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Tsai CH, Kung PT, Wang SM, Tsai TH, Tsai WC. The association between the workload of emergency physicians and the outcomes of acute myocardial infarction: a population-based study. Sci Rep 2023; 13:21212. [PMID: 38040727 PMCID: PMC10692142 DOI: 10.1038/s41598-023-48150-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 11/22/2023] [Indexed: 12/03/2023] Open
Abstract
Acute myocardial infarction (AMI) is the second leading cause of mortality in Taiwan. The correlation between the workload of emergency physicians and the outcome of AMI remains unknown. To determine the effects of the workload of emergency physicians on the outcomes of AMI. We included 17 661 patients (age > 18 years) with STEMI undergoing PCI, who visited the emergency department between 2012 and 2018. We used the logistic regression model with generalized estimating equations (GEEs) to analyze the risk of death within 30 days after emergency department visit, the risk of emergency department revisits within 3 days, and the risk of readmission within 14 days in all subgroups. After covariate adjustment, the risk of mortality within 30 days after visiting the emergency department was significantly higher in the subgroup whose visiting emergency physicians had the highest workload (odds ratio [OR]: 1.39; 95% confidence interval [CI]: 1.12 to 1.72). Furthermore, the risk of revisiting the emergency department within 3 days after discharge from the hospital was significantly higher in the subgroup whose visiting emergency physicians' workload was within the second and third quartiles (OR 1.85; 95% CI 1.18 to 2.89). The workload of emergency physicians appears to be positively correlated with the mortality risk of patients with STEMI undergoing PCI.
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Affiliation(s)
- Chang-Hung Tsai
- Miao-Li General Hospital, Ministry of Health and Welfare, Miaoli City, Taiwan, ROC
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, ROC
- Department of Public Health, China Medical University, Taichung, Taiwan, ROC
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan, ROC
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan, ROC
| | - Shun-Mu Wang
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan, ROC
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, ROC
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung, 406040, Taiwan, ROC.
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Tsai CH, Kung PT, Wang SM, Tsai TH, Tsai WC. 24-h PCI model does affect the outcome of STEMI patients: a population-based study. Sci Rep 2023; 13:13063. [PMID: 37567948 PMCID: PMC10421952 DOI: 10.1038/s41598-023-40276-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023] Open
Abstract
Acute myocardial infarction has been the second leading cause of death in Taiwan. It's a novel issue to evaluate the relationship between the 24-h PCI service model and the outcome of STEMI patients. The objective of this study was to determine the effect of 24-h PCI service model in STEMI patients to improving survival rate. This population-based cohort study included those STEMI patients, older than 18 year-old, who had ever called emergency department from 2012 to 2018. We had two groups of our study participant, one group for STEMI patients with 24-h PCI model and the other group for STEMI patients with non-24-h PCI model. We used the Logistic regression model to analyze the risk of death within 30 days, emergency department (ED) revisits within 3 days, and readmission within 14 days. After the relevant variables were controlled, the risk of death after an ED visit among the patients with STEMI who were sent to hospitals with 24-h PCI services was significantly lower than that among the patients with STEMI who were sent to hospitals without 24-h PCI services (OR 0.85; 95% CI 0.75-0.98). However, the model could not reduce the risk of ER revisits and readmission.
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Affiliation(s)
- Chang-Hung Tsai
- Miao-Li General Hospital, Ministry of Health and Welfare, Miaoli, Taiwan, R.O.C
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung City, 406040, Taiwan, R.O.C
- Department of Public Health, China Medical University, Taichung City, Taiwan, R.O.C
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan, R.O.C
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung City, Taiwan, R.O.C
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung City, Taiwan, R.O.C
| | - Shun-Mu Wang
- Department of Senior Services Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan, R.O.C
| | - Tung-Han Tsai
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung City, 406040, Taiwan, R.O.C
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Section 1, Jingmao Road, Beitun District, Taichung City, 406040, Taiwan, R.O.C..
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Piccolo R, Manzi L, Simonetti F, Leone A, Angellotti D, Immobile Molaro M, Verde N, Cirillo P, Di Serafino L, Franzone A, Spaccarotella CAM, Esposito G. Management of Non-Culprit Lesions in STEMI Patients with Multivessel Disease. J Clin Med 2023; 12:jcm12072572. [PMID: 37048655 PMCID: PMC10095226 DOI: 10.3390/jcm12072572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/19/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
Multivessel disease is observed in approximately 50% of patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Data from randomized clinical trials has shown that complete revascularization in the STEMI setting improves clinical outcomes by reducing the risk of reinfarction and urgent revascularization. However, the timing and modality of revascularization of non-culprit lesions are still debated. PCI of non-culprit lesions can be performed during the index primary PCI or as a staged procedure and can be guided by angiography, functional assessment, or intracoronary imaging. In this review, we summarize the available evidence about the management of non-culprit lesions in STEMI patients with or without cardiogenic shock.
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Rashidi A, Whitehead L, Glass C. Factors affecting hospital readmission rates following an acute coronary syndrome: A systematic review. J Clin Nurs 2021; 31:2377-2397. [PMID: 34811845 PMCID: PMC9546456 DOI: 10.1111/jocn.16122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 01/04/2023]
Abstract
Aim To synthesise quantitative evidence on factors that impact hospital readmission rates following ACS with comorbidities. Design Systematic review and narrative synthesis. Data sources A search of eight electronic databases, including Embase, Medline, PsycINFO, Web of Science, CINAHL, Cochrane Library, Scopus and the Joanna Briggs Institute (JBI). Review methods The search strategy included keywords and MeSH terms to identify English language studies published between 2001 and 2020. The quality of included studies was assessed by two independent reviewers, using Joanna Briggs Institute (JBI) critical appraisal tools. Results Twenty‐four articles were included in the review. All cause 30‐day readmission rate was most frequently reported and ranged from 4.2% to 81%. Reported factors that were associated with readmission varied across studies from socio‐demographic, behavioural factors, comorbidity factors and cardiac factors. Findings from some of the studies were limited by data source, study designs and small sample size. Conclusion Strategies that integrate comprehensive discharge planning and individualised care planning to enhance behavioural support are related to a reduction in readmission rates. It is recommended that nurses are supported to influence discharge planning and lead the development of nurse‐led interventions to ensure discharge planning is both coordinated and person‐centred.
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Affiliation(s)
- Amineh Rashidi
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Courtney Glass
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
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Yerasi C, Tripathi B, Wang Y, Forrestal BJ, Case BC, Khan JM, Torguson R, Ben-Dor I, Satler LF, Garcia-Garcia HM, Weintraub WS, Rogers T, Waksman R. National trends and 30-day readmission rates for next-day-discharge transcatheter aortic valve replacement: An analysis from the Nationwide Readmissions Database, 2012-2016. Am Heart J 2021; 231:25-31. [PMID: 33091365 DOI: 10.1016/j.ahj.2020.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/28/2020] [Indexed: 01/27/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has evolved toward a minimalist approach, resulting in shorter hospital stays. Real-world trends of next-day discharge (NDD) TAVR are unknown. This study aimed to evaluate underlying trends and readmissions of NDD TAVR. METHODS This study was derived from the Nationwide Readmissions Database from 2012 to 2016. International Classification of Diseases, Ninth and Tenth Revisions, codes were used to identify patients. Any discharge within 1 day of admission was identified as NDD. NDD TAVR trends over the years were analyzed, and any admissions within 30 days were considered readmissions. A hierarchical logistic regression model was used to identify predictors of readmission. RESULTS Of 49,742 TAVR procedures, 3,104 were NDD. The percentage of NDD TAVR increased from 1.5% (46/3,051) in 2012 to 12.2% (2,393/19,613) in 2016. However, the 30-day readmission rate remained the same over the years (8.6%). The patients' mean age was 80.3 ± 8.4 years. Major readmission causes were heart-failure exacerbation (16%), infections (9%), and procedural complications (8%). In 2016, there were significantly higher late conduction disorder and gastrointestinal bleeding readmission rates than in 2012-2015. Significant predictors of readmission were anemia, baseline conduction disease, cardiac arrhythmias, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, neoplastic disorders, and discharge to facility. CONCLUSIONS The percentage of NDD TAVR increased over the years; however, readmission rates remained the same, with a higher rate of conduction abnormality-related hospitalizations in 2016. Careful discharge planning that includes identification of baseline factors that predict readmission and knowledge of etiologies may further prevent 30-day readmissions.
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Steitieh DA, Lu DY, Kalil RK, Kim LK, Sharma G, Yeo I, Feldman DN, Cheung JW, Mecklai A, Paul TK, Ascunce RR, Amin NP. Sex-based differences in revascularization and 30-day readmission after ST-segment-elevation myocardial infarction in the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 31:41-47. [PMID: 33358184 DOI: 10.1016/j.carrev.2020.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/13/2020] [Accepted: 12/14/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death for women in the United States. Revascularization is considered the standard of care for treatment of ST-segment elevation myocardial infarction (STEMI) and is known to reduce readmission. However there is a paucity of data that examines the sex-dependent impact of revascularization on readmission. We aimed to investigate sex differences in revascularization rates, 30-day readmission rates, and primary cause of readmissions following STEMIs. METHODS STEMI hospitalizations were selected in the Nationwide Readmissions Database from 2010 to 2014. Revascularization rates, 30-day readmission rates, and primary cause of readmission were examined. Interaction between sex and revascularization was assessed. Multivariable regression analysis was performed to identify predictors of 30-day readmission and revascularization for both sexes. RESULTS 219,944 women and 489,605 men were admitted with STEMIs. Women were more likely to be older, and have more comorbidities. Women were less likely to undergo revascularization by percutaneous coronary intervention (adjusted odds ratio [OR]: 0.68; 95% confidence interval [CI]: 0.66-0.70) or coronary artery bypass graft surgery (adjusted OR 0.40; CI 0.39-0.44). Women had higher 30-day readmission rates (15.7% vs. 10.8%, p < 0.001; OR 1.20, CI 1.17-1.23), and revascularization in women was not associated with a decreased likelihood of 30-day readmission. The primary cardiac cause of readmission in women was heart failure. CONCLUSION Compared to men, women with STEMIs had lower rates of revascularization and higher rates of 30-day readmission. When revascularized, women were still more likely to be readmitted as compared to non-revascularized women.
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Affiliation(s)
- Diala A Steitieh
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America.
| | - Daniel Y Lu
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America
| | - Ramsey K Kalil
- Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 525 East 68th Street, Box 130, New York, NY 10065, United States of America
| | - Luke K Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor - Cardiology, New York, NY 10021, United States of America
| | - Garima Sharma
- Ciccarone Center for Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 7th Floor, Baltimore, MD 21287, United States of America
| | - Ilhwan Yeo
- Division of Cardiology, New York Presbyterian Queens Hospital, 56-45 Main Street, Flushing, NY 11355, United States of America
| | - Dmitriy N Feldman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor - Cardiology, New York, NY 10021, United States of America
| | - Jim W Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor - Cardiology, New York, NY 10021, United States of America
| | - Alicia Mecklai
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8th Floor - Cardiology, New York, NY 10021, United States of America
| | - Tracy K Paul
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8th Floor - Cardiology, New York, NY 10021, United States of America
| | - Rebecca R Ascunce
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8th Floor - Cardiology, New York, NY 10021, United States of America
| | - Nivee P Amin
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor, New York, NY 10021, United States of America; Weill Cornell Cardiovascular Outcomes Research Group (CORG), Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8(th) Floor - Cardiology, New York, NY 10021, United States of America; Weill Cornell Women's Heart Program, Division of Cardiology, Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 1305 York Ave, 8th Floor - Cardiology, New York, NY 10021, United States of America
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Tripathi B, Sawant AC, Sharma P, Tandon V, Patel T, Klein J, Pershad A. Short term outcomes after transcatheter mitral valve repair. Int J Cardiol 2020; 327:163-169. [PMID: 33278417 DOI: 10.1016/j.ijcard.2020.11.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Outcome data following transcatheter mitral valve repair (TMVR) with the MITRACLIP® device are scarce outside the pivotal randomized controlled trials. METHODS The Nationwide Readmission Data base (NRD) was utilized for years 2013-2017 to identify the study population. Thirty-day readmission pattern, in-hospital complications, causes of readmissions, and multivariate predictors for readmission, complications and mortality were explored. RESULTS We noted a total of 14,647 index admissions related to MITRACLIP of which 48% of procedures were performed at high volume centers (Annual hospital volume ≥ 25). A total of 15% of patients were readmitted within 30 days of discharge most frequently due to cardiac causes. Approximately 33% of patients were discharged within 24 h of the procedure. The in-hospital mortality rate was 2.8% and in-hospital complication rate was 14.6%. The most common complications were cardiac complications (8.2%), bleeding related complications (5.9%) and vascular complications (0.65%). On multivariate modeling, female sex, CHF, Atrial fibrillation, prior PCI, COPD, CKD, transfer to skilled nursing facility, length of stay ≥2 days were associated with a high risk of readmission. Additionally, coagulopathy, chronic kidney disease and lengthier hospital stays were associated with high risk of complication or death. CONCLUSION The 30-day readmission rate following commercial treatment with the MITRACLIP device is 15%. Half of these admission were from a cardiac etiology. Heart failure, atrial arrhythmias and clip related complications round out the top 3 cardiac reasons for readmission. There was no impact of hospital size, teaching status or case volume on mortality and in hospital complication rates.
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Affiliation(s)
- Byomesh Tripathi
- University of Arizona College of Medicine, Phoenix, AZ, United States of America.
| | - Abhishek C Sawant
- University of Arizona College of Medicine, Phoenix, AZ, United States of America
| | - Purnima Sharma
- University of Arizona College of Medicine, Phoenix, AZ, United States of America
| | - Varun Tandon
- University of Arizona College of Medicine, Phoenix, AZ, United States of America
| | - Toralben Patel
- Advent Health East Orlando, Orlando, FL, United States of America
| | - Jason Klein
- Heart & Vascular Center of Arizona, Phoenix, AZ, United States of America
| | - Ashish Pershad
- University of Arizona College of Medicine, Phoenix, AZ, United States of America
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Lazkani M, Tripathi B, Dattilo P. Impact of intracoronary imaging on in‐hospital mortality and 30‐day readmission rates following percutaneous coronary intervention: A nationwide readmissions database analysis. Catheter Cardiovasc Interv 2020; 98:1082-1094. [DOI: 10.1002/ccd.29394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/10/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Mohamad Lazkani
- Internal medicine, Cardiovascular disease UCHealth, Medical Center of the Rockies Loveland Colorado USA
| | - Byomesh Tripathi
- Internal medicine, Cardiovascular disease Banner University Medical Center Phoenix Arizona USA
| | - Philip Dattilo
- Internal medicine, Cardiovascular disease UCHealth, Medical Center of the Rockies Loveland Colorado USA
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Tripathi B, Nerusu LA, Sawant AC, Atti L, Sharma P, Pershad A. Transcatheter Aortic Valve Implantation Readmissions in the Current Era (from the National Readmission Database). Am J Cardiol 2020; 130:115-122. [PMID: 32665132 DOI: 10.1016/j.amjcard.2020.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/06/2020] [Accepted: 06/09/2020] [Indexed: 10/24/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has become the mainstream treatment for severe aortic stenosis. Despite improvement in device iteration and operator experience rigorous outcome data outside the scope of clinical trials is lacking. Nationwide readmission database 2016 and 2017 was utilized to identify the study population. International Classification of Disease,10th edition codes were used to identify TAVI admissions. Outcomes of interest were the 90-day readmission pattern and in hospital complications of the TAVI procedure. A total of 73,784 TAVI related index admissions were identified in the Nationwide Readmission Database in 2016 to 2017. Forty four percent of patients undergoing TAVI in that timeframe were discharged within 48 hours of their procedure. 16,343 patients (22.2%) were readmitted within 90 days after discharge. Major cardiac co-morbidities like heart failure were prevalent more often in the group of patients that were readmitted within 90 days. Noncardiac causes however accounted for two thirds of these readmissions. The median time to 90-day readmission was 31 days. Multivariate analysis showed that nonagenarians, patients undergoing transapical TAVI, and patients with a higher comorbidity burden were more likely to be readmitted within 90 days. In conclusion, almost half of TAVI patients in the US are discharged within 48 hours after their procedure and 20% of all TAVI patients are readmitted within 90 days. Most readmissions are due to noncardiac causes.
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Tripathi B, Kumar V, Kalra A, Gupta T, Sawant AC, Sharma P, Arora S, Panhwar MS, Gopalan R, Deshmukh A, Pershad A, Gulati M, Bhatt DL. Influence of Influenza Infection on In-Hospital Acute Myocardial Infarction Outcomes. Am J Cardiol 2020; 130:7-14. [PMID: 32636019 DOI: 10.1016/j.amjcard.2020.05.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
Influenza is associated with significant morbidity in the United States but its influence on in-hospital outcomes in patients with AMI has not been well studied. The Nationwide Readmission Database (NRD) from 2010 to 2014 was queried using the International Classification of Diseases-Ninth edition, Clinical Modification (ICD-9-CM) codes to identify all patients ≥18 years who were admitted for AMI with and without concurrent influenza. Propensity score matching was used to adjust patients' baseline characteristics and co-morbidities. In-hospital mortality, 30-day readmission rates, in-hospital complications, and resource utilization were analyzed. We identified a total of 2,428,361 patients admitted with AMI, of whom 3,006 (0.12%) had coexisting influenza. We noted significantly higher in-hospital mortality (7.7% vs 5.6%, p <0.01) and 30-day readmission rates (15.8% vs 14.1%, p <0.01) in patients with influenza compared with those without it. After propensity matching, the differences in in-hospital mortality and 30-day readmission were no longer statistically significant between the groups. Patients with influenza had a higher incidence of acute kidney injury (30.9% vs 24.6%, p <0.01), acute respiratory failure (50.2% vs 32.2%, p <0.01), need for mechanical ventilation (13.9% vs 9.2%, p <0.01), and sepsis (10% vs 3.8%, p <0.01) in the matched cohort. Patients with influenza had longer hospital stays (8.4 days vs 6.4 days, p <0.01) and mean costs of care (26,200USD vs 23,400USD, p <0.01). In conclusion, AMI patients with concomitant influenza infection had higher in-hospital mortality, 30-day readmission, in-hospital complications, and higher resource utilization compared with those without influenza.
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Multivessel Versus Culprit-Only Revascularization in STEMI and Multivessel Coronary Artery Disease. JACC Cardiovasc Interv 2020; 13:1571-1582. [DOI: 10.1016/j.jcin.2020.04.055] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 11/21/2022]
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Tripathi B, Kumbhani DJ, Giri J, Sardar P, Chatterjee S. Current trends in utilization of fibrinolytic‐based reperfusion strategies and bleeding outcomes in
ST
‐elevation myocardial infarction. Catheter Cardiovasc Interv 2020; 96:E566-E567. [DOI: 10.1002/ccd.29094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/05/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Byomesh Tripathi
- Division of Cardiovascular Medicine University of Arizona Phoenix Arizona USA
| | - Dharam J. Kumbhani
- Division of Cardiology University of Texas Southwestern School of Medicine Dallas Texas USA
| | - Jay Giri
- Division of Cardiovascular Medicine Perelman School of Medicine, University of Pennsylvania, Philadelphia and The Leonard Davis Institute of Health Economics, University of Pennsylvania Philadelphia Pennsylvania USA
| | - Partha Sardar
- Division of Cardiology Massachusetts General Hospital Boston Massachusetts USA
| | - Saurav Chatterjee
- Division of Cardiovascular Medicine, North Shore‐Long Island Jewish Medical Centers Northwell Health, and Assistant Professor, Zucker School of Medicine New York New York USA
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Sharma P, Tripathi B, Naraparaju V, Patel M, Bhagat A, Yerasi C, Kumar V, Aujla P, Singh G, Lahewala S, Arora S, Deshmukh A, Tolat A. Short‐term outcomes associated with inpatient ventricular tachycardia catheter ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:444-455. [DOI: 10.1111/pace.13905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/27/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Purnima Sharma
- Cardiovascular disease department, College of MedicineUniversity of Arizona Phoenix Arizona
| | - Byomesh Tripathi
- Cardiovascular disease department, College of MedicineUniversity of Arizona Phoenix Arizona
| | - Vamsidhar Naraparaju
- Hoffman Heart and Vascular Institute, St. Francis Hospital and Medical CenterUniversity of Connecticut School of Medicine Hartford Connecticut
| | - Mayur Patel
- Cardiovascular disease department, College of MedicineUniversity of Arizona Phoenix Arizona
| | - Abhishek Bhagat
- Cardiovascular disease department, College of MedicineUniversity of Arizona Phoenix Arizona
| | - Charan Yerasi
- Medstar Georgetown University Hospital Washington, DC
| | | | - Parvir Aujla
- Nova Southeastern University Fort Lauderdale Florida
| | - Gagandeep Singh
- Hoffman Heart and Vascular Institute, St. Francis Hospital and Medical CenterUniversity of Connecticut School of Medicine Hartford Connecticut
| | - Sopan Lahewala
- Hoffman Heart and Vascular Institute, St. Francis Hospital and Medical CenterUniversity of Connecticut School of Medicine Hartford Connecticut
| | - Shilpkumar Arora
- Cardiovascular disease departmentUniversity Hospitals Cleveland Ohio
| | | | - Aneesh Tolat
- Hoffman Heart and Vascular Institute, St. Francis Hospital and Medical CenterUniversity of Connecticut School of Medicine Hartford Connecticut
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Clegg SD, Blankenship JC. In STEMI, more stenting = less readmissions? Catheter Cardiovasc Interv 2019; 94:915-916. [PMID: 31793179 DOI: 10.1002/ccd.28604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/13/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Stacey D Clegg
- Division of Cardiology, University of New Mexico, Albuquerque, New Mexico
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