Fine-Gray sub-distribution hazard model, accounting for the competing risk of non-cardiovascular death, was used to determine factors for incident post-stroke MACE. Results: Among 5,994 patients with a first-ever ischemic stroke (median age 73 years, 45% female), 17% were admitted for MACE within 2 years (129 events per 1,000 person-years). The median time to first post-stroke MACE was 117 days (89 days if aged <65 years vs. 126 days if aged ≥65 years; p = 0.025). Among patients aged 18–64 years, receiving intravenous thrombolysis (sub-distribution hazard ratio [SHR] 0.51 [95% CI, 0.28–0.92]) or being discharged to inpatient rehabilitation (SHR 0.65 [95% CI, 0.46–0.92]) were associated with a reduced incidence of post-stroke MACE. In those aged ≥65 years, being unable to walk on admission (SHR 1.33 [95% CI 1.15–1.54]), and history of smoking (SHR 1.40 [95% CI 1.14–1.71]) or atrial fibrillation (SHR 1.31 [95% CI 1.14–1.51]) were associated with an increased incidence of post-stroke MACE. Acute management in a large hospital (>300 beds) for the initial stroke event was associated with reduced incidence of post-stroke MACE, irrespective of age group. Conclusions: MACE is common within 2 years of stroke, with most events occurring within the first year. We have identified important factors to consider when designing interventions to prevent MACE after stroke, particularly among those aged <65 years. [ABSTRACT FROM AUTHOR]

Objective To examine the feasibility of applying the International Classification of Diseases-perinatal mortality (ICD-PM) coding to an existing data set in the classification of perinatal deaths.Methods One author, a researcher with a non-clinical public health background, applied the ICD-PM coding system to South Africa's national perinatal mortality audit system, the Perinatal Problem Identification Program. The database for this study included all perinatal deaths (n = 26810), defined as either stillbirths (of birth weight > 1000 g and after 28 weeks of gestation) or early neonatal deaths (age 0-7 days) that occurred between 1 October 2013 and 31 December 2016. A clinical obstetrician verified the coding.Findings The South African classification system does not include the timing of death; however, under the ICD-PM system deaths could be classified as antepartum (n = 15619; 58.2%), intrapartum (n = 3725; 14.0%) or neonatal (n = 7466; 27.8%). Further, the South African classification system linked a maternal condition to only 40.3% (10802/26810) of all perinatal deaths; this proportion increased to 68 9% (18467/26810) under the ICD-PM system.Conclusion The main benefit of using the clinically relevant and user-friendly ICD-PM system was an enhanced understanding of the data, in terms of both timing of death and maternal conditions. We have also demonstrated that it is feasible to convert an existing perinatal mortality classification system to one which is globally comparable and can inform policy-makers internationally.Objectif Examiner s'il est faisable d'appliquer les codes de la Classification internationale des maladies pour la periode perinatale (ICD-PM) a un ensemble de donnees existantes de classification des deces perinatals.Methodes L'une des auteurs de cette publication, une chercheuse ayant une experience non clinique en sante publique, a applique le systeme de codage ICD-PM au systeme d'audit national de la mortalite perinatale d'Afrique du Sud, le Perinatal Problem Identification Program. La base de donnees utilisee pour cette etude incluait l'integralite des deces perinatals (n = 26810) survenus entre le Foctobre 2013 et le 31 decembre 2016 et deftnis soit comme des mortinaissances (poids de naissance > 1 000 g et 28 semaines de gestation revolues), soit comme des deces neonatals precoces (entre l'age de 0 a 7 jours). Une clinicienne-obstetricienne a verifie ce codage.Resultats Le systeme de classification d'Afrique du Sud ne consigne pas le moment d'intervention du deces, neanmoins, avec le systeme ICD PM, les deces ont pu etre classes en tant que deces fcetaux (n = 15 619; 58,2%), deces per-partum (n = 3 725; 14,0%) ou deces neonatals (n = 7 466; 27,8%). Par ailleurs, dans le systeme de classification d'Afrique du Sud, seuls 40,3% (10 802/26 810) des deces perinatals avaient ete relies a une affection maternelle; une proportion qui est passee a 68,9% (18 467/26 810) avec le systeme ICD-PM.Conclusion Le principal avantage obtenu avec l'utilisation du systeme ICD-PM, par ailleurs facile d'emploi et cliniquement pertinent, a ete de permettre une meilleure comprehension des donnees, a Ia fois concernant le moment du deces et concernant les affections maternelles. Nous avons egalement demontre qu'il etait faisable de convertir un systeme de classification de Ia mortalite perinatale existant vers un systeme qui permet d'obtenir des donnees comparables internationalement et susceptibles d'eclairer les decisions politiques a l'echelle mondiale.Objetivo Examinar la viabilidad de aplicar la codificacion de la Clasificacion Internacional de Enfermedades-Mortalidad Perinatal (CIEMP) a un conjunto de datos existente en la clasificacion de muertes perinatales.Metodos Un autor, un Investigador con formacion no clinica en salud publica, aplico el sistema de codificacion CIE-MP al sistema nacional de auditoria de mortalidad perinatal de Sudafrica, el Programa de Identificacion de Problemas Perinatales. La base de datos para este estudio incluyo todas las muertes perinatales (n = 26810), definidas como mortinatos (con un peso al nacer > 1000 g y despues de 28 semanas de gestacion) o muertes neonatales tempranas (de 0 a 7 dias de edad), que tuvieron lugar entre el 1 de octubre de 2013 y el 31 de diciembre de 2016. Un obstetra clinico verifico el codigo.Resultados El sistema de clasificacion sudafricano no incluye el momento de la muerte;sin embargo, con el sistema CIE-MP, las muertes se pueden clasificar como anteparto (n = 15 619; 58,2 %), intraparto (n = 3725; 14,0 %) o neonatales (n = 7466; 27,8 %). Ademas, el sistema de clasificacion sudafricano vinculo una afeccion materna con solo el 40,3 % (10 802/26 810) de todas las muertes perinatales; esta proporcion aumento al 68,9 % (18 467/26 810) en el marco del sistema CIE-MP.Conclusion El principal beneficio de utilizar el clinicamente relevante y facil de usar sistema CIE-MP fue la mejor comprension de los datos, tanto en lo relativo al momento de la muerte como a las condiciones maternas. Tambien se ha demostrado que es factible convertir un sistema existente de clasificacion de mortalidad perinatal en uno que sea globalmente comparable y que pueda informar a los responsables de la formulacion de politicas a nivel internacional., IntroductionHigh on the global health agenda is the need to accelerate progress towards ending preventable perinatal deaths, defined by the World Health Organization (WHO) as either a stillbirth of weight [...]