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Khan MZ, Zahid S, Khan MU, Kichloo A, Jamal S, Khan AM, Ullah W, Sattar Y, Munir MB, Balla S. Comparison of In-Hospital Outcomes of Transcatheter Mitral Valve Repair in Patients With vs Without Pulmonary Hypertension (From the National Inpatient Sample). Am J Cardiol 2021; 153:101-108. [PMID: 34210502 DOI: 10.1016/j.amjcard.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
Pulmonary hypertension (PH) is common in patients with left heart disease and is present in varying degrees in patients with severe mitral valve disease. There is paucity of data regarding outcomes following transcatheter mitral valve repair (TMVr) in patients with PH. For this study, we analyzed NIS data from 2014 to 2018 using the ICD-9-CM and 10-CM codes. Baseline characteristics were compared using a Pearson chi-squared test for categorical variables and independent samples t-test for continuous variables. To account for selection bias, a 1:1 propensity match cohort was derived using logistic regression. Trend analysis was- done using linear regression. Of 21,505 encounters, 6780 encounters had PH. 6610 PH encounters were matched with 6610 encounters without PH. In-hospital mortality (3.3% versus 1.9%, p <0.01) was higher in PH population. Complications such as blood transfusion (3.6% versus 1.7%, p <0.01), GI bleed (1.4% versus 1%, p = 0.04), vascular complications (5.3% versus 3.3%, p <0.01), vasopressors use (2.9% versus 1.7%, p <0.01) and pacemaker placement (1.3% versus 0.8%, p = 0.01) remained significantly higher for encounters with PH. Multiple Logistic regression showed PH was associated with higher mortality (adjusted odds ratio [AOR], 1.68 [95% confidence interval [CI], 1.39-2.05], p <0.01). The mean length of stay (6.2 versus 5.3 days, p <0.01) and cost per hospitalization ($53,780 versus $50,801, p <0.01) remained significantly higher in the PH group when compared to group without PH. In conclusion, TMVr in PH as compared to without PH is associated with higher mortality, post-procedure complication rates, length of stay, and cost of stay.
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Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia.
| | - Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Asim Kichloo
- St. Mary's of Saginaw Hospital, Saginaw, Michigan
| | | | | | | | - Yasar Sattar
- Icahn school of Medicine at Mount Sinai Elmhurst Hospital Queens New York
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
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Zahid S, Ullah W, Khan MZ, Rai D, Bandyopadhyay D, Din MTU, Abbas S, Ubaid A, Thakkar S, Chowdhury M, Khan MU, Bhaibhav B, Roa M, Depta JP, Alam M, Alraies C, Balla S. Trends and Outcomes of Ischemic Stroke after Transcatheter Aortic Valve Implantation, A US National Propensity Matched Analysis. Curr Probl Cardiol 2021; 47:100961. [PMID: 34391762 DOI: 10.1016/j.cpcardiol.2021.100961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/08/2021] [Indexed: 11/15/2022]
Abstract
Contemporary data on stroke predictors and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) remains limited. We analyzed National Inpatient Sample (NIS) data from the year 2011 to 2018. A total of 215,938 patients underwent TAVI. Of the patients who underwent TAVI, 4579 (2.2%) suffered from stroke and 211359 (97.8%) did not have a stroke. Adjusted mortality was higher in patients who had a stroke (10.9%) as compared to patients who did not have a stroke (3.1%). Lower percentage of patients were discharged home who developed a stroke compared to patients without a stroke (10.2% vs 52.3%). Multivariate logistic regression analysis showed that at baseline, age, female sex, atrial fibrillation, chronic kidney disease and peripheral vascular disease were significant predictors of stroke. Median Cost of care ($63367 vs $48070) and length of stay (8 vs 4 days) were considerably higher for patients with stroke when compared to the comparison group (p<0.01 for all). In conclusion we report that stroke is associated with increased mortality, morbidity, and resource utilization in patients undergoing TAVI. Baseline characteristics like age, gender, atrial fibrillation, chronic kidney disease and peripheral vascular disease are significant predictors of this adverse event.
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Affiliation(s)
- Salman Zahid
- Sands Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA.
| | - Waqas Ullah
- Department of Cardiology, Jefferson University Hospitals, PA, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Devesh Rai
- Sands Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | | | - Mian Tanveer Ud Din
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Aamer Ubaid
- Internal Medicine, University of Missouri- Kansas City, Kansas City, MO, USA
| | - Samarthkumar Thakkar
- Sands Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Medhat Chowdhury
- Sands Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Muhammad Usman Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Bipul Bhaibhav
- Sands Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Mohan Roa
- Sands Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Jeremiah P Depta
- Sands Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | | | | | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
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Ullah W, Ur Rahman M, Rauf A, Zahid S, Thalambedu N, Mir T, Khan MZ, Fischman DL, Virani S, Alam M. Comparative analysis of revascularization with percutaneous coronary intervention versus coronary artery bypass surgery for patients with end-stage renal disease: a nationwide inpatient sample database. Expert Rev Cardiovasc Ther 2021; 19:763-768. [PMID: 34275404 DOI: 10.1080/14779072.2021.1955350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The role of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) in patients with coronary artery disease (CAD) and concomitant end-stage renal disease (ESRD) remains unknown. RESEARCH DESIGN & METHODS The National Inpatient Sample (NIS) (2002-2017) was queried to identify all cases of CAD and ESRD. The relative merits of PCI vs CABG were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for mortality and other in-hospital complications were calculated. RESULTS A total of 350,623 [CABG = 112,099 (32%) and PCI = 238,524 (68%)] hospitalizations were included in the analysis. The overall adjusted odds for major bleeding (aOR 1.28, 95% CI 1.25-1.31, P < 0.0001), post-procedure bleeding (aOR 5.19, 95% CI 4.93-5.47, P < 0.0001), sepsis (aOR 1.29, 95% CI 1.26-1.33, P < 0.0001), cardiogenic shock (aOR 1.23, 95% CI 1.20-1.26, P < 0.0001), and in-hospital mortality (aOR 1.65, 95% CI 1.61-1.69, P < 0.0001) were significantly higher for patients undergoing CABG compared with PCI. The need for intra-aortic balloon pump (IABP) placement (aOR 2.52, 95% CI 2.45-2.59, P < 0.001) was higher in the CABG group, while the adjusted odds of vascular complications were similar between the two groups (aOR 0.99, 95% CI 0.94-1.06, P = 0.82). As expected, patients undergoing CABG had a higher mean length of stay and mean cost of hospitalization. CONCLUSION CABG in ESRD may be associated with higher in-hospital complications, increased length of stay, and higher resource utilization.
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Affiliation(s)
- Waqas Ullah
- Department of Medicine, Section of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | | | - Abdul Rauf
- Department of Medicine, SSM health St. Mary's Hospital, Missouri, USA
| | - Salman Zahid
- Department of Medicine, Rochester General Hospital, New York, USA
| | - Nishanth Thalambedu
- Department of Medicine, Section of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Tanveer Mir
- Department of Medicine, Detroit Medical Center, Detroit, Michigan, USA
| | - Muhammad Zia Khan
- Department of Medicine, University of West Virginia Morgantown, West Virginia, USA
| | - David L Fischman
- Department of Medicine, Section of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Salim Virani
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
| | - Mahboob Alam
- Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Texas, USA
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Khan MZ, Zahid S, Khan MU, Kichloo A, Jamal S, Minhas AMK, Munir MB, Balla S. In-hospital outcomes of transcatheter mitral valve repair in patients with and without end stage renal disease: A national propensity match study. Catheter Cardiovasc Interv 2021; 98:343-351. [PMID: 33527676 DOI: 10.1002/ccd.29517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/29/2020] [Accepted: 01/15/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To study trends of utilization, outcomes, and cost of care in patients undergoing undergoing transcatheter mitral valve repair (TMVr) with end-stage renal disease (ESRD). BACKGROUND Renal disease has been known to be a predictor of poor outcome in patients with mitral valve disease. Outcome data for patients with ESRD undergoing TMVr remains limited. Therefore, our study aims to investigate trends of utilization, outcomes, and cost of care among patients with ESRD undergoing TMVr. METHODS We analyzed NIS data from January 2010 to December 2017 using the ICD-9-CM codes ICD-10-CM to identify patients who underwent TMVr. Baseline characteristics were compared using a Pearson 𝜒2 test for categorical variables and independent samples t-test for continuous variables. Propensity matched analysis was done for adjusted analysis to compare outcomes between TMVr with and without ESRD. Markov chain Monte Carlo was used to account for missing values. RESULTS A total of 15,260 patients (weighted sample) undergoing TMVr were identified between 2010 and 2017. Of these, 638 patients had ESRD compared to 14,631 patients who did not have ESRD. Adjusted in-hospital mortality was lower in non-ESRD group (3.9 vs. <1.8%). Similarly, ESRD patients were more likely to have non-home discharges (85.6 vs. 74.9%). ESRD patients also had a longer mean length of stay (7.9 vs. 13.5 days) and higher mean cost of stay ($306,300 vs. $271,503). CONCLUSION ESRD is associated with higher mortality, complications, and resource utilization compared to non-ESRD patients. It is important to include this data in shared decision-making process and patient selection.
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Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Asim Kichloo
- Department of Medicine, St. Mary's of Saginaw Hospital, Saginaw, Michigan, USA
| | - Shakeel Jamal
- Department of Medicine, St. Mary's of Saginaw Hospital, Saginaw, Michigan, USA
| | | | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
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Munir MB, Khan MZ, Darden D, Pasupula DK, Balla S, Han FT, Reeves R, Hsu JC. B-PO03-156 PROCEDURAL COMPLICATIONS AND IN-HOSPITAL OUTCOMES FROM LEFT ATRIAL APPENDAGE OCCLUSION DEVICE IMPLANTATION IN PATIENTS WITH CHRONIC AND END STAGE RENAL DISEASE. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zahid S, Ullah W, Khan MU, Salama A, Krupica T, Khan MZ. Predictors of Acute Kidney Injury After Transcatheter Aortic Valve Implantation (From National Inpatient Sample [2011-2018]). Am J Cardiol 2021; 151:120-122. [PMID: 34006370 DOI: 10.1016/j.amjcard.2021.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 02/07/2023]
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Kichloo A, Shaka H, Aljadah M, Amir R, Albosta M, Jamal S, Khan MZ, Wani F, Mir KM, Kanjwal K. Predictors of outcomes in hospitalized patients undergoing pacemaker insertion: Analysis from the national inpatient database (2016-2017). Pacing Clin Electrophysiol 2021; 44:1562-1569. [PMID: 34245027 DOI: 10.1111/pace.14314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/19/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pacemaker implantation in the U.S. is rising due to an aging population. The aim of this analysis was to identify risk factors associated with increased mortality and complications in hospitalized patients requiring pacemaker implantation. METHODS We performed a retrospective analysis using the National Inpatient Sample database, identifying hospitalized patients who underwent pacemaker implantation using International Classification of Disease, Tenth Revision, Clinical Modification codes. Independent predictors of inpatient mortality were identified using multivariate logistic regression analysis. RESULTS There were 242,980 hospitalizations with pacemaker implantation during 2016 and 2017. The most frequently encountered indications for hospitalizations involving pacemaker insertion included sick sinus syndrome (SSS) (27.60%), complete atrioventricular (AV) block (21.57%), and second-degree AV block (7.83%). Chronic liver disease was associated with the highest adjusted odds of inpatient mortality (aOR = 5.76, 95% CI: 4.46 to 7.44, p < .001). Comorbid anemia had the highest statistically significant adjusted odds ratio (aOR) for predictors of post-procedural cardiac complications (aOR = 3.17, 95% CI: 2.81 to 3.58, p < .001). Mortality in hospitalized patients needing pacemaker implantation was 1.05%. About 3.36% of hospitalizations developed post procedural circulatory complications (PPCC), 2.45% developed sepsis, and 1.84% developed mechanical complications of cardiac electronic devices. CONCLUSIONS We identified several predictors of inpatient mortality in hospitalized patients undergoing pacemaker implantation, including chronic liver disease, protein-calorie malnutrition, chronic heart failure, anemia, and history of malignancy. Anemia, chronic liver disease, and congestive heart failure were independent predictors of adverse outcomes in such patients.
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Affiliation(s)
- Asim Kichloo
- Central Michigan University, Saginaw, Michigan, USA.,Samaritan Medical Center, Watertown, New York, USA
| | - Hafeez Shaka
- John H. Stroger, Jr. Hospital, Chicago, Illinois, USA
| | | | - Rawan Amir
- University of Maryland Medical Center, Baltimore, Maryland, USA
| | | | | | | | - Farah Wani
- Samaritan Medical Center, Watertown, New York, USA
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Kichloo A, Minhas AMK, Jamal S, Shaikh AT, Albosta M, Singh J, Khan MZ, Aljadah M, Wani F, Wazir MHK, Kanjwal K. Trends and Inpatient Outcomes of Primary Heart Failure Hospitalizations with a Concurrent Diagnosis of Acute Exacerbation of Chronic Obstructive Pulmonary Disease (from The National Inpatient Sample Database from 2004 to 2014). Am J Cardiol 2021; 150:69-76. [PMID: 34001343 DOI: 10.1016/j.amjcard.2021.03.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Heart failure (HF) and acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are considered significant causes of morbidity and mortality worldwide. Concurrent presentation of HF with AECOPD can pose a diagnostic challenge due to an overlap in symptomatology. We queried the National Inpatient Sample (NIS) database to assess outcomes of HF hospitalizations with a secondary diagnosis of AECOPD. We performed a retrospective analysis of discharge data from the Healthcare Cost Utilization Project NIS between January 1, 2004, and December 31, 2014, with a primary diagnosis of HF with and without a secondary diagnosis of AECOPD. Data was abstracted from the NIS using International Classification of Disease 9 codes. Primary outcomes included mortality, length of stay, and inflation-adjusted cost of stay. During 2004-2014, a total of (n = 10,392,628) HF hospitalizations were identified without a secondary diagnosis of AECOPD while (n = 989,713) HF hospitalizations were identified with a secondary diagnosis of AECOPD. We identified higher mortality (3.25% vs 3.56%, p <0.001), length of stay (5.2 vs 6.1 days, p <0.001) and inflation-adjusted cost of stay (12,562 vs 13,072 USD, p <0.001) in HF hospitalizations with AECOPD when compared to HF without AECOPD from 2004 to 2014. We presented AECOPD as an independent predictor of mortality in patients admitted for HF. In conclusion, further interdisciplinary collaboration between pulmonologists and cardiologists is needed for the identification and stratification of patients who present with concurrent HF and COPD for better outcomes.
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Khan MZ, Zahid S, Khan MU, Kichloo A, Ullah W, Sattar Y, Munir MB, Singla A, Goldsweig AM, Balla S. Use and outcomes of cerebral embolic protection for transcatheter aortic valve replacement: A US nationwide study. Catheter Cardiovasc Interv 2021; 98:959-968. [PMID: 34145716 DOI: 10.1002/ccd.29842] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/10/2021] [Accepted: 06/11/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Outcomes data on the use of cerebral embolic protection devices (CPDs) with transcatheter aortic valve replacement (TAVR) remain limited. Previous randomized trials were underpowered for primary outcomes of stroke prevention and mortality. METHODS The National Inpatient Sample and Nationwide Readmissions Database were queried from 2017 to 2018 to study utilization and inpatient mortality, neurological complications (ischemic stroke, hemorrhagic stroke, and transient ischemic attack), procedural complications, resource utilization, and 30-day readmissions with and without use of CPD. A 1:3 ratio propensity score matched model was created. RESULTS Among 108,315 weighted encounters, CPD was used in 4380 patients (4.0%). Adjusted mortality was lower in patients undergoing TAVR with CPD (1.3% vs. 0.5%, p < 0.01). Neurological complications (2.5% vs. 1.7%, p < 0.01), hemorrhagic stroke (0.2% vs. 0%, p < 0.01) and ischemic stroke (2.2% vs. 1.4%, p < 0.01) were also lower in TAVR with CPD. Multiple logistic regression showed CPD use was associated with lower adjusted mortality (odds ratio (OR], 0.34 [95% confidence interval [CI], 0.22-0.52), p < 0.01) and lower adjusted neurological complications (OR, 0.68 (95% CI, 0.54-0.85], p < 0.01). On adjusted analysis, 30-day all-cause readmissions (Hazard ratio, HR 0.839, [95% CI, 0.773-0.911], p < 0.01) and stroke (HR, 0.727 [95% CI, 0.554-0.955), p = 0.02) were less likely in TAVR with CPD. CONCLUSION We report real-world data on utilization and in-hospital outcomes of CPD use in TAVR. CPD use is associated with lower inpatient mortality, neurological, and clinical complications as compared to TAVR without CPD.
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Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Asim Kichloo
- Division of medicine, St. Mary's of Saginaw Hospital, Saginaw, Michigan, USA
| | - Waqas Ullah
- Division of medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Yasar Sattar
- Division of medicine, Icahn school of Medicine at Mount Sinai Elmhurst Hospital, New York, New York, USA
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Atul Singla
- Division of Cardiology/Department. of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
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Kichloo A, Jamal S, Albosta M, Khan MZ, Aljadah M, Edigin E, Amir R, Wani F, Ul-Haq E, Kanjwal K. Increased inpatient mortality in patients hospitalized for atrial fibrillation and atrial flutter with concomitant amyloidosis: Insight from National Inpatient Sample (NIS) 2016-2017. Indian Pacing Electrophysiol J 2021; 21:344-348. [PMID: 34153477 PMCID: PMC8577133 DOI: 10.1016/j.ipej.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/31/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Using National Inpatient Database (NIS), comparison of clinical outcomes for patients primarily admitted for atrial fibrillation/flutter with and without a secondary diagnosis of amyloidosis was done. Inpatient mortality was the primary outcome and hospital length of stay (LOS), mean total hospital charges, odds of undergoing cardiac ablation, pharmacologic cardioversion, having a secondary discharge diagnosis of heart block, cardiogenic shock and cardiac arrest were secondary outcomes. Methods NIS database of 2016, 2017 was used for only adult hospitalizations with atrial fibrillation/flutter as principal diagnosis with and without amyloidosis as secondary diagnosis using ICD-10 codes. Multivariate logistic with linear regression analysis was used to adjust for confounders. Results 932,054 hospitalizations were for adult patients with a principal discharge diagnosis of atrial fibrillation/flutter. 830 (0.09%) of these hospitalizations had amyloidosis. Atrial fibrillation/flutter hospitalizations with co-existing amyloidosis have higher inpatient mortality (4.22% vs 0.88%, AOR: 3.92, 95% CI 1.81–8.51, p = 0.001) and likelihood of having a secondary discharge diagnosis of cardiac arrest (2.40% vs 0.51%, AOR: 4.80, 95% CI 1.89–12.20, p = 0.001) compared to those without amyloidosis. Conclusions Hospitalizations of atrial fibrillation/flutter with co-existing amyloidosis have higher inpatient mortality and odds of having a secondary discharge diagnosis of cardiac arrest compared to those without amyloidosis. However, LOS, total hospital charges, likelihood of undergoing cardiac ablation, pharmacologic cardioversion, having a secondary discharge diagnosis of heart block and cardiogenic shock were similar between both groups.
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Affiliation(s)
- Asim Kichloo
- Central Michigan University College of Medicine, Saginaw, MI, USA; Samaritan Medical Center, Watertown, NY, USA.
| | - Shakeel Jamal
- Central Michigan University College of Medicine, Saginaw, MI, USA.
| | - Michael Albosta
- Central Michigan University College of Medicine, Saginaw, MI, USA.
| | | | | | | | - Rawan Amir
- University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Farah Wani
- Samaritan Medical Center, Watertown, NY, USA.
| | - Ehtesham Ul-Haq
- University of Kentucky College of Medicine, Bowling Green, KY, USA.
| | - Khalil Kanjwal
- Michigan State University McLaren Greater Lansing Hospital, Lansing, MI, USA.
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Zahid S, Ullah W, Khan MU, Sarvepalli D, Inayat A, Salman F, Khan MZ. Meta-Analysis Comparing Valve in Valve Transcatheter Mitral Valve Replacement Versus Redo Surgical Mitral Valve Replacement for Degenerating Bioprosthetic Valves. Am J Cardiol 2021; 149:155-156. [PMID: 33736998 DOI: 10.1016/j.amjcard.2021.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/09/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | | | - Fnu Salman
- St. Vincent Medical Center, Toledo, Ohio
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Khan MZ, Munir MB, Khan MU, Khan SU, Vasudevan A, Balla S. Contemporary Trends and Outcomes of Prosthetic Valve Infective Endocarditis in the United States: Insights from the Nationwide Inpatient Sample. Am J Med Sci 2021; 362:472-479. [PMID: 34033810 DOI: 10.1016/j.amjms.2021.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/18/2020] [Accepted: 05/19/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prosthetic valve endocarditis (PVE) carries high mortality and morbidity as compared to native valve endocarditis (NVE). Contemporary data on PVE are lacking, we aimed to study contemporary trends, outcomes, and burden of PVE using nationally representative data. METHODS We used the National Inpatient Sample from 2000 to 2017 to identify patients admitted with PVE using ICD-9-CM and ICD-10 codes. Risk-adjusted rates were calculated using an Analysis of Covariance (ANCOVA) with the Generalized Linear Model (GLM). Trends were assessed with linear regression and Pearson's Chi-square when appropriate. Binomial logistic regression was used to assess predictors of in-hospital mortality. RESULTS We identified 43,602 hospitalizations for PVE. PVE hospitalizations increased from 1803 in 2000 to 3450 in 2017. Risk-adjusted mortality decreased from 10.7% in 2002 to 7.3% in 2017 (P<0.01). Logistic regression analysis on mortality showed increase association with age (OR, 1.021, 95%CI [1.017-1.024], p<0.01), Hispanics (OR, 1.493, 95%CI [1.296-1.719], p<0.01) and patients with drug abuse(OR, 1.233, 95%CI [1.05-1.449], p=0.01). Co-morbid conditions like congestive heart failure (OR, 1.511, 95%CI [1.366-1.673], p<0.01), renal failure (OR, 1.572, 95%CI [1.427-1.732], p<0.01) and weight loss (OR, 1.425, 95%CI [1.093-1.419], p<0.01) were also associated with higher mortality. CONCLUSIONS Over the years the adjusted in-hospital mortality in PVE has trended down but the average cost of stay has increased despite decrease in length of stay.
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Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia.
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia; Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Muhammad U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Archana Vasudevan
- Division of Infectious Diseases, Department of Medicine, University of Missouri School of Medicine, Columbia, Missouri
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
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Zahid S, Ullah W, Khan MU, Abbas S, Ud Din MT, Uddin MF, Inayat A, Ubaid A, Salman F, Thakkar S, Salama A, Khan MZ. Trends, predictors, and outcomes of major bleeding after transcatheter aortic valve implantation, from national inpatient sample (2011-2018). Expert Rev Cardiovasc Ther 2021; 19:557-563. [PMID: 33926363 DOI: 10.1080/14779072.2021.1924678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Major bleeding remains one of the most frequent complications seen in transcatheter aortic valve implantation (TAVI). The purpose of this study was to evaluate outcomes, trends, and predictors of major bleeding in patients undergoing TAVI. METHODS We utilized the National Inpatient Sample (NIS) data from the year 2011 to 2018. Baseline characteristics were compared using a Pearsonχ2 test for categorical variables and Mann-Whitney U-Test for continuous variables. A multivariable logistic regression model was used to evaluate predictors of major bleeding. Propensity Matching was done for adjusted analysis to compare outcomes in TAVI with and without major bleeding. RESULTS A total of 215,938 weighted hospitalizations for TAVI were included in the analysis. Of the patient undergoing the procedure, 20,102 (9.3%) had major bleeding and 195,836 (90.7%) patients did not have in-hospital bleeding events. Patients in the major bleeding cohort were older and had greater female gender representation. At baseline patients with thrombocytopenia (Odds Ratio [OR], 1.47[confidence interval (CI), 1.36-1.59]), colon cancer (OR, 1.70[CI, 1.27-2.28]), coagulopathy (OR, 1.17[CI, 1.08-1.27]), liver disease (OR, 1.31[CI, 1.21-1.41]), chronic obstructive pulmonary disease (OR, 1.29[CI, 1.25-1.33]), congestive heart failure (OR, 1.12[CI, 1.08-1.16]), and end-stage renal disease (ESRD) (OR, 1.47[CI, 1.38-1.57]) had higher adjusted rates of major bleeding. The percentage of adjusted in-hospital mortality (14.4% vs. 4.2%, P < 0.01) was significantly higher in the major bleeding group Patients with major bleeding had higher median cost of stay ($235,274 vs. $177,920) and length of stay (7 vs 3 days). CONCLUSION In conclusion, we report that mortality is higher in patients with major bleeding and that baseline comorbidities like ESRD, liver disease, coagulopathy and colonic malignancy are important predictors of this adverse event.
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Affiliation(s)
- Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester,NY,USA
| | - Waqas Ullah
- Department of Medicine, Abington Jefferson Health, PA, USA
| | - Muhammad Usman Khan
- Department of Cardiology, Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Sakina Abbas
- Department of Medicine, Dow Medical College, Karachi, PK
| | | | | | - Arslan Inayat
- Department of Medicine, Internal Medicine, University at Buffalo, Catholic Health System, Buffalo, NY, USA
| | - Aamer Ubaid
- Department of Medicine, Internal Medicine, University of Missouri- Kansas City, Kansas City, MO
| | - Fnu Salman
- Department of Medicine, Mercy Health St. Vincent Medical Center, Toledo, USA
| | | | - Amr Salama
- Department of Medicine, Rochester General Hospital, Rochester,NY,USA
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, Medicine, Morgantown, WV, USA
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Munir B, Khan MZ, Darden D, Pasupula DK, Han F, Reeves R, Hsu J. RACIAL DISPARITIES IN PATIENTS IMPLANTED WITH A WATCHMAN DEVICE: A NATIONAL PERSPECTIVE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Munir B, Khan MZ, Darden D, Pasupula DK, Balla S, Han F, Reeves R, Hsu J. PERICARDIAL EFFUSION REQUIRING CATHETER OR SURGICAL BASED INTERVENTION IN PATIENTS IMPLANTED WITH WATCHMAN PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION IN THE UNITED STATES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02601-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Khan MZ, Munir MB, Darden D, Pasupula DK, Balla S, Han FT, Reeves R, Hsu JC. Racial Disparities in In-Hospital Adverse Events Among Patients With Atrial Fibrillation Implanted With a Watchman Left Atrial Appendage Occlusion Device: A US National Perspective. Circ Arrhythm Electrophysiol 2021; 14:e009691. [PMID: 33909473 DOI: 10.1161/circep.120.009691] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown (M.Z.K., S.B.)
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla (M.B.M., D.D., F.T.H., R.R., J.C.H.)
| | - Douglas Darden
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla (M.B.M., D.D., F.T.H., R.R., J.C.H.)
| | | | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown (M.Z.K., S.B.)
| | - Frederick T Han
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla (M.B.M., D.D., F.T.H., R.R., J.C.H.)
| | - Ryan Reeves
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla (M.B.M., D.D., F.T.H., R.R., J.C.H.)
| | - Jonathan C Hsu
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla (M.B.M., D.D., F.T.H., R.R., J.C.H.)
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Khan SU, Khan MZ, Khan MU, Khan MS, Mamas MA, Rashid M, Blankstein R, Virani SS, Johansen MC, Shapiro MD, Blaha MJ, Cainzos-Achirica M, Vahidy FS, Nasir K. Clinical and Economic Burden of Stroke Among Young, Midlife, and Older Adults in the United States, 2002-2017. Mayo Clin Proc Innov Qual Outcomes 2021; 5:431-441. [PMID: 33997639 PMCID: PMC8105541 DOI: 10.1016/j.mayocpiqo.2021.01.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective To assess trends of stroke hospitalization rates, inpatient mortality, and health care resource use in young (aged ≤44 years), midlife (aged 45-64 years), and older (aged ≥65 years) adults. Patients and Methods We studied the National Inpatient Sample database (January 1, 2002 to December 31, 2017) to analyze stroke-related hospitalizations. We identified data using the International Classification of Diseases, Ninth/Tenth Revision codes. Results Of 11,381,390 strokes, 79% (n=9,009,007) were ischemic and 21% (n=2,372,383) were hemorrhagic. Chronic diseases were more frequent in older adults; smoking, alcoholism, and migraine were more prevalent in midlife adults; and coagulopathy and intravenous drug abuse were more common in young patients with stroke. The hospitalization rates of stroke per 10,000 increased overall (31.6 to 33.3) in young and midlife adults while decreasing in older adults. Although mortality decreased overall and in all age groups, the decline was slower in young and midlife adults than older adults. The mean length of stay significantly decreased in midlife and older adults and increased in young adults. The inflation-adjusted mean cost of stay increased consistently, with an average annual growth rate of 2.44% in young, 1.72% in midlife, and 1.45% in older adults owing to the higher use of health care resources. These trends were consistent in both ischemic and hemorrhagic stroke. Conclusion Stroke-related hospitalization and health care expenditure are increasing in the United States, particularly among young and midlife adults. A higher cost of stay counterbalances the benefits of reducing stroke and mortality in older patients.
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Affiliation(s)
- Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV
| | | | - Muhammad U Khan
- Department of Medicine, West Virginia University, Morgantown, WV
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom.,Department of Medicine, Jefferson University, Philadelphia, PA
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United Kingdom
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center.,Department of Medicine, Baylor College of Medicine, Houston, TX
| | | | - Michael D Shapiro
- Section of Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center.,Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Farhaan S Vahidy
- Division of Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center.,Center for Outcomes Research, Houston Methodist, Houston, TX
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Khan MZ, Munir MB, Khan MU, Kuprica T, Balla S. Burden of Infective Endocarditis in Homeless Patients in the United States: A National Perspective. Am J Med Sci 2021; 362:39-47. [PMID: 33798460 DOI: 10.1016/j.amjms.2021.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/06/2020] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Earlier studies have shown disparate cardiovascular care in homeless patients. Limited data exist on burden of infective endocarditis (IE) in homeless patients and in this study, we aimed to analyze it using a nationally representative United States population sample. METHODS Data were extracted from National Inpatient Sample database from January 2000 to December 2017. Patients with endocarditis were sampled using International Classification of Diseases, 9th Revision, Clinical Modification codes of 421.0, 421.1 or 421.9 and International Classification of Diseases, 10th Revision, Clinical Modification codes of I33.0 or I33.9. Homeless patients were identified using codes of V60 and Z59. Linear regression was used for trend analysis and logistic regression was utilized to identify predictors of mortality. 1:1 propensity score (PS) matching was also done to balance confounders and outcomes were assessed in both unmatched and matched cohorts. RESULTS We found an increase in proportion of homeless patients admitted with endocarditis from 0.2% in year 2000 to 2.4% in year 2017. Mortality was not statistically significant in PS matched homeless and non-homeless cohorts (4.7% vs 6.6%, p = 0.072). There was a trend towards increased mortality in homeless endocarditis patients over our study years with lower utilization of valvular surgeries. Advanced age, alcohol abuse and admission to large hospitals were independently associated with mortality in homeless endocarditis patients. CONCLUSION Homeless patients have rising trend of IE and IE related mortality and also found to have low utilization of life saving valvular surgeries when compared to general population.
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Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA.
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA; Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
| | - Muhammad U Khan
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Troy Kuprica
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
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Khan MZ, Syed M, Agrawal P, Osman M, Khan MU, Alharbi A, Benjamin MM, Khan SU, Balla S, Munir MB. Baseline characteristics and outcomes of end-stage renal disease patients after in-hospital sudden cardiac arrest: a national perspective. J Interv Card Electrophysiol 2021; 63:503-512. [PMID: 33728550 DOI: 10.1007/s10840-021-00977-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/07/2021] [Indexed: 01/10/2023]
Abstract
PURPOSE End-stage renal disease (ESRD) is a well-recognized risk factor for the development of sudden cardiac arrest (SCA). There is limited data on baseline characteristics and outcomes after an in-hospital SCA event in ESRD patients. METHODS For the purpose of this study, data were obtained from the National Inpatient Sample from January 2007 to December 2017. In-hospital SCA was identified using the International Classification of Disease, 9th Revision, Clinical Modification and International Classification of Disease, 10th Revision, Clinical Modification codes of 99.60, 99.63, and 5A12012. ESRD patients were subsequently identified using codes of 585.6 and N18.6. Baseline characteristics and outcomes were compared among ESRD and non-ESRD patients in crude and propensity score (PS)-matched cohorts. Predictors of mortality in ESRD patients after an in-hospital SCA event were analyzed using a multivariate logistic regression model. RESULTS A total of 1,412,985 patients sustained in-hospital SCA during our study period. ESRD patients with in-hospital SCA were younger and had a higher burden of key co-morbidities. Mortality was similar in ESRD and non-ESRD patients in PS-matched cohort (70.4% vs. 70.7%, p = 0.45) with an overall downward trend over our study years. Advanced age, Black race, and key co-morbidities independently predicted increased mortality while prior implantable defibrillator was associated with decreased mortality in ESRD patients after an in-hospital SCA event. CONCLUSIONS In the context of in-hospital SCA, mortality is similar in ESRD and non-ESRD patients in adjusted analysis. Adequate risk factor modification could further mitigate the risk of in-hospital SCA among ESRD patients.
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Affiliation(s)
- Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Moinuddin Syed
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Pratik Agrawal
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Mohammed Osman
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Anas Alharbi
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Mina M Benjamin
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Safi U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California San Diego, 9452 Medical Center Dr., MC 7411, La Jolla, CA, 92037, USA.
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Yedlapati SH, Khan SU, Talluri S, Lone AN, Khan MZ, Khan MS, Navar AM, Gulati M, Johnson H, Baum S, Michos ED. Effects of Influenza Vaccine on Mortality and Cardiovascular Outcomes in Patients With Cardiovascular Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e019636. [PMID: 33719496 PMCID: PMC8174205 DOI: 10.1161/jaha.120.019636] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Influenza infection causes considerable morbidity and mortality in patients with cardiovascular disease. We assessed the effects of the influenza vaccine on mortality and cardiovascular outcomes in patients with cardiovascular disease. Methods and Results We searched PubMed, Embase, and the Cochrane Library through January 2020 for randomized controlled trials and observational studies assessing the effects of influenza vaccine on mortality and cardiovascular outcomes in patients with cardiovascular disease. Estimates were reported as random effects risk ratios (RRs) with 95% CIs. Analyses were stratified by study design into randomized controlled trials and observational studies. A total of 16 studies (n=237 058), including 4 randomized controlled trials (n=1667) and 12 observational studies (n=235 391), were identified. Participants' mean age was 69.2±7.01 years, 36.6% were women, 65.1% had hypertension, 31.1% had diabetes mellitus, and 23.4% were smokers. At a median follow‐up duration of 19.5 months, influenza vaccine was associated with a lower risk of all‐cause mortality (RR, 0.75; 95% CI, 0.60–0.93 [P=0.01]), cardiovascular mortality (RR, 0.82; 95% CI, 0.80–0.84 [P<0.001]), and major adverse cardiovascular events (RR, 0.87; 95% CI, 0.80–0.94 [P<0.001]) compared with control. The use of the influenza vaccine was not associated with a statistically significant reduction of myocardial infarction (RR, 0.73; 95% CI, 0.49–1.09 [P=0.12]) compared with control. Conclusions Data from both randomized controlled trials and observational studies support the use of the influenza vaccine in adults with cardiovascular disease to reduce mortality and cardiovascular events, as currently supported by clinical guidelines. Clinicians and health systems should continue to promote the influenza vaccine as part of comprehensive secondary prevention.
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Affiliation(s)
| | - Safi U Khan
- Department of Medicine West Virginia University Morgantown WV
| | - Swapna Talluri
- Department of Medicine Guthrie Health System/Robert Packer Hospital Sayre PA
| | - Ahmed N Lone
- Department of Medicine Erie County Medical Center Buffalo NY
| | | | | | - Ann M Navar
- Division of Cardiology UT Southwestern Medical Center Dallas TX
| | - Martha Gulati
- Division of Cardiology University of Arizona Phoenix AZ
| | - Heather Johnson
- Boca Raton Regional Hospital/Baptist Health of South Florida Boca Raton FL
| | - Seth Baum
- Excel Medical Clinical Trials Boca Raton FL
| | - Erin D Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
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Ullah W, Sattar Y, Al-Khadra Y, Mukhtar M, Darmoch F, Rajput N, Hakim Z, Zahid S, Khan MZ, Fischman D, Alraies MC. Clinical outcomes of renal and liver transplant patients undergoing transcatheter aortic valve replacement: analysis of national inpatient sample database. Expert Rev Cardiovasc Ther 2021; 19:363-368. [PMID: 33615950 DOI: 10.1080/14779072.2021.1892489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: The transcatheter aortic valve replacement (TAVR) has recently gained traction as a viable alternative to surgical aortic valve replacement (SAVR), but data on its safety and clinical outcomes in transplant patients are limited.Methods: We retrieved relevant demographic and clinical outcome data from the U.S. National Inpatient Sample (NIS) for the year 2012-2015. The clinical outcomes of TAVR in renal transplant (RT) and liver transplant (LT) were ascertained using an adjusted odds ratio (aOR) with a 95% confidence interval (CI) on Mantzel-Hensel test.Results: A total of 62,399 TAVR patients were identified; 62,180 (99.6%) with no history of transplant, 219 (0.4%) with RT and 85 (0.1%) with LT. There was no significant difference in odds of in-hospital mortality (OR 0.61, 95% CI 0.25-1.5, p = 0.37), major cardiovascular, respiratory or neurological complications in patients with and without RT. Similarly, the odds of cardiac complications, renal and neurological complications between patients with and without LT were identical.Conclusion: Compared to non-transplant patients, TAVR appears to be associated with similar odds of major systemic complications or mortality in patients with a history of kidney or liver transplant.
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Affiliation(s)
- Waqas Ullah
- Department of Medicine, Abington Jefferson Health, Abington, PA, USA
| | - Yasar Sattar
- Department of Medicine, Icahn School of Medicine at Mount Sinai Elmhurst, Elmhurst, Queens, NY, USA
| | - Yasser Al-Khadra
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Maryam Mukhtar
- Department of Medicine, University Hospitals of Leicester NHS Trust, UK
| | - Fahed Darmoch
- Department of Cardiology, St. Vincent Charity Medical Center, cleveland, OH, USA
| | - Nida Rajput
- Farmingdale State College, Farmingdale, NY, USA
| | - Zaher Hakim
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
| | - Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | | | - David Fischman
- Department of Cardiology, Thomas Jefferson University Hospitals, PA, USA
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Detroit, MI, USA
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Khan MZ, Khan MU, Syed M, Balla S. Trends in Microbiology Data and Association With Mortality in Infective Endocarditis (2002-2017). Am J Cardiol 2021; 142:155-156. [PMID: 33387471 DOI: 10.1016/j.amjcard.2020.12.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
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Ullah W, Thalambedu N, Zahid S, Zia Khan M, Mir T, Roomi S, Fischman DL, Virani SS, Alam M. Percutaneous coronary intervention in patients with cardiac allograft vasculopathy: a Nationwide Inpatient Sample (NIS) database analysis. Expert Rev Cardiovasc Ther 2021; 19:269-276. [PMID: 33507114 DOI: 10.1080/14779072.2021.1882851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cardiac allograft vasculopathy (CAV) is a major cause of heart transplant failure and mortality. The role of percutaneous coronary intervention (PCI) in these patients remains unknown.Methods: The National Inpatient Sample (NIS) (2015-2017) was queried to identify all cases of CAV. The merits of PCI were determined using a propensity-matched multivariate logistic regression model. Adjusted odds ratios (aOR) for in-hospital complications were calculated.Results: A total of 2,380 patients (PCI 185, no-PCI 21,95) with CAV were included in the analysis. There was no significant difference in the odds of major bleeding (OR 1.87, 95% CI 0.94-3.7, P = 0.11), post-procedure bleeding (P = 0.37), cardiogenic shock (OR 0.87, 95% CI 0.45-1.69, P = 0.80), acute kidney injury (uOR 0.92, 95% CI 0.68-1.24, P = 0.64), cardiopulmonary arrest (OR 0.84, 95% CI 0.34-2.11, P = 0.88), and in-hospital mortality (OR 1.59, 95% CI 0.91-2.79, P = 0.14) between patients undergoing PCI compared to those treated conservatively. A propensity-matched analysis closely followed the results of unadjusted crude analysis.Conclusion: PCI in CAV may be associated with increased in-hospital complications and higher resource utilization.
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Affiliation(s)
- Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | | | - Salman Zahid
- Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Muhammad Zia Khan
- Department of Medicine, University of West Virginia, Morgantown, WV, USA
| | - Tanveer Mir
- Department of Cardiovascular Medicine, Detroit Medical Center, Detroit, MI, USA
| | - Sohaib Roomi
- Internal Medicine, Abington Jefferson Health, Abington, PA, USA
| | - David L Fischman
- Department of Cardiovascular Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.,Department of Cardiovascular Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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Ullah W, Jafar M, Zahid S, Ahmed F, Khan MZ, Sattar Y, Fischman DL, Virani SS, Alam M. Predictors of in-hospital mortality in patients with end-stage renal disease undergoing transcatheter aortic valve replacement: A nationwide inpatient sample database analysis. Cardiovascular Revascularization Medicine 2021; 34:63-68. [DOI: 10.1016/j.carrev.2021.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/15/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022]
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Khan MZ, Munir MB, Khan SU, Subramanian CR, Khan MU, Asad ZUA, Talluri S, Madhanakumar A, Lone AN, Khan MS, Michos ED, Alkhouli M. Representation of women, older patients, ethnic, and racial minorities in trials of atrial fibrillation. Pacing Clin Electrophysiol 2021; 44:423-431. [PMID: 33512027 DOI: 10.1111/pace.14178] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/28/2020] [Accepted: 01/18/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Representation trends of women, older adults, and ethnic/racial minorities in randomized controlled trials (RCTs) of atrial fibrillation (AF) are uncertain. METHODS We systematically reviewed 134 AF related RCTs (phase II and III) encompassing 149,162 participants using Medline and ClinicalTrials.gov through April 2019 to determine representation trends of women, older patients (≥75 years), and ethnic/racial minorities. Weighted data on the prevalence of AF from epidemiological studies were used to compare the representation of the studied groups of interest in AF RCTs to their expected burden of the disease. RESULTS Only 18.7% of the RCTs reported proportion of older patients, and 12.7% RCTs reported ethnic/racial minorities. The proportions of women in RCTs versus general population were 35.2% and 35.1%, of Hispanics were 11.9% and 5.2%, of Blacks were 1.2% and 5.7%, of American Indian/Alaskans were 0.2% and 0.2%, of Asians were 14.2% and 2.4%, of native Hawaiian/Pacific Islanders were 0.05% and 0.1% and of non-Whites were 19.5% and 22.5%, respectively. The weighted mean age (SD) across the trials was 65.3 (3.2) years which was less than the corresponding weighted mean age of 71.1 (4.5) years in the comparative epidemiological data. CONCLUSION The reporting of older patients and ethnic/racial minorities was poor in RCTs of AF. The representation of women and American Indian/Alaskan natives matched their expected population share of disease burden. Hispanics and Asians were over-represented and Blacks, native Hawaiian/Pacific Islanders and non-Whites were under-represented in RCTs of AF.
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Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | | | - Muhammad Usman Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Zain Ul Abideen Asad
- Cardiovascular Disease Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Swapna Talluri
- Department of Medicine, Guthrie Health System/Robert Packer Hospital, Sayre, Pennsylvania, USA
| | - Aarthi Madhanakumar
- Department of Cardiovascular Medicine, Allegheny General hospital, Pittsburgh, Pennsylvania, USA
| | - Ahmad Naeem Lone
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, John H. Stroger Cook County Hospital, Chicago, Illinois, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Osman M, Khan MZ, Farjo PD, Khan MU, Khan SU, Benjamin MM, Munir MB, Balla S. In-hospital outcomes of percutaneous mitral valve repair in patients with chronic obstructive pulmonary disease: insights from the national inpatient sample database. Catheter Cardiovasc Interv 2021; 97:E104-E112. [PMID: 32374943 DOI: 10.1002/ccd.28913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/10/2020] [Accepted: 04/06/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES We aimed to assess the in-hospital outcomes in patients with mitral regurgitation treated with percutaneous mitral valve repair (PMVR) among patients with chronic obstructive pulmonary disease (COPD). BACKGROUND There is lack of data on the outcomes of PMVR for mitral regurgitation in patients with COPD. METHODS We analyzed the national inpatient sample (NIS) database from January 2012 to December 2016. RESULTS A total of 9125 patients underwent PMVR in the period between January 2012 and December 2016, of whom 2,495 (27.3%) patients had concomitant COPD. Comparing COPD patients to non-COPD patients, COPD patients had higher proportion of females (48.3% vs. 46.6%, p = .16), were younger (75.8 ± 10.0 years vs. 76.4 ± 12.2 years; p = .04), had higher prevalence of peripheral vascular disease (17.4% vs. 13.5%; p < .01) and renal failure (39.3% vs. 37%; p < .01). After propensity matching, there was no significant difference in mortality among the COPD group versus non-COPD patients (2.6% vs. 2.9%; p = .6). Patients with COPD had higher proportion of in-hospital morbidities including St-segment elevation myocardial infarction (1.8% vs. 1.0%; p = .02), cardiogenic shock (1.4% vs. 0.4%; p < .01), vascular complications (2% vs. 0.8; p < .01), pneumothorax (1% vs. 0.4%; p < .01), and septic shock (1.2% vs. 0.4%; p < .01). Moreover, surrogates of severe disability (mechanical intubation and non-home discharges), cost of hospitalization, and length of stay were higher in the COPD group. CONCLUSIONS There was no difference in mortality between the COPD and non-COPD patients after PMVR. Moreover, we observed higher rates of in-hospital morbidities, surrogates of severe disability, and higher resources utilization by the COPD group.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Peter D Farjo
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Mina M Benjamin
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA.,Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
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Syed M, Khan MZ, Osman M, Alharbi A, Khan MU, Munir MB, Balla S. Comparison of Outcomes in Patients With Takotsubo Syndrome With-vs-Without Cardiogenic Shock. Am J Cardiol 2020; 136:24-31. [PMID: 32941812 DOI: 10.1016/j.amjcard.2020.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023]
Abstract
There is limited data on the in-hospital outcomes of cardiogenic shock (CS) secondary to takotsubo syndrome (TS). We aimed to assess the incidence, predictors, and outcomes of CS in hospitalized patients with TS. All patients with TS were identified from the National Inpatient Sample database from September 2006 to December 2017. The cohort was divided into those with versus without CS and logistic regression analysis was used to identify predictors of CS and mortality in patients admitted with TS. A total of 260,144 patients with TS were included in our study, of whom 14,703 (6%) were diagnosed with CS. In-hospital mortality in patients with CS was approximately six-fold higher compared with those without CS (23% vs 4%, p <0.01). TS patients with CS had a higher incidence of malignant arrhythmias like ventricular tachycardia or ventricular fibrillation (15.0% vs 4%, p <0.01) and non-shockable cardiac arrests (12% vs 2%, p <0.01). Independent predictors of CS were male gender, Asian and Hispanic ethnicity, increased burden of co-morbidities including congestive heart failure, chronic pulmonary disease, and chronic diabetes. Independent predictors of mortality were male gender, advanced age, history of congestive heart failure, chronic renal failure, and chronic liver disease. In conclusion, CS occurs in approximately 6% of patients admitted with TS, in-hospital mortality in TS patients with CS was approximately six-fold higher compared with those without CS (23% vs 4%, p <0.01), male gender and increased burden of co-morbidities at baseline were independent predictors of CS and mortality.
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Khan SU, Khan MU, Virani SS, Khan MS, Khan MZ, Rashid M, Kalra A, Alkhouli M, Blaha MJ, Blumenthal RS, Michos ED. Efficacy and safety for the achievement of guideline-recommended lower low-density lipoprotein cholesterol levels: a systematic review and meta-analysis. Eur J Prev Cardiol 2020; 28:2001-2009. [DOI: 10.1093/eurjpc/zwaa093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/23/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022]
Abstract
Abstract
Aim
The 2018 American Heart Association/American College of Cardiology/Multi-Society Cholesterol Guidelines recommended the addition of non-statins to statin therapy for high-risk secondary prevention patients above a low-density lipoprotein cholesterol (LDL-C) threshold of ≥70 mg/dL (1.8 mmol/L). We compared effectiveness and safety of treatment to achieve lower (<70) vs. higher (≥70 mg/dL) LDL-C among patients receiving intensive lipid-lowering therapy (statins alone or plus ezetimibe or proprotein convertase subtilisin/kexin type 9 inhibitors).
Methods and results
Eleven randomized controlled trials (130 070 patients), comparing intensive vs. less-intensive lipid-lowering therapy, with follow-up ≥6 months and sample size ≥1000 patients were selected. Meta-analysis was reported as random effects risk ratios (RRs) [95% confidence intervals] and absolute risk differences (ARDs) as incident cases per 1000 person-years. The median LDL-C levels achieved in lower LDL-C vs. higher LDL-C groups were 62 and 103 mg/dL, respectively. At median follow-up of 2 years, the lower LDL-C vs. higher LDL-C group was associated with significant reduction in all-cause mortality [ARD −1.56; RR 0.94 (0.89–1.00)], cardiovascular mortality [ARD −1.49; RR 0.90 (0.81–1.00)], and reduced risk of myocardial infarction, cerebrovascular events, revascularization, and major adverse cardiovascular events (MACE). These benefits were achieved without increasing the risk of incident cancer, diabetes mellitus, or haemorrhagic stroke. All-cause mortality benefit in lower LDL-C group was limited to statin therapy and those with higher baseline LDL-C (≥100 mg/dL). However, the RR reduction in ischaemic and safety endpoints was independent of baseline LDL-C or drug therapy.
Conclusion
This meta-analysis showed that treatment to achieve LDL-C levels below 70 mg/dL using intensive lipid-lowering therapy can safely reduce the risk of mortality and MACE.
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Affiliation(s)
- Safi U Khan
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Muhammad U Khan
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center, Department of Medicine, Baylor College of Medicine, 2002 Holcombe Blvd, Houston, TX 77030, USA
| | - Muhammad Shahzeb Khan
- Department of Medicine, John H Stroger Jr. Hospital of Cook County, 1969 Ogden Ave, Chicago, IL 60612, USA
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26505, USA
| | - Muhammad Rashid
- Department of Cardiology, Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Michael J Blaha
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287, USA
| | - Roger S Blumenthal
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 524-D1, Baltimore, MD 21287, USA
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Munir MB, Khan MZ, Darden D, Pasupula DK, Balla S, Han FT, Reeves R, Hsu JC. Contemporary procedural trends of Watchman percutaneous left atrial appendage occlusion in the United States. J Cardiovasc Electrophysiol 2020; 32:83-92. [PMID: 33155356 DOI: 10.1111/jce.14804] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/21/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine trends in real-world utilization and in-hospital adverse events from Watchman implantation since its approval by the Food and Drug Administration in 2015. BACKGROUND The risk of embolic stroke caused by atrial fibrillation is reduced by oral anticoagulants, but not all patients can tolerate long-term anticoagulation. Left atrial appendage occlusion with the Watchman device has emerged as an alternative therapy. METHODS This was a retrospective cohort study utilizing data from National Inpatient Sample for calendar years 2015-2017. The outcomes assessed in this study were associated complications, in-hospital mortality, and resource utilization trends after Watchman implantation. Trends analysis were performed using analysis of variance. Multivariable adjusted logistic regression analysis was performed to determine predictors of mortality. RESULTS A total of 17 700 patients underwent Watchman implantation during the study period. There was a significantly increased trend in the number of Watchman procedures performed over the study years (from 1195 in 2015 to 11 165 devices in 2017, p < .01). A significant decline in the rate of complications (from 26.4% in 2015% to 7.9% in 2017, p < .01) and inpatient mortality (from 1.3% in 2015% to 0.1% in 2017, p < .01) were noted. Predictors of in-hospital mortality included a higher CHA2 DS2 -VASc score (odds ratio [OR]: 2.61 per 1-point increase, 95% confidence interval [CI]: 1.91-3.57), chronic blood loss anemia (OR: 3.63, 95% CI: 1.37-9.61) and coagulopathy (OR: 4.90, 95% CI: 2.32-10.35). CONCLUSION In contemporary United States clinical practice, Watchman utilization has increased significantly since approval in 2015, while complications and in-patient mortality have declined.
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Affiliation(s)
- Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Douglas Darden
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Deepak K Pasupula
- Division of Cardiology, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Frederick T Han
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Ryan Reeves
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California, USA
| | - Jonathan C Hsu
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California, USA
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Nasar J, Shao Z, Arshad A, Jones FG, Liu S, Li C, Khan MZ, Khan T, Banda JSK, Zhou X, Gao Q. The effect of maize-alfalfa intercropping on the physiological characteristics, nitrogen uptake and yield of maize. Plant Biol (Stuttg) 2020; 22:1140-1149. [PMID: 32609937 DOI: 10.1111/plb.13157] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/28/2020] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
In Northeastern China, the intensive cropping system and increased use of chemical fertilizer has caused severe problems in terms of sustainable agricultural development. Therefore, to improve agricultural sustainability and crop productivity the farming system needs to be modified in the region. A pot experiment was conducted to evaluate the effect of maize-alfalfa intercropping on the physiological characteristics, nitrogen (N) uptake and yield of the maize crops in northeast China in 2017-2018. The study findings showed that intercropping under N fertilization progressively improved the physio-agronomic indices of the maize crop as compared to mono-cropping. The grain yield, 100 seed weight and biomass dry matter of maize crop improved in intercropping when it was practiced with N fertilizer. Furthermore, intercropping with N fertilization increased the chlorophyll content of the maize crop at bell-mouthed, silking, filing and mature stages by 19%, 44%, 12%, and 9% in 2017 and by 23%, 43%, 15%, and 11% in 2018, respectively, as compared with the monocropping system. Unlike monocropping, intercropping with N fertilization increased the photosynthesis rate (14% and 15%), stomatal conductance (74% and 98%) and transpiration rate (74% and 75%) in 2017 and 2018, respectively. However, intercropping reduced intercellular CO2 (Ci ). Moreover, intercropping with N fertilization increased the maize N content of grain and leaves as well as total N uptake by 49%, 31% and 93% in 2017 and 53%, 34% and 132%, respectively, in 2018 as compared to monocropping. In conclusion, our results suggest that maize-alfalfa intercropping with optimal N fertilization provides a practical method for improving growth, yield and N accumulation in the maize crop.
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Affiliation(s)
- J Nasar
- Key Laboratory of Sustainable Utilization of Soil Resources in the Commodity Grain Bases in Jilin Province, Jilin Agricultural University, Changchun, 130118, China
| | - Z Shao
- Key Laboratory of Sustainable Utilization of Soil Resources in the Commodity Grain Bases in Jilin Province, Jilin Agricultural University, Changchun, 130118, China
| | - A Arshad
- College of Resources and Environmental Sciences, China Agricultural University, Beijing, 100193, China
| | - F G Jones
- Key Laboratory of Sustainable Utilization of Soil Resources in the Commodity Grain Bases in Jilin Province, Jilin Agricultural University, Changchun, 130118, China
| | - S Liu
- Key Laboratory of Sustainable Utilization of Soil Resources in the Commodity Grain Bases in Jilin Province, Jilin Agricultural University, Changchun, 130118, China
| | - C Li
- Key Laboratory of Sustainable Utilization of Soil Resources in the Commodity Grain Bases in Jilin Province, Jilin Agricultural University, Changchun, 130118, China
| | - M Z Khan
- College of Plant Protection, Jilin Agricultural University, Changchun, 130118, Jilin Province, China
| | - T Khan
- Department of Mathematics and Statistics, Lanzhou University, Lanzhou, China
| | - J S K Banda
- Zambia Agriculture Research Institute, P/B 7, Chilanga, Zambia
| | - X Zhou
- Key Laboratory of Sustainable Utilization of Soil Resources in the Commodity Grain Bases in Jilin Province, Jilin Agricultural University, Changchun, 130118, China
| | - Q Gao
- Key Laboratory of Sustainable Utilization of Soil Resources in the Commodity Grain Bases in Jilin Province, Jilin Agricultural University, Changchun, 130118, China
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Khan SU, Kalra A, Kapadia SR, Khan MU, Zia Khan M, Khan MS, Mamas MA, Warraich HJ, Nasir K, Michos ED, Alkhouli M. Demographic, Regional, and State-Level Trends of Mortality in Patients With Aortic Stenosis in United States, 2008 to 2018. J Am Heart Assoc 2020; 9:e017433. [PMID: 33070675 PMCID: PMC7763421 DOI: 10.1161/jaha.120.017433] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Aortic stenosis–related mortality might vary across demographic subsets, regions, and states in the United States. Methods and Results We reviewed the death certificate data from the Centers for Disease Control and Prevention Wide‐Ranging OnLine Data for Epidemiologic Research database to examine aortic stenosis–related mortality trends from 2008 to 2018. Crude and age‐adjusted mortality rates (AAMRs) per 100 000 people and annual percentage change with 95% CIs were calculated. Between 2008 and 2018, AAMR reduced from 12.7 to 11.5 (average annual percentage change, −1.0 [95% CI, −1.5 to −0.5]), because of an accelerated decline between 2015 and 2018 (annual percentage change, −4.4 [95% CI, −6.0 to −2.7]). Older (aged >85 years), male, and White patients had higher death rates than younger, female, and non‐White patients, respectively. Although mortality reduction was similar across sexes, significant mortality reduction was limited to White patients only. The AAMRs were higher in rural than urban areas. States with AAMRs >90th percentile were distributed in the West and the Northeast, and <10th percentile in the South. The AAMRs for sex and race were highest in the West and lowest in the South. None of the states located in the Midwest showed a significant reduction in mortality. Mortality remained stable for hospital setting and nursing home/long‐term care facility, except that the number of deaths increased at home and hospice facility since 2014. Conclusions The reduction in mortality in patients with aortic stenosis was not consistent among demographic subsets and states. The substantial public health and economic implications call for determination of underlying clinical and socioeconomic factors to narrow the gap.
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Affiliation(s)
- Safi U Khan
- Department of Medicine West Virginia University Morgantown WV
| | - Ankur Kalra
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH.,Section of Cardiovascular Research Heart, Vascular and Thoracic Department Cleveland Clinic Akron General Akron OH
| | - Samir R Kapadia
- Department of Cardiovascular Medicine Heart, Vascular and Thoracic Institute Cleveland Clinic Cleveland OH
| | - Muhammad U Khan
- Department of Medicine West Virginia University Morgantown WV
| | | | | | - Mamas A Mamas
- Keele Cardiovascular Research Group Keele University Stoke-on-Trent UK.,Department of Medicine Jefferson University Philadelphia PA
| | | | - Khurram Nasir
- Department of Cardiovascular Medicine Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Erin D Michos
- Division of Cardiology Department of Medicine Johns Hopkins School of Medicine Baltimore MD.,The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins School of Medicine Baltimore MD
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Lone AN, Khan MZ, Khan MS, Talluri S, Khan SU. Trends of Co-morbidities in Clinical Trials of Lipid Lowering Therapies. Am J Cardiol 2020; 133:184-185. [PMID: 32811648 DOI: 10.1016/j.amjcard.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Ahmad N Lone
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Muhammad Shahzeb Khan
- Department of Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, Illinois
| | - Swapna Talluri
- Department of Medicine, Guthrie Health System/Robert Packer Hospital, Sayre, Pennsylvania
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia.
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Khan MZ, Zahid S, Khan MU, Khan SU, Munir MB, Balla S. Gender Disparities in Percutaneous Mitral Valve Repair (from the National Inpatient Sample). Am J Cardiol 2020; 132:179-181. [PMID: 32768141 DOI: 10.1016/j.amjcard.2020.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia.
| | - Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Muhammad U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia; Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
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Lone AN, Khan MZ, Khan MU, Khan S, Balla S. Trends In Utilization of Palliative Care In Acute Heart Failure Admissions. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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85
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Lone AN, Khan MZ, Khan MU, Khan S, Balla S. Gender, Racial and Ethnicity Based Trends in Acute Congestive Heart Failure Admissions. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lone AN, Khan MZ, Khan M, Khan S, Balla S. Trends in the Use of Cardiac Assist Devices in Heart Failure Patients with Cardiogenic Shock. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khan SU, Khan MZ, Lone AN, Khan MS, Subramanian CR, Michos ED, Alkhouli M. Trends of Comorbidities in Clinical Trials of Atrial Fibrillation. Am J Cardiol 2020; 131:127-128. [PMID: 32709421 DOI: 10.1016/j.amjcard.2020.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 10/24/2022]
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88
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Khan MU, Khan MZ, Munir MB, Balla S, Khan SU. Meta-analysis of the Safety and Efficacy of Bempedoic Acid. Am J Cardiol 2020; 131:130-132. [PMID: 32711805 DOI: 10.1016/j.amjcard.2020.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/18/2020] [Accepted: 06/19/2020] [Indexed: 10/24/2022]
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89
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Khan SU, Bashir ZS, Khan MZ, Khan MS, Gulati M, Blankstein R, Blumenthal RS, Michos ED. Trends in Cardiovascular Deaths Among Young Adults in the United States, 1999-2018. Am J Prev Cardiol 2020. [DOI: 10.1016/j.ajpc.2020.100049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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90
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Khan SU, Khan MU, Virani SS, Khan MS, Khan MZ, Rashid M, Kalra A, Alkhouli M, Blaha MJ, Blumenthal RS, Michos ED. Efficacy and Safety for the Achievement of Guideline-Recommended Lower Low-Density Lipoprotein Cholesterol Levels: A Systematic Review and Meta-Analysis. Am J Prev Cardiol 2020. [DOI: 10.1016/j.ajpc.2020.100050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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91
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Khan MZ, Khan MU, Munir MB. Trends and Disparities in Palliative Care Encounters in Acute Heart Failure Admissions; Insight From National Inpatient Sample. Cardiovasc Revasc Med 2020; 23:52-56. [PMID: 32861636 DOI: 10.1016/j.carrev.2020.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/25/2020] [Accepted: 08/12/2020] [Indexed: 12/17/2022]
Abstract
Heart failure is a leading cause of readmissions in the United States, although treatment has come along away, palliative care is often not appropriately offered in advanced heart failure. The purpose of this study was to use a large database of national in-patient sample to find out the use of palliative care in acute heart failure admissions. Data from 2002 to 2017 was used for analysis. Simple linear regression was used for trend analysis over the years. Variables that were statistically significant in univariate analysis were used in single-step (entry method) multiple logistic analysis. The use of palliative care was found to be low at 4.1%, although recent trends have shown an increase (from 0.4% in 2002 to 6.2% in 2017). Women (0.3% in 2002 to 6.5% in 2017) and Caucasians (0.6% in 2002 to 6.9% in 2017) had a higher proportion of PC encounters as compared to men (0.5% in 2002 to 5.9% in 2017) and other racial minorities, increasing age (OR, 1.04[CI; 1.03-1.04], p < 0.01), female gender (OR, 1.03[CI; 1.02-1.03], p < 0.01), do not resuscitate status (OR, 10.62[CI; 10.53-10.70], p < 0.01), diabetes mellitus (OR, 1.10[CI; 1.01-1.11], p < 0.01), liver disease (OR, 1.63[CI; 1.60-1.66], p < 0.01), renal failure (OR, 1.40[CI; 1.39-1.41], p < 0.01), acute myocardial infarction (OR, 1.28[CI; 1.27-1.30], p < 0.01), and cardiogenic shock (OR, 2.89[CI; 2.84-2.93], p < 0.01) were associated with higher odds of having PC encounter. In conclusion, the use of palliative care has increased in the United States over the years, however, it is still low as compared to other high-income countries.
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Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA.
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92
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Khan MZ, Khan SU, Khan MS, Butler J, Alkhouli M. Disparities in Discharge Disposition After Hospitalizations for Decompensated Heart Failure. Cardiovasc Revasc Med 2020; 28:95-97. [PMID: 32798116 DOI: 10.1016/j.carrev.2020.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/24/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA.
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | | | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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93
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Khan SU, Singh M, Valavoor S, Khan MU, Lone AN, Khan MZ, Khan MS, Mani P, Kapadia SR, Michos ED, Stone GW, Kalra A, Bhatt DL. Dual Antiplatelet Therapy After Percutaneous Coronary Intervention and Drug-Eluting Stents: A Systematic Review and Network Meta-Analysis. Circulation 2020; 142:1425-1436. [PMID: 32795096 PMCID: PMC7547897 DOI: 10.1161/circulationaha.120.046308] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention with drug-eluting stents remains uncertain. We compared short-term (<6-month) DAPT followed by aspirin or P2Y12 inhibitor monotherapy; midterm (6-month) DAPT; 12-month DAPT; and extended-term (>12-month) DAPT after percutaneous coronary intervention with drug-eluting stents. METHODS Twenty-four randomized, controlled trials were selected using Medline, Embase, Cochrane library, and online databases through September 2019. The coprimary end points were myocardial infarction and major bleeding, which constituted the net clinical benefit. A frequentist network meta-analysis was conducted with a random-effects model. RESULTS In 79 073 patients, at a median follow-up of 18 months, extended-term DAPT was associated with a reduced risk of myocardial infarction in comparison with 12-month DAPT (absolute risk difference, -3.8 incident cases per 1000 person-years; relative risk, 0.68 [95% CI, 0.54-0.87]), midterm DAPT (absolute risk difference, -4.6 incident cases per 1000 person-years; relative risk, 0.61 [0.45-0.83]), and short-term DAPT followed by aspirin monotherapy (absolute risk difference, -6.1 incident cases per 1000 person-years; relative risk, 0.55 [0.37-0.83]), or P2Y12 inhibitor monotherapy (absolute risk difference, -3.7 incident cases per 1000 person-years; relative risk, 0.69 [0.51-0.95]). Conversely, extended-term DAPT was associated with a higher risk of major bleeding than all other DAPT groups. In comparison with 12-month DAPT, no significant differences in the risks of ischemic end points or major bleeding were observed with midterm or short-term DAPT followed by aspirin monotherapy, with the exception that short-term DAPT followed by P2Y12 inhibitor monotherapy was associated with a reduced risk of major bleeding. There were no significant differences with respect to mortality between the different DAPT strategies. In acute coronary syndrome, extended-term in comparison with 12-month DAPT was associated with a reduced risk of myocardial infarction without a significant increase in the risk of major bleeding. CONCLUSIONS The present network meta-analysis suggests that, in comparison with 12-month DAPT, short-term DAPT followed by P2Y12 inhibitor monotherapy reduces major bleeding after percutaneous coronary intervention with drug-eluting stents, whereas extended-term DAPT reduces myocardial infarction at the expense of more bleeding events.
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Affiliation(s)
- Safi U Khan
- Department of Medicine, West Virginia University, Morgantown (S.U.K., S.V., M.U.K., A.N.L., M.Z.K.)
| | - Maninder Singh
- Department of Cardiovascular Medicine, Guthrie Health System/Robert Packer Hospital, Sayre, PA (M.S.)
| | - Shahul Valavoor
- Department of Medicine, West Virginia University, Morgantown (S.U.K., S.V., M.U.K., A.N.L., M.Z.K.)
| | - Muhammad U Khan
- Department of Medicine, West Virginia University, Morgantown (S.U.K., S.V., M.U.K., A.N.L., M.Z.K.)
| | - Ahmad N Lone
- Department of Medicine, West Virginia University, Morgantown (S.U.K., S.V., M.U.K., A.N.L., M.Z.K.)
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown (S.U.K., S.V., M.U.K., A.N.L., M.Z.K.)
| | - Muhammad Shahzeb Khan
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL (M.S.K.)
| | - Preethi Mani
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH (P.M., S.R.K., A.K.)
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH (P.M., S.R.K., A.K.)
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD (E.D.M.)
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY, and the Cardiovascular Research Foundation (G.W.S.)
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH (P.M., S.R.K., A.K.).,Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, OH (A.K.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
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94
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Khan SU, Bashir ZS, Khan MZ, Khan MS, Gulati M, Blankstein R, Blumenthal RS, Michos ED. Trends in Cardiovascular Deaths Among Young Adults in the United States, 1999 to 2018. Am J Cardiol 2020; 128:216-217. [PMID: 32534735 DOI: 10.1016/j.amjcard.2020.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/08/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia.
| | - Zubair Shahid Bashir
- Department of Medicine, University of Pittsburgh Medical Center/Mckeesport, McKeesport, Pennsylvania
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Muhammad Shahzeb Khan
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois
| | - Martha Gulati
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, Arizona
| | - Ron Blankstein
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland
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95
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Khan MZ, Khan MU, Kalra A, Krupica T, Kaluski E, Khan SU. Transcatheter versus surgical aortic valve replacement in patients with end stage renal disease. Catheter Cardiovasc Interv 2020; 96:1102-1109. [PMID: 33034959 DOI: 10.1002/ccd.29109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/12/2020] [Accepted: 06/05/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To assess contemporary national trends of comorbidities, outcomes, and health care resource utilization in patients with aortic stenosis (AS) and end-stage renal disease (ESRD) undergoing transcatheter and surgical aortic valve replacement (TAVR and SAVR). METHODS AND RESULTS The National-Inpatient-Sample was used to study trends in patients with AS and ESRD undergoing TAVR and SAVR between January 2012 and December 2017. Of 12,550 patients, 5,735 underwent TAVR and 6,815 underwent SAVR. Over the years, the utilization of SAVR declined (from 82.0 to 37.7%); and increased for TAVR (from 18.0 to 62.3%; p < .001). Patients receiving TAVR were older (74.6 [9.1] vs. 66.8 years [9.1]), had a higher proportion of females (37.1 vs. 32.5%), Caucasians (68.7 vs. 60.9%) and Asian /Pacific Islanders (3.1 vs. 2.7%; p < .001 for all). The TAVR patients, despite having higher comorbidity burden (anemia, coronary artery disease, chronic pulmonary disease, congestive heart failure, cerebrovascular disease, and peripheral vascular disease) had lower inpatient mortality and complications (ST-elevation myocardial infarction, pneumonia, pneumothorax, pulmonary embolism, cardiogenic shock, cardiac arrest, and need for mechanical ventilators and vasopressors). The median length of stay (13.9-6.5 days; p < .001) and cost of stay ($311,538.16 to $255,693.40; p < .001) reduced with TAVR; but remained unchanged with SAVR. Higher proportion of patients was discharged home after TAVR vs. SAVR. CONCLUSION Among patients with AS and ESRD, despite providing therapy to subjects with higher comorbidity burden, TAVR was associated with lower inpatient mortality, complications, length of stay, cost of care, and higher home disposition rates when compared with SAVR.
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Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Muhammad U Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Ankur Kalra
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Troy Krupica
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Edo Kaluski
- Guthrie Clinic/Robert Packer Hospital, Sayre, Pennsylvania, USA.,Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
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96
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Khan MZ, Khan MU, Patel K, Khan SU, Valavoor S, Osman M, Balla S, Munir MB. Trends, Predictors and Outcomes After Utilization of Targeted Temperature Management in Cardiac Arrest Patients With Anoxic Brain Injury. Am J Med Sci 2020; 360:363-371. [PMID: 32624168 DOI: 10.1016/j.amjms.2020.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/30/2020] [Accepted: 05/15/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Targeted Temperature Management (TTM) is a class I recommendation for the management of sudden cardiac arrest (SCA) patients with presumed brain injury. We aimed to study trends, predictors and outcomes in SCA patients from a nationally represented US population sample. METHODS We utilized the National Inpatient Sample from years 2005 to 2014 for the purpose of our study. Patients with SCA and anoxic brain injury were selected using relevant ICD-9 codes. Data were analyzed for trends over the years and key outcomes were assessed. Logistic regression analysis was done to determine predictors of TTM utilization in our study population. RESULTS A total of 78,465 patients with SCA and anoxic brain injury were identified from January 2005 to December 2014. Out of these, approximately 4,481 (5.7%) patients underwent TTM. Patients that underwent TTM were younger compared to patients without TTM utilization (60.67 vs. 63.27 years, P < 0.01). African Americans, Hispanics and women were less likely to undergo TTM. Myocardial infarction, electrolyte disorders and cardiogenic shock were associated with higher odds of TTM utilization. Sepsis, renal failure and diabetes were associated with underutilization of TTM. Inpatient mortality was higher in patients who did not undergo TTM when compared to patients who underwent TTM (67.30% vs. 65.10%, P < 0.01). CONCLUSIONS Although TTM utilization increased over our study period, the overall application of TTM was still dismal. Factors that circumvent TTM utilization need to be addressed in future studies so more eligible patients could benefit from this life saving therapy.
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MESH Headings
- Aged
- Brain Injuries/complications
- Brain Injuries/mortality
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Female
- Humans
- Hypothermia, Induced/statistics & numerical data
- Hypothermia, Induced/trends
- Hypoxia, Brain/complications
- Hypoxia, Brain/mortality
- Logistic Models
- Male
- Middle Aged
- Treatment Outcome
- United States/epidemiology
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Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Muhammad U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Kinjan Patel
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Safi U Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Shahul Valavoor
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Mohammed Osman
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia; Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California.
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Abstract
Background Heart failure (HF) imparts a significant clinical and economic burden on the health system in the United States. Methods and Results We used the National Inpatient Sample database between September 2002 and December 2016. We examined trends of comorbidities, inpatient mortality, and healthcare resource use in patients admitted with acute HF. Outcomes were adjusted for demographic variables, comorbidities, and inflation. A total of 11 806 679 cases of acute HF hospitalization were identified. The burden of coronary artery disease, peripheral vascular disease, valvular heart disease, diabetes mellitus, hypertension, anemia, cancer, depression, and chronic kidney disease among patients admitted with acute HF increased over time. The adjusted mortality decreased from 6.8% in 2002 to 4.9% in 2016 (P-trend<0.001; average annual decline, 1.99%), which was consistent across age, sex, and race. The adjusted mean length of stay decreased from 8.6 to 6.5 days (P<0.001), but discharge disposition to a long-term care facility increased from 20.8% to 25.6% (P<0.001). The adjusted mean cost of stay increased from $51 548 to $72 075 (P<0.001; average annual increase, 2.78%), which was partially explained by the higher proportion of procedures (echocardiogram, right heart catheterization, use of ventricular assist devices, coronary artery bypass grafting) and the higher incidence of HF complications (cardiogenic shock, respiratory failure, ventilator, and renal failure requiring dialysis). Conclusions This national data set showed that despite increasing medical complexities, there was significant reduction in inpatient mortality and length of stay. However, these measures were counterbalanced by a higher proportion of discharge disposition to long-term care facilities and expensive cost of care.
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Affiliation(s)
- Safi U Khan
- Department of Medicine West Virginia University Morgantown WV
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98
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Khan MZ, Sulaiman S, Agrawal P, Osman M, Khan MU, Khan SU, Balla S, Munir MB. Targeted temperature management in cardiac arrest patients with a non-shockable rhythm: A national perspective. Am Heart J 2020; 225:129-137. [PMID: 32485327 DOI: 10.1016/j.ahj.2020.04.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/28/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Retrospective studies have shown conflicting benefit of utilizing targeted temperature management (TTM) in cardiac arrest (CA) patients with a non-shockable rhythm and presently there is only one randomized trial in this realm. We sought to determine trends and outcomes of TTM utilization in these patients from a large nationally representative United States population database. METHODS AND RESULTS Data were derived from National Inpatient Sample (NIS) from January 2006 to December 2013. All patients were identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Patients with evidence of shockable rhythm (ventricular tachycardia, ventricular flutter and ventricular fibrillation) were excluded. Trends in TTM utilization and mortality were assessed over our study period. Various outcomes were measured in patients receiving TTM and no TTM in unmatched and propensity matched cohorts. Logistic regression analysis was done to determine predictors of mortality. A total of 1,185,479 CA patients were identified in whom cause of arrest was a non-shockable rhythm. Overall, there was a steady increase in TTM utilization over our study period. In propensity-matched groups, mortality was higher in patients in whom TTM was utilized compared to non-TTM group (72.9% vs 68.7%, P < .01). In adjusted analysis, TTM remains an independent predictor of increased mortality in our group. Mortality remained high with TTM utilization regardless of location of CA. CONCLUSIONS TTM utilization was associated with increased mortality in CA patients with a non-shockable rhythm. These findings merit further confirmation in a large randomized trial before application into clinical practice.
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99
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Khan SU, Khan MZ, Alkhouli M. Reader's Comments: Trends in the Utilization of Left Atrial Appendage Exclusion in the United States. Am J Cardiol 2020; 126:106-107. [PMID: 32336535 DOI: 10.1016/j.amjcard.2020.03.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022]
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100
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Khan MZ, Munir MB, Khan MU, Khan SU, Benjamin MM, Balla S. Contemporary Trends in Native Valve Infective Endocarditis in United States (from the National Inpatient Sample Database). Am J Cardiol 2020; 125:1678-1687. [PMID: 32278463 DOI: 10.1016/j.amjcard.2020.02.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/18/2022]
Abstract
Infective Endocarditis (IE) is associated with high mortality and morbidity. The data on contemporary trends and health care utilization remain scarce for IE. Consequently, we used the National Inpatient Sample database from 2002 to 2016 to study burden of IE. Risk-adjusted rates were calculated using an Analysis of Covariance with the Generalized Linear Model. Trends were assessed with linear regression and Pearson's Chi-square modeling, where appropriate. Binomial logistic regression was used for computing predictors of in-hospital mortality. We identified 523,432 hospitalizations for native valve IE. Risk-adjusted mortality decreased from 16.7% in 2002 to 9.7% in 2016 (p <0.01). The risk-adjusted length of stay decreased from 17.4 days in 2002 to 13.4 days in 2016 (p <0.01). Mean cost of stay adjusted for risk factors and inflation increased from 112,702$ in 2002 to 164,767$ in 2016 (p <0.01). Valve replacement increased from 10.2% in 2002 in to 13.4% in 2016, (p <0.01). Independent predictors of mortality included age (OR, 1.02 [1.02 to 1.020], p <0.01), female gender (OR, 1.07 [1.05 to 1.09], p <0.01), Blacks (OR, 1.28 [1.24 to 1.31], p <0.01), Hispanics (OR, 1.15 [1.11 to 1.19], p <0.01) and patients with co-morbid conditions like congestive heart failure (OR, 1.78 [1.74 to 1.82], p <0.01), renal failure (OR, [1.69 [1.65 to 1.73], p <0.01) and weight loss (OR, 1.40 [1.36 to 1.43], p <0.01). In summary, in-hospital mortality from native valve IE has been decreasing but total hospitalization and average cost of stay has increased.
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