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Singh V, Savani GT, Mendirichaga R, Jonnalagadda AK, Cohen MG, Palacios IF. Frequency of Complications Including Death from Coronary Artery Bypass Grafting in Patients With Hepatic Cirrhosis. Am J Cardiol 2018; 122:1853-1861. [PMID: 30293650 DOI: 10.1016/j.amjcard.2018.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 06/20/2018] [Revised: 08/14/2018] [Accepted: 08/20/2018] [Indexed: 01/20/2023]
Abstract
Advanced liver disease is a risk factor for cardiac surgery. However, liver dysfunction is not included in cardiac risk assessment models. We sought to identify trends in utilization, complications, and outcomes of patients with cirrhosis who underwent coronary artery bypass graft surgery (CABG). Using the National Inpatient Sample database, we identified patients with cirrhosis who underwent CABG from 2002 to 2014. Propensity-score matching was used to identify differences in in-hospital mortality and postoperative complications in cirrhosis and noncirrhosis patients. We identified a total of 698,799 CABG admissions of which 2,231 (0.3%) had cirrhosis (mean age 63.6 ± 9.6 years, 74% men, 63% white, mean Charlson co-morbidity index 3.3 ± 1.8). Cardiopulmonary bypass was used in 71% of patients. Mean length of stay was 13.7 ± 11.4 days and hospitalization cost $67,744.6 ± 58,320.4. One or more complications occurred in 44% of cases. After propensity-score matching, patients with cirrhosis had a higher rate of complications (43.9% vs 38.93%; p < 0.001) and in-hospital mortality (7.2% vs 4.07%; p < 0.001) than noncirrhosis patients. On multivariate analysis, cirrhosis and ascites were associated with increased in-hospital mortality (odds ratio 2.87; 95% confidence intervals 2.37 to 3.48) and postoperative complications (odds ratio 5.11; 95% confidence intervals 3.88 to 6.72). In conclusion, patients with cirrhosis constitute a small portion of patients who underwent CABG in the United States but have a higher rate of complications and in-hospital mortality compared with noncirrhosis patients. In-hospital mortality remains high for this subset of patients but has decreased in recent years.
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Affiliation(s)
- Vikas Singh
- Division of Cardiology, University of Louisville School of Medicine, Louisville, Kentucky.
| | - Ghanshyambhai T Savani
- Department of Medicine, Baystate Medical Center, University of Massachusetts, Springfield, Massachusetts
| | - Rodrigo Mendirichaga
- Division of Cardiovascular Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Anil K Jonnalagadda
- Department of Medicine, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Mauricio G Cohen
- Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Massachusetts
| | - Igor F Palacios
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Singh V, Mendirichaga R, Savani GT, Rodriguez AP, Dabas N, Munagala A, Alfonso CE, Cohen MG, Elmariah S, Palacios IF. Coronary revascularization for acute myocardial infarction in the HIV population. J Interv Cardiol 2017; 30:405-414. [PMID: 28833489 DOI: 10.1111/joic.12433] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 07/06/2017] [Revised: 07/30/2017] [Accepted: 08/01/2017] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To analyze trends in management and outcomes of patients infected with the human immunodeficiency virus (HIV) undergoing percutaneous coronary intervention (PCI) for an acute myocardial infarction (AMI) in the United States. BACKGROUND Infection with HIV is an independent risk factor for accelerated atherosclerosis associated with higher rates of AMI. Current trends and outcomes of HIV-infected individuals presenting with AMI in the United States remain unknown. METHODS Using the Healthcare Cost and Utilization Project National Inpatient Sample database we identified HIV-infected individuals who underwent PCI for an AMI from 2002 to 2013. Multivariable logistic regression and propensity-score matching were performed to analyze outcomes. RESULTS We identified a total of 59 194 patients of which 7841 underwent PCI during index hospitalization (13.3%). Most patients were men (71%), ≥50 years of age (82%), and white (74%). ST-elevation myocardial infarction was present in 21% of cases. Charlson comorbidity index (CCI) was 5.67 ± 0.4. Predictors of post-procedural complications included female sex, black race, higher CCI, and placement of a bare metal stent, whereas predictors of mortality included occurrence of a complication, ST-elevation myocardial infarction, age ≥70 years, and higher CCI. Conversely, placement of a drug-eluting stent was associated with a reduced risk of complications and mortality. After propensity-score matching, HIV-infected individuals were less likely to undergo PCI and receive a drug-eluting stent, while having longer length of stay, higher hospitalization costs, and higher in-hospital mortality when compared to non-infected individuals. CONCLUSION Significant disparities continue to affect HIV-infected individuals undergoing PCI for AMI in the United States.
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Affiliation(s)
- Vikas Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rodrigo Mendirichaga
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Nitika Dabas
- University of Miami Miller School of Medicine, Miami, Florida
| | | | | | | | - Sammy Elmariah
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Igor F Palacios
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Ahmed M, Kanotra R, Savani GT, Kotadiya F, Patel N, Tareen S, Fasullo MJ, Kesavan M, Kahn A, Nalluri N, Khan HM, Pau D, Abergel J, Deeb L, Andrawes S, Das A. Utilization trends in inpatient endoscopic retrograde cholangiopancreatography (ERCP): A cross-sectional US experience. Endosc Int Open 2017; 5:E261-E271. [PMID: 28382324 PMCID: PMC5378548 DOI: 10.1055/s-0043-102402] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Study aims The goal of our study was to determine the current trends for inpatient utilization for endoscopic retrograde cholangiopancreatography (ERCP) and its economic impact in the United States between 2002 and 2013. Patients and methods A Nationwide Inpatient Sample from 2002 through 2013 was examined. We identified ERCPs using International Classification of Diseases (ICD-9) codes; Procedure codes 51.10, 51.11, 52.13, 51.14, 51.15, 52.14 and 52.92 for diagnostic and 51.84, 51.86, 52.97 were studied. Rate of inpatient ERCP was calculated. The trends for therapeutic ERCPs were compared to the diagnostic ones. We analyzed patient and hospital characteristics, length of hospital stay, and cost of care after adjusting for weighted samples. We used the Cochran-Armitage test for categorical variables and linear regression for continuous variables. Results A total of 411,409 ERCPs were performed from 2002 to 2013. The mean age was 59 ± 19 years; 61 % were female and 57 % were white. The total numbers of ERCPS increased by 12 % from 2002 to 2011, which was followed by a 10 % decrease in the number of ERCPs between 2011 and 2013. There was a significant increase in therapeutic ERCPs by 37 %, and a decrease in diagnostic ERCPs by 57 % from 2002 to 2013. Mean length of stay was 7 days (SE = 0.01) and the mean cost of hospitalization was $20,022 (SE = 41). Conclusions Our large cross-sectional study shows a significant shift in ERCPs towards therapeutic indications and a decline in its conventional diagnostic utility. Overall there has been a reduction in inpatient ERCPs.
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Affiliation(s)
- Moiz Ahmed
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, United States
| | - Ritesh Kanotra
- Department of Internal Medicine, Banner Baywood Medical Center, Mesa, Arizona, USA,Corresponding author Ritesh Kanotra 1139 W Spur AvenueGilbert, AZ 85233+1-646-515-8435
| | | | | | - Nileshkumar Patel
- Department of Cardiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Florida, United States
| | - Sarah Tareen
- Institute of Clinical Research India (ICRI), Bangalore, India
| | | | - Mayurathan Kesavan
- Department of Gastroenterology, Staten Island University hospital, Northwell Health, Staten Island, United States
| | - Ahsan Kahn
- Department of Gastroenterology, Staten Island University hospital, Northwell Health, Staten Island, United States
| | - Nikhil Nalluri
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, United States
| | - Hafiz M. Khan
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, United States
| | - Dhaval Pau
- Department of Internal Medicine, Staten Island University Hospital, Northwell Health, Staten Island, New York, United States
| | - Jeffrey Abergel
- Department of Gastroenterology, Staten Island University hospital, Northwell Health, Staten Island, United States
| | - Liliane Deeb
- Department of Gastroenterology, Staten Island University hospital, Northwell Health, Staten Island, United States
| | - Sherif Andrawes
- Department of Gastroenterology, Staten Island University hospital, Northwell Health, Staten Island, United States
| | - Ananya Das
- St. Joseph Hospital Medical center, Phoenix, Arizona, USA/Arizona Center for Digestive health, Gastroenterology, Gilbert, Arizona, United States
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Badheka AO, Patel NJ, Panaich SS, Patel SV, Jhamnani S, Singh V, Pant S, Patel N, Patel N, Arora S, Thakkar B, Manvar S, Dhoble A, Patel A, Savani C, Patel J, Chothani A, Savani GT, Deshmukh A, Grines CL, Curtis J, Mangi AA, Cleman M, Forrest JK. Effect of Hospital Volume on Outcomes of Transcatheter Aortic Valve Implantation. Am J Cardiol 2015; 116:587-94. [PMID: 26092276 DOI: 10.1016/j.amjcard.2015.05.019] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 01/10/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is associated with a significant learning curve. There is paucity of data regarding the effect of hospital volume on outcomes after TAVI. This is a cross-sectional study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database of 2012. Subjects were identified by International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, 35.05 (Trans-femoral/Trans-aortic Replacement of Aortic Valve) and 35.06 (Trans-apical Replacement of Aortic Valve). Annual hospital TAVI volumes were calculated using unique identification numbers and then divided into quartiles. Multivariate logistic regression models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and periprocedural complications. Length of stay (LOS) and cost of hospitalization were assessed. The study included 1,481 TAVIs (weighted n = 7,405). Overall inhospital mortality rate was 5.1%, postprocedural complication rate was 43.4%, median LOS was 6 days, and median cost of hospitalization was $51,975. Inhospital mortality rates decreased with increasing hospital TAVI volume with a rate of 6.4% for lowest volume hospitals (first quartile), 5.9% (second quartile), 5.2% (third quartile), and 2.8% for the highest volume TAVI hospitals (fourth quartile). Complication rates were significantly higher in hospitals with the lowest volume quartile (48.5%) compared to hospitals in the second (44.2%), third (39.7%), and fourth (41.5%) quartiles (p <0.001). Increasing hospital volume was independently predictive of shorter LOS and lower hospitalization costs. In conclusion, higher annual hospital volumes are significantly predictive of reduced postprocedural mortality, complications, shorter LOS, and lower hospitalization costs after TAVI.
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Badheka AO, Patel NJ, Grover P, Singh V, Patel N, Arora S, Chothani A, Mehta K, Deshmukh A, Savani GT, Patel A, Panaich SS, Shah N, Rathod A, Brown M, Mohamad T, Makkar RR, Schreiber T, Grines CL, Rihal CS, Cohen MG. Response to Letter Regarding Article "Impact of Annual Operator and Institutional Volume on Percutaneous Coronary Intervention Outcomes: A 5-Year United States Experience (2005-2009)". Circulation 2015; 132:e36-7. [PMID: 26240270 DOI: 10.1161/circulationaha.115.015221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | - Vikas Singh
- Miller School of Medicine, University of Miami, Miami, FL
| | - Nilay Patel
- Saint Peter's University Hospital, New Brunswick, NJ
| | | | | | - Kathan Mehta
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Achint Patel
- Icahn School of Medicine at Mount Sinai, New York, NY
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Panaich SS, Badheka AO, Arora S, Patel NJ, Thakkar B, Patel N, Singh V, Chothani A, Deshmukh A, Agnihotri K, Jhamnani S, Lahewala S, Manvar S, Panchal V, Patel A, Patel N, Bhatt P, Savani C, Patel J, Savani GT, Solanki S, Patel S, Kaki A, Mohamad T, Elder M, Kondur A, Cleman M, Forrest JK, Schreiber T, Grines C. Variability in utilization of drug eluting stents in United States: Insights from nationwide inpatient sample. Catheter Cardiovasc Interv 2015; 87:23-33. [DOI: 10.1002/ccd.25977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/14/2015] [Revised: 03/25/2015] [Accepted: 04/04/2015] [Indexed: 11/10/2022]
Affiliation(s)
| | - Apurva O. Badheka
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
| | - Shilpkumar Arora
- Department of Internal Medicine, Mount Sinai St. Luke's Roosevelt Hospital; New York New York
| | - Nileshkumar J. Patel
- Department of Internal Medicine; Staten Island University Hospital; Staten Island New York
| | - Badal Thakkar
- Department of Internal Medicine; Tulane School of Public Health & Tropical Medicine; New Orleans Louisiana
| | - Nilay Patel
- Department of Internal Medicine; Saint Peter's University Hospital; New Brunswick New Jersey
| | - Vikas Singh
- Department of Cardiology; University of Miami Miller School of Medicine; Miami Florida
| | - Ankit Chothani
- Department of Internal Medicine; MedStar Washington Hospital Center; Washington District of Columbia
| | | | - Kanishk Agnihotri
- Department of Internal Medicine; Saint Peter's University Hospital; New Brunswick New Jersey
| | - Sunny Jhamnani
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
| | - Sopan Lahewala
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | | | - Vinaykumar Panchal
- Department of Internal Medicine; Tulane School of Public Health & Tropical Medicine; New Orleans Louisiana
| | - Achint Patel
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Neil Patel
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Parth Bhatt
- Department of Internal Medicine; Tulane School of Public Health & Tropical Medicine; New Orleans Louisiana
| | - Chirag Savani
- Department of Internal Medicine; New York Medical College; Valhalla New York
| | - Jay Patel
- Detroit Medical Center; Detroit Michigan
| | | | - Shantanu Solanki
- Department of Internal Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Samir Patel
- Department of Internal Medicine, Western Reserve Health System; Youngstown Ohio
| | - Amir Kaki
- Detroit Medical Center; Detroit Michigan
| | | | | | | | - Michael Cleman
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
| | - John K. Forrest
- Department of Cardiology, Yale School of Medicine; New Haven Connecticut
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Singh V, Patel NJ, Badheka AO, Arora S, Patel N, Macon C, Savani GT, Manvar S, Patel J, Thakkar B, Panchal V, Solanki S, Patel N, Chothani A, Panaich SS, Ram V, Kliger CA, Schreiber T, O' Neill W, Cohen MG, Alfonso CE, Grines CL, Mangi A, Pfau S, Forrest JK, Cleman M, Makkar R. Comparison of outcomes of balloon aortic valvuloplasty plus percutaneous coronary intervention versus percutaneous aortic balloon valvuloplasty alone during the same hospitalization in the United States. Am J Cardiol 2015; 115:480-6. [PMID: 25543235 DOI: 10.1016/j.amjcard.2014.11.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 10/30/2014] [Revised: 11/20/2014] [Accepted: 11/20/2014] [Indexed: 11/29/2022]
Abstract
The use of percutaneous aortic balloon balvotomy (PABV) in high surgical risk patients has resurged because of development of less invasive endovascular therapies. We compared outcomes of concomitant PABV and percutaneous coronary intervention (PCI) with PABV alone during same hospitalization using nation's largest hospitalization database. We identified patients and determined time trends using the International Classification of Diseases, Ninth Revision, Clinical Modification, procedure code for valvulotomy from Nationwide Inpatient Sample database 1998 to 2010. Only patients >60 years with aortic stenosis were included. Primary outcome included in-hospital mortality, and secondary outcomes included procedural complications, length of stay (LOS), and cost of hospitalization. Total 2,127 PABV procedures were identified, with 247 in PABV + PCI group and 1,880 in the PABV group. Utilization rate of concomitant PABV + PCI during same hospitalization increased by 225% from 5.1% in 1998 to 1999 to 16.6% in 2009 to 2010 (p <0.001). Overall in-hospital mortality rate and complication rates in PABV + PCI group were similar to that of PABV group (10.3% vs 10.5% and 23.4% vs 24.7%, respectively). PABV + PCI group had similar LOS but higher hospitalization cost (median [interquartile range] $30,089 [$21,925 to $48,267] versus $18,421 [$11,482 to $32,215], p <0.001) in comparison with the PABV group. Unstable condition, occurrence of any complication, and weekend admission were the main predictors of increased LOS and cost of hospital admission. Concomitant PCI and PABV during the same hospitalization are not associated with change in in-hospital mortality, complications rate, or LOS compared with PABV alone; however, it increases the cost of hospitalization.
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Affiliation(s)
- Vikas Singh
- Cardiovascular division, University of Miami Miller School of Medicine, Miami, Florida
| | - Nileshkumar J Patel
- Cardiovascular division, Staten Island University Hospital, Staten Island, New York
| | - Apurva O Badheka
- Cardiovascular division, Yale School of Medicine, New Haven, Connecticut.
| | - Shilpkumar Arora
- Cardiovascular division, Mount Sinai St Luke's Roosevelt Hospital, New York, New York
| | - Nilay Patel
- Cardiovascular division, Saint Peter's University Hospital, New Brunswick, New Jersey
| | - Conrad Macon
- Cardiovascular division, University of Miami Miller School of Medicine, Miami, Florida
| | | | | | - Jay Patel
- Cardiovascular division, Detroit Medical Center, Detroit, Michigan
| | - Badal Thakkar
- Cardiovascular division, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Vinaykumar Panchal
- Cardiovascular division, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Shantanu Solanki
- Cardiovascular division, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Neil Patel
- Cardiovascular division, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ankit Chothani
- Cardiovascular division, MedStar Washington Hospital Center, Washington, District of Columbia
| | | | - Vinny Ram
- Cardiovascular division, University of Arizona, Tucson, Arizona
| | - Chad A Kliger
- Cardiovascular division, Lenox Hill Heart and Vascular Institute-North Shore LIJ Health System, New York, New York
| | | | | | - Mauricio G Cohen
- Cardiovascular division, University of Miami Miller School of Medicine, Miami, Florida
| | - Carlos E Alfonso
- Cardiovascular division, University of Miami Miller School of Medicine, Miami, Florida
| | - Cindy L Grines
- Cardiovascular division, Detroit Medical Center, Detroit, Michigan
| | - Abeel Mangi
- Cardiovascular division, Yale School of Medicine, New Haven, Connecticut
| | - Steven Pfau
- Cardiovascular division, Yale School of Medicine, New Haven, Connecticut
| | - John K Forrest
- Cardiovascular division, Yale School of Medicine, New Haven, Connecticut
| | - Michael Cleman
- Cardiovascular division, Yale School of Medicine, New Haven, Connecticut
| | - Raj Makkar
- Cardiovascular division, Cedars Sinai Medical Center, Los Angeles, California
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Singh V, Badheka AO, Patel NJ, Chothani A, Mehta K, Arora S, Patel N, Deshmukh A, Shah N, Savani GT, Rathod A, Manvar S, Thakkar B, Panchal V, Patel J, Palacios IF, Rihal CS, Cohen MG, O'Neill W, De Marchena E. Influence of hospital volume on outcomes of percutaneous atrial septal defect and patent foramen ovale closure: a 10-years US perspective. Catheter Cardiovasc Interv 2015; 85:1073-81. [PMID: 25534392 DOI: 10.1002/ccd.25794] [Citation(s) in RCA: 18] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/02/2014] [Accepted: 12/14/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Contemporary data regarding percutaneous closure of atrial septal defect/patent foramen ovale (ASD/PFO) are lacking. We evaluated the current trends in utilization of ASD/PFO closure in adults and investigated the effect of annual hospital volume on in-hospital outcomes. METHODS We queried the Nationwide Inpatient Sample between the years 2001 and 2010 using the International Classification of Diseases (ICD-9-CM) procedure code for percutaneous closure of ASD/PFO with device. Hierarchical mixed effects models were generated to identify the independent multivariate predictors of outcomes. RESULTS A total of 7,107 percutaneous ASD/PFO closure procedures (weighted n = 34,992) were available for analysis. A 4.7-fold increase in the utilization of this procedure from 3/million in 2001 to 14/million adults in 2010 in US (P < 0.001) was noted. Overall, percutaneous ASD/PFO closure was associated with 0.5% mortality and 12% in-hospital complications. The utilization of intracardiac echocardiography (ICE) increased 15 fold (P < 0.001) during the study period. The procedures performed at the high volume hospitals [2nd (14-37 procedures/year) and 3rd (>38 procedures/year) tertile] were associated with significant reduction in complications, length of stay and cost of hospitalization when compared to those performed at lowest volume centers (<13 procedures/year). Majority (70.5%) of the studied hospitals were found to be performing <10 procedures/year hence deviating from the ACC/AHA/SCAI clinical competency guidelines. CONCLUSIONS Low hospital volume is associated with an increased composite (mortality and procedural complications) adverse outcome following ASD/PFO closure. In the interest of patient safety, implementation of the current guidelines for minimum required annual hospital volume to improve clinical outcomes is warranted.
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Affiliation(s)
- Vikas Singh
- Cardiology, University of Miami Miller School of Medicine, Miami, Florida
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9
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Badheka AO, Chothani A, Mehta K, Patel NJ, Deshmukh A, Hoosien M, Shah N, Singh V, Grover P, Savani GT, Panaich SS, Rathod A, Patel N, Arora S, Bhalara V, Coffey JO, O'Neill W, Makkar R, Grines CL, Schreiber T, Di Biase L, Natale A, Viles-Gonzalez JF. Utilization and adverse outcomes of percutaneous left atrial appendage closure for stroke prevention in atrial fibrillation in the United States: influence of hospital volume. Circ Arrhythm Electrophysiol 2014; 8:42-8. [PMID: 25480543 DOI: 10.1161/circep.114.001413] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [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: 12/23/2022]
Abstract
BACKGROUND Safety data on percutaneous left atrial appendage closure arises from centers with considerable expertise in the procedure or from clinical trial, which might not be reproducible in clinical practice. We sought to estimate the frequency and predictors of adverse outcomes and costs of percutaneous left atrial appendage closure procedure in the US. METHODS AND RESULTS The data were obtained from the Nationwide Inpatient Sample from the years 2006 to 2010. The Nationwide Inpatient Sample is the largest all-payer inpatient data set in the US. Complications were calculated using patient safety indicators and International Classification of Diseases-Ninth Revision, Clinical Modification codes. Annual hospital volume was calculated using unique hospital identifiers. Weights provided by the Nationwide Inpatient Sample were used to generate national estimates. A total of 268 (weighted=1288) procedures were analyzed. The overall composite rate of mortality or any adverse event was 24.3% (65), with 3.4% patients required open cardiac surgery after procedure. Average length of stay was 4.61±1.05 days and cost of care was 26,024±34,651. Annual hospital procedural volume was significantly associated with reduced complications and mortality (every unit increase: odds ratio, 0.89; 95% confidence interval, 0.85-0.94; P<0.001), decrease in length of stay (every unit increase: hazard ratio, 0.95; 95% confidence interval, 0.92-0.98; P<0.001) and cost of care (every unit increase: hazard ratio, 0.96; 95% confidence interval, 0.93-0.98; P<0.001). CONCLUSIONS Our study demonstrates that the frequency of inhospital adverse outcomes associated with percutaneous left atrial appendage closure is higher in the real-world population than in clinical trials. We also demonstrate that higher annual hospital volume is associated with safer procedures, with lower length of stay and cost.
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Affiliation(s)
- Apurva O Badheka
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Ankit Chothani
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Kathan Mehta
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Nileshkumar J Patel
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Abhishek Deshmukh
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Michael Hoosien
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Neeraj Shah
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Vikas Singh
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Peeyush Grover
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Ghanshyambhai T Savani
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Sidakpal S Panaich
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Ankit Rathod
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Nilay Patel
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Shilpkumar Arora
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Vipulkumar Bhalara
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - James O Coffey
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - William O'Neill
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Raj Makkar
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Cindy L Grines
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Theodore Schreiber
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Luigi Di Biase
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Andrea Natale
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.)
| | - Juan F Viles-Gonzalez
- From the Detroid Medical Center, Detroit, MI (A.O.B., S.S.P., N.P., S.A., V.B., C.L.G., T.S.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); Staten Island University Hospital, NY (N.J.P., N.S.); University of Arkansas, Little Rock (A.D.); University of Miami Miller School of Medicine, FL (M.H., V.S., P.G., G.T.S., J.O.C., J.F.V.-G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., R.M.); Henry Ford Hospital, Detroit, MI (W.O'N.); and Texas Cardiac Arrhythmia Institute, Austin (L.D.B., A.N.).
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Badheka AO, Arora S, Panaich SS, Patel NJ, Patel N, Chothani A, Mehta K, Deshmukh A, Singh V, Savani GT, Agnihotri K, Grover P, Lahewala S, Patel A, bambhroliya C, Kondur A, Brown M, Elder M, Kaki A, Mohammad T, Grines C, Schreiber T. Impact on in-hospital outcomes with drug-eluting stents versus bare-metal stents (from 665,804 procedures). Am J Cardiol 2014; 114:1629-37. [PMID: 25439448 DOI: 10.1016/j.amjcard.2014.08.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 12/23/2022]
Abstract
Contemporary large-scale data, regarding in-hospital outcomes depending on the types of stent used for percutaneous coronary intervention (PCI) is lacking. We queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample from 2006 to 2011 using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code 36.06 (bare-metal coronary artery stent, BMS) or 36.07 (drug-eluting coronary artery stent, DES) for PCI. All analyses were performed using the designated weighting specified to the Nationwide Inpatient Sample database to minimize bias. Primary outcome was in-hospital mortality. Wald's chi-square test was used for categorical variables. We built a hierarchical 2 level model adjusted for multiple confounding factors, with hospital identification incorporated as random effects in the model and propensity match analyses were used to adjust confounding variables. A total of 665,804 procedures were analyzed, which were representative of 3,277,884 procedures in the United States. Use of bare-metal stents (BMS) was associated with greater occurrence of in-hospital mortality compared with that of drug-eluting stents (DES; 1.4% vs 0.5%, p <0.001). The association stayed significant after adjustment of various possible confounding factors (odds ratio for DES versus BMS 0.59 [0.54 to 0.64, p <0.001]) and also in propensity matched cohorts (1.2% vs 0.7%, p <0.001). The results continued to be similar in the following high-risk subgroups: diabetes (0.57 [0.50 to 0.64, <0.001]), acute myocardial infarction and/or shock (0.53 [0.49 to 0.57, <0.001]), age >80 (0.66 [0.58 to 0.74, <0.001]), and multivessel PCI (0.55 [0.46 to 0.66, <0.001]). In conclusion, DES use was associated with lesser in-hospital mortality compared with BMS. This outcome benefit was seen across subgroups in various subgroups including elderly, diabetics, and acute myocardial infarction as well as multivessel interventions.
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11
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Badheka AO, Shah N, Ghatak A, Patel NJ, Chothani A, Mehta K, Singh V, Patel N, Grover P, Deshmukh A, Panaich SS, Savani GT, Bhalara V, Arora S, Rathod A, Desai H, Kar S, Alfonso C, Palacios IF, Grines C, Schreiber T, Rihal CS, Makkar R, Cohen MG, O'Neill W, de Marchena E. Balloon mitral valvuloplasty in the United States: a 13-year perspective. Am J Med 2014; 127:1126.e1-1126.e12. [PMID: 24859718 DOI: 10.1016/j.amjmed.2014.05.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 03/24/2014] [Revised: 05/13/2014] [Accepted: 05/13/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Incidence and prevalence of mitral stenosis is declining in the US. We performed this study to determine recent trends in utilization, complications, mortality, length of stay, and cost associated with balloon mitral valvuloplasty. METHODS Utilizing the nationwide inpatient sample database from 1998 to 2010, we identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure code for "percutaneous valvuloplasty." Patients ≥18 years of age with mitral stenosis were included. Patients with concomitant aortic, tricuspid, or pulmonic stenosis were excluded. Primary outcome included death and procedural complications. RESULTS A total of 1308 balloon mitral valvuloplasties (weighted n = 6540) were analyzed. There was a 7.5% decrease in utilization of the procedure from 24.6 procedures/10 million population in 1998-2001 to 22.7 procedures/10 million population in 2008-2010 (P for trend = .098). We observed a 15.9% overall procedural complication rate and 1.7% mortality rate. The procedural complication rates have increased in recent years (P = .001), corresponding to increasing age and burden of comorbidities in patients. The mean cost per admission for balloon mitral valvuloplasty has gone up significantly over the 10 years, from $11,668 ± 1046 in 2001 to $23,651 ± 301 in 2010 (P <.001). CONCLUSIONS In a large cross-sectional study of balloon mitral valvuloplasty in the US, we have reported trends of decreasing overall utilization and increasing procedural complication rates and cost over a period of 13 years.
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Affiliation(s)
| | | | | | | | | | | | - Vikas Singh
- University of Miami Miller School of Medicine, Fla
| | | | | | | | | | | | | | | | | | - Harit Desai
- University of Miami Miller School of Medicine, Fla
| | - Saibal Kar
- Cedars-Sinai Medical Centre, Los Angeles, Calif
| | | | | | | | | | | | - Raj Makkar
- Cedars-Sinai Medical Centre, Los Angeles, Calif
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12
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Panaich SS, Badheka AO, Chothani A, Mehta K, Patel NJ, Deshmukh A, Singh V, Savani GT, Arora S, Patel N, Bhalara V, Grover P, Shah N, Elder M, Mohamad T, Kaki A, Kondur A, Brown M, Grines C, Schreiber T. Results of ventricular septal myectomy and hypertrophic cardiomyopathy (from Nationwide Inpatient Sample [1998-2010]). Am J Cardiol 2014; 114:1390-5. [PMID: 25205630 DOI: 10.1016/j.amjcard.2014.07.075] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [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: 05/15/2014] [Revised: 07/18/2014] [Accepted: 07/18/2014] [Indexed: 12/18/2022]
Abstract
Ventricular septal myomectomy (VSM) is the primary modality for left ventricular outflow tract gradient reduction in patients with obstructive hypertrophic cardiomyopathy with refractory symptoms. Comprehensive postprocedural data for VSM from a large multicenter registry are sparse. The primary objective of this study was to evaluate postprocedural mortality, complications, length of stay (LOS), and cost of hospitalization after VSM and to further appraise the multivariate predictors of these outcomes. The Healthcare Cost and Utilization Project's Nationwide Inpatient Sample was queried from 1998 through 2010 using International Classification of Diseases, Ninth Revision, procedure codes 37.33 for VSM and 425.1 for hypertrophic cardiomyopathy. The severity of co-morbidities was defined using the Charlson co-morbidity index. Hierarchical mixed-effects models were generated to identify independent multivariate predictors of in-hospital mortality, procedural complications, LOS, and cost of hospitalization. The overall mortality was 5.9%. Almost 9% (8.7%) of patients had postprocedural complete heart block requiring pacemakers. Increasing Charlson co-morbidity index was associated with a higher rate of complications and mortality (odds ratio 2.41, 95% confidence interval 1.17 to 4.98, p = 0.02). The mean cost of hospitalization was $41,715 ± $1,611, while the average LOS was 8.89 ± 0.35 days. Occurrence of any postoperative complication was associated with increased cost of hospitalization (+$33,870, p <0.001) and LOS (+6.08 days, p <0.001). In conclusion, the postoperative mortality rate for VSM was 5.9%; cardiac complications were most common, specifically complete heart block. Age and increasing severity of co-morbidities were predictive of poorer outcomes, while a higher burden of postoperative complications was associated with a higher cost of hospitalization and LOS.
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Affiliation(s)
| | | | - Ankit Chothani
- MedStar Washington Hospital Center, Washington, District of Columbia
| | - Kathan Mehta
- University of Pittsburgh Medical Center Shadyside Hospital, Pittsburgh, Pennsylvania
| | | | | | - Vikas Singh
- University of Miami Miller School of Medicine, Miami, Florida
| | | | | | | | | | - Peeyush Grover
- University of Miami Miller School of Medicine, Miami, Florida
| | - Neeraj Shah
- Staten Island University Hospital, Staten Island, New York
| | | | | | - Amir Kaki
- Detroit Medical Center, Detroit, Michigan
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13
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Badheka AO, Patel NJ, Grover P, Singh V, Patel N, Arora S, Chothani A, Mehta K, Deshmukh A, Savani GT, Patel A, Panaich SS, Shah N, Rathod A, Brown M, Mohamad T, Tamburrino FV, Kar S, Makkar R, O'Neill WW, De Marchena E, Schreiber T, Grines CL, Rihal CS, Cohen MG. Impact of annual operator and institutional volume on percutaneous coronary intervention outcomes: a 5-year United States experience (2005-2009). Circulation 2014; 130:1392-406. [PMID: 25189214 DOI: 10.1161/circulationaha.114.009281] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [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
BACKGROUND The relationship between operator or institutional volume and outcomes among patients undergoing percutaneous coronary interventions (PCI) is unclear. METHODS AND RESULTS Cross-sectional study based on the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample between 2005 to 2009. Subjects were identified by International Classification of Diseases, 9(th) Revision, Clinical Modification procedure code, 36.06 and 36.07. Annual operator and institutional volumes were calculated using unique identification numbers and then divided into quartiles. Three-level hierarchical multivariate mixed models were created. The primary outcome was in-hospital mortality; secondary outcome was a composite of in-hospital mortality and peri-procedural complications. A total of 457,498 PCIs were identified representing a total of 2,243,209 PCIs performed in the United States during the study period. In-hospital, all-cause mortality was 1.08%, and the overall complication rate was 7.10%. The primary and secondary outcomes of procedures performed by operators in 4(th) [annual procedural volume; primary and secondary outcomes] [>100; 0.59% and 5.51%], 3(rd) [45-100; 0.87% and 6.40%], and 2(nd) quartile [16-44; 1.15% and 7.75%] were significantly less (P<0.001) when compared with those by operators in the 1(st) quartile [≤15; 1.68% and 10.91%]. Spline analysis also showed significant operator and institutional volume outcome relationship. Similarly operators in the higher quartiles witnessed a significant reduction in length of hospital stay and cost of hospitalization (P<0.001). CONCLUSIONS Overall in-hospital mortality after PCI was low. An increase in operator and institutional volume of PCI was found to be associated with a decrease in adverse outcomes, length of hospital stay, and cost of hospitalization.
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Affiliation(s)
- Apurva O Badheka
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.).
| | - Nileshkumar J Patel
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Peeyush Grover
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Vikas Singh
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Nilay Patel
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Shilpkumar Arora
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Ankit Chothani
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Kathan Mehta
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Abhishek Deshmukh
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Ghanshyambhai T Savani
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Achint Patel
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Sidakpal S Panaich
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Neeraj Shah
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Ankit Rathod
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Michael Brown
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Tamam Mohamad
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Frank V Tamburrino
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Saibal Kar
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Raj Makkar
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - William W O'Neill
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Eduardo De Marchena
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Theodore Schreiber
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Cindy L Grines
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Charanjit S Rihal
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
| | - Mauricio G Cohen
- From Yale New Haven Medical Center, New Haven, CT (A.O.B.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., F.V.T.); UMass Memorial Medical Center, Worcester, MA (P.G.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., E.D.M., M.G.C.); Saint Peter's University Hospital, New Brunswick, NJ (N.P.); Mount Sinai's St Luke Roosevelt Hospital Center, New York, NY (S.A.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside Hospital, Pittsburgh, PA (K.M.); University of Arkansas, Little Rock, AR (A.D.); Icahn School of Medicine at Mount Sinai, New York, NY (A.P.); Detroit Medical Center, Detroit, MI (S.S.P., M.B., T.M., T.S., C.L.G.); Cedar-Sinai Medical Center, Los Angeles, CA (A.R., S.K., R.M.); Henry Ford Hospital, Detroit, MI (W.W.O.); Mayo Clinic, Rochester, MN (C.S.R.)
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Singh V, Patel NJ, Badheka A, Patel N, Macon C, Savani GT, Patel J, Thakkar B, Manvar S, Panchal V, Solanki S, Patel N, Chothani A, Kliger C, Schreiber T, O'Neill WW, Cohen MG, Alfonso C, Grines C, Forrest JK, Cleman M, Makkar R. TCT-786 In-Hospital Outcomes of balloon aortic valvuloplasty and percutaneous coronary intervention during the same hospitalization in the US. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.859] [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: 11/24/2022]
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Patel NJ, Hoosien M, Deshmukh A, Badheka AO, Grover PM, Shah N, Singh V, Mehta K, Chothani A, Savani GT, Arora S, Bhalara V, Patel N, Khalpada D, Rathod A, Vazzana TJ, Lafferty J, Viles-Gonzalez JF, Mitrani RD. Digoxin significantly improves all-cause mortality in atrial fibrillation patients with severely reduced left ventricular systolic function. Int J Cardiol 2014; 169:e84-6. [PMID: 24377111 DOI: 10.1016/j.ijcard.2013.10.040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Badheka AO, Patel NJ, Singh V, Shah N, Chothani A, Mehta K, Deshmukh A, Ghatak A, Rathod A, Desai H, Savani GT, Grover P, Patel N, Arora S, Grines CL, Schreiber T, Makkar R, Rihal CS, Cohen MG, De Marchena E, O'Neill WW. Percutaneous aortic balloon valvotomy in the United States: a 13-year perspective. Am J Med 2014; 127:744-753.e3. [PMID: 24608018 DOI: 10.1016/j.amjmed.2014.02.025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 01/02/2014] [Revised: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND We determined the contemporary trends of percutaneous aortic balloon valvotomy and its outcomes using the nation's largest hospitalization database. There has been a resurgence in the use of percutaneous aortic balloon valvotomy in patients at high surgical risk because of the development of less-invasive endovascular therapies. METHODS This is a cross-sectional study with time trends using the Nationwide Inpatient Sample database between the years 1998 and 2010. We identified patients using the International Classification of Diseases, 9th Revision, Clinical Modification procedure code for valvotomy. Only patients aged more than 60 years with aortic stenosis were included. Primary outcome included in-hospital mortality, and secondary outcomes included procedural complications and length of hospital stay. RESULTS A total of 2127 percutaneous aortic balloon valvotomies (weighted n = 10,640) were analyzed. The use rate of percutaneous aortic balloon valvotomy increased by 158% from 12 percutaneous aortic balloon valvotomies per million elderly patients in 1998-1999 to 31 percutaneous aortic balloon valvotomies per million elderly patients in 2009-2010 in the United States (P < .001). The hospital mortality decreased by 23% from 11.5% in 1998-1999 to 8.8% in 2009-2010 (P < .001). Significant predictors of in-hospital mortality were the presence of increasing comorbidities (P = .03), unstable patient (P < .001), any complication (P < .001), and weekend admission (P = .008), whereas increasing operator volume was associated with significantly reduced mortality (P = .03). Patients who were admitted to hospitals with the highest procedure volume and the highest volume operators had a 51% reduced likelihood (P = .05) of in-hospital mortality when compared with those in hospitals with the lowest procedure volume and lowest volume operators. CONCLUSION This study comprehensively evaluates trends for percutaneous aortic balloon valvotomy in the United States and demonstrates the significance of operator and hospital volume on outcomes.
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Affiliation(s)
| | | | - Vikas Singh
- University of Miami Miller School of Medicine, Miami, Fla
| | - Neeraj Shah
- Staten Island University Hospital, Staten Island, NY
| | | | | | | | - Abhijit Ghatak
- University of Miami Miller School of Medicine, Miami, Fla
| | | | - Harit Desai
- University of Miami Miller School of Medicine, Miami, Fla
| | | | - Peeyush Grover
- University of Miami Miller School of Medicine, Miami, Fla
| | | | | | | | | | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, Calif
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Shah N, Badheka AO, Grover PM, Patel NJ, Chothani A, Mehta K, Hoosien M, Singh V, Savani GT, Deshmukh A, Rathod A, Patel N, Panaich SS, Arora S, Schwartz C, Blisker M, Coffey JO, Mitrani RD, Fuster V, Viles-Gonzalez JF. Influence of left ventricular remodeling on atrial fibrillation recurrence and cardiovascular hospitalizations in patients undergoing rhythm-control therapy. Int J Cardiol 2014; 174:288-92. [DOI: 10.1016/j.ijcard.2014.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 04/01/2014] [Accepted: 04/02/2014] [Indexed: 11/24/2022]
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18
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Patel NJ, Deshmukh A, Pant S, Singh V, Patel N, Arora S, Shah N, Chothani A, Savani GT, Mehta K, Parikh V, Rathod A, Badheka AO, Lafferty J, Kowalski M, Mehta JL, Mitrani RD, Viles-Gonzalez JF, Paydak H. Contemporary trends of hospitalization for atrial fibrillation in the United States, 2000 through 2010: implications for healthcare planning. Circulation 2014; 129:2371-9. [PMID: 24842943 DOI: 10.1161/circulationaha.114.008201] [Citation(s) in RCA: 311] [Impact Index Per Article: 31.1] [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 Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The associated morbidity and mortality make AF a major public health burden. Hospitalizations account for the majority of the economic cost burden associated with AF. The main objective of this study is to examine the trends of AF-related hospitalizations in the United States and to compare patient characteristics, outcomes, and comorbid diagnoses. METHODS AND RESULTS With the use of the Nationwide Inpatient Sample from 2000 through 2010, we identified AF-related hospitalizations using International Classification of Diseases, 9th Revision, Clinical Modification code 427.31 as the principal discharge diagnosis. Overall AF hospitalizations increased by 23% from 2000 to 2010, particularly in patients ≥65 years of age. The most frequent coexisting conditions were hypertension (60.0%), diabetes mellitus (21.5%), and chronic pulmonary disease (20.0%). Overall in-hospital mortality was 1%. The mortality rate was highest in the group of patients ≥80 years of age (1.9%) and in the group of patients with concomitant heart failure (8.2%). In-hospital mortality rate decreased significantly from 1.2% in 2000 to 0.9% in 2010 (29.2% decrease; P<0.001). Although there was no significant change in mean length of stay, mean cost of AF hospitalization increased significantly from $6410 in 2001 to $8439 in 2010 (24.0% increase; P<0.001). CONCLUSIONS Hospitalization rates for AF have increased exponentially among US adults from 2000 to 2010. The proportion of comorbid chronic diseases has also increased significantly. The last decade has witnessed an overall decline in hospital mortality; however, the hospitalization cost has significantly increased.
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Affiliation(s)
- Nileshkumar J Patel
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.).
| | - Abhishek Deshmukh
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Sadip Pant
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Vikas Singh
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Nilay Patel
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Shilpkumar Arora
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Neeraj Shah
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Ankit Chothani
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Ghanshyambhai T Savani
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Kathan Mehta
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Valay Parikh
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Ankit Rathod
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Apurva O Badheka
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - James Lafferty
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Marcin Kowalski
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Jawahar L Mehta
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Raul D Mitrani
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Juan F Viles-Gonzalez
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
| | - Hakan Paydak
- From the Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., V.P., J.L., M.K.); University of Arkansas, Little Rock (A.D., S.P., J.L.M., H.P.); University of Miami Miller School of Medicine, Miami, FL (V.S., G.T.S., R.D.M., J.F.V.-G.); Detroit Medical Centre, Detroit, MI (N.P., S.A., A.O.B.); MedStar Washington Hospital Center, Washington, DC (A.C.); UPMC Shadyside, Pittsburgh, PA (K.M.); and Cedar-Sinai Medical Center, Los Angeles, CA (A.R.)
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Pothineni NVK, Deshmukh A, Pant S, Patel NJ, Badheka A, Chothani A, Shah N, Mehta K, Savani GT, Singh V, Grover P, Bhalara V, Patel N, Arora S, Rathod A, Viles-Gonzalez J, Paydak H. Complication rates of atrial fibrillation ablations: comparison of safety outcomes from real world to contemporary randomized control trials. Int J Cardiol 2014; 175:372-3. [PMID: 24948560 DOI: 10.1016/j.ijcard.2014.04.250] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 04/25/2014] [Indexed: 01/01/2023]
Affiliation(s)
| | | | - Sadip Pant
- University of Arkansas, Little Rock, AR, United States
| | | | | | - Ankit Chothani
- MedStar Washington Hospital Center, Washington, DC, United States
| | - Neeraj Shah
- Staten Island University Hospital, Staten Island, NY, United States
| | - Kathan Mehta
- UPMC Shadyside Hospital, Pittsburgh, PA, United States
| | | | - Vikas Singh
- University of Miami Miller School of Medicine, Miami, FL, United States
| | - Peeyush Grover
- University of Miami Miller School of Medicine, Miami, FL, United States
| | | | - Nilay Patel
- Detroit Medical Center, Detroit, MI, United States
| | | | - Ankit Rathod
- Cedar-Sinai Medical Center, Los Angeles, CA, United States
| | | | - Hakan Paydak
- University of Arkansas, Little Rock, AR, United States
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20
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Patel NJ, Pant S, Deshmukh AJ, Nalluri N, Badheka AO, Shah N, Chothani A, Savani GT, Schwartz C, Duvvuri S, Bogin M, Vazzana TJ. Seasonal variation of acute myocardial infarction related hospitalizations in the United States: perspective over the last decade. Int J Cardiol 2014; 172:e441-2. [PMID: 24485617 DOI: 10.1016/j.ijcard.2013.12.319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 12/31/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Sadip Pant
- University of Arkansas, Little Rock, AR, USA
| | | | - Nikhil Nalluri
- Staten Island University Hospital, Staten Island, NY, USA
| | | | - Neeraj Shah
- Staten Island University Hospital, Staten Island, NY, USA
| | | | | | | | | | - Marcin Bogin
- Staten Island University Hospital, Staten Island, NY, USA
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Deshmukh A, Patel NJ, Pant S, Shah N, Chothani A, Mehta K, Grover P, Singh V, Vallurupalli S, Savani GT, Badheka A, Tuliani T, Dabhadkar K, Dibu G, Reddy YM, Sewani A, Kowalski M, Mitrani R, Paydak H, Viles-Gonzalez JF. In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation 2013; 128:2104-2112. [PMID: 24061087 DOI: 10.1161/circulation.113.003862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Atrial fibrillation ablation has made tremendous progress with respect to innovation, efficacy, and safety. However, limited data exist regarding the burden and trends in adverse outcomes arising from this procedure. The aim of our study was to examine the frequency of adverse events attributable to atrial fibrillation (AF) ablation and the influence of operator and hospital volume on outcomes. METHODS AND RESULTS With the use of the Nationwide Inpatient Sample, we identified AF patients treated with catheter ablation. We investigated common complications including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, vascular access complications (hemorrhage/hematoma, vascular complications requiring surgical repair, and accidental arterial puncture), and in-hospital death described with AF ablation, and we defined these complications by using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. An estimated 93,801 AF ablations were performed from 2000 to 2010. The overall frequency of complications was 6.29% with combined cardiac complications (2.54%) being the most frequent. Cardiac complications were followed by vascular complications (1.53%), respiratory complications (1.3%), and neurological complications (1.02%). The in-hospital mortality was 0.46%. Annual operator (<25 procedures) and hospital volume (<50 procedures) were significantly associated with adverse outcomes. There was a small (nonsignificant) rise in overall complication rates. CONCLUSIONS The overall complication rate was 6.29% in patients undergoing AF ablation. There was a significant association between operator and hospital volume and adverse outcomes. This suggests a need for future research into identifying the safety measures in AF ablations and instituting appropriate interventions to improve overall AF ablation outcomes.
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Affiliation(s)
- Abhishek Deshmukh
- University of Arkansas for Medical Sciences, Little Rock, AR (A.D., S.D., S.V., G.D., A.S., H.P.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., M.K.); Medstar Institute, Washington Hospital Center, Washington, DC (A.C.); University of Miami - Miller School Of Medicine, Miami, FL (P.G., V.S., G.T.S., A.B., R.M., J.F.V.-G.); Drexel University College of Medicine, Philadelphia, PA (K.M.); Wayne State University, Detroit, MI (T.T.); Emory University, Atlanta, GA (K.D.); and University of Kansas, Kansas City, KS (Y.M.R.)
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Savani GT, Chothani A, Shah N, Patel NJ, Mehta K, Singh V, Grover P, Deshmukh AJ, Rathod A, Khalpada DB, Bhalara V, Parmar NG, Panaich SS, Gupta SJ, Badheka A, Cohen MG, O'Neill WW, de Marchena E. TCT-679 Effect of Operator Volume on Complications during Percutaneous Closure of Atrial Septal Defects and Patent Foramen Ovale - A US Perspective of the Last Decade. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1429] [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: 10/26/2022]
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23
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Deshmukh AJ, Chothani A, Singh V, Mehta K, Savani GT, Shah N, Rathod A, Arora S, Patel NJ, Grover P, Khalpada DB, Bhalara V, Parmar NG, Gupta SJ, Patel N, Sachdeva R, Badheka A, Cohen MG, O'Neill WW, de Marchena E, Viles-Gonzalez JF. TCT-681 Effect of Intra-Cardiac Echocardiography on Complications of Percutaneous Left Atrial Appendage Closure: A 5 Year Perspective of the United States. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1431] [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: 10/26/2022]
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Mehta K, Grover PM, Shah N, Patel NJ, Chothani A, Singh V, Savani GT, Deshmukh A, Rathod A, Patel N, Panaich SS, Arora S, Nalluri N, Khalpada D, Bhalaria V, Parmar NG, Badheka AO, Viles-Gonzalez JF, Mitrani RD. Non-influence of lipid lowering therapy in atrial fibrillation recurrence. Int J Cardiol 2013; 168:5006-7. [DOI: 10.1016/j.ijcard.2013.07.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 07/13/2013] [Indexed: 11/25/2022]
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25
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Arora S, Patel NJ, Chothani A, Shah N, Mehta K, Grover P, Singh V, Deshmukh AJ, Rathod A, Khalpada DB, Savani GT, Panaich SS, Parmar NG, Bhalara V, Patel N, Badheka A, Cohen MG, de Marchena E, O'Neill WW. TCT-100 Effect of Intra cardiac echocardiography and yearly operator volume on Length of Stay and Cost of Care for Percutaneous Closure of Atrial Septal Defects and Patent Foramen Ovale: A Perspective of Last Decade. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.827] [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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Grover PM, Badheka AO, Shah N, Patel NJ, Mehta K, Chothani A, Singh V, Savani GT, Deshmukh A, Rathod A, Patel N, Panaich SP, Arora S, Khalpada D, Bhalara V, Parmar NG, Mohamad T, Cohen MG. Presence of anti-viral and anti-parasitic antibodies and cardiovascular mortality: Insights from NHANES III. Int J Cardiol 2013; 168:4826-30. [DOI: 10.1016/j.ijcard.2013.07.007] [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] [Received: 05/30/2013] [Accepted: 07/01/2013] [Indexed: 10/26/2022]
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Deshmukh A, Patel NJ, Pant S, Shah N, Chothani A, Mehta K, Grover P, Singh V, Vallurupalli S, Savani GT, Badheka A, Tuliani T, Dabhadkar K, Dibu G, Reddy YM, Sewani A, Kowalski M, Mitrani R, Paydak H, Viles-Gonzalez JF. In-hospital complications associated with catheter ablation of atrial fibrillation in the United States between 2000 and 2010: analysis of 93 801 procedures. Circulation 2013; 128:2104-12. [PMID: 24061087 DOI: 10.1161/circulationaha.113.003862] [Citation(s) in RCA: 430] [Impact Index Per Article: 39.1] [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: 01/07/2023]
Abstract
BACKGROUND Atrial fibrillation ablation has made tremendous progress with respect to innovation, efficacy, and safety. However, limited data exist regarding the burden and trends in adverse outcomes arising from this procedure. The aim of our study was to examine the frequency of adverse events attributable to atrial fibrillation (AF) ablation and the influence of operator and hospital volume on outcomes. METHODS AND RESULTS With the use of the Nationwide Inpatient Sample, we identified AF patients treated with catheter ablation. We investigated common complications including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, vascular access complications (hemorrhage/hematoma, vascular complications requiring surgical repair, and accidental arterial puncture), and in-hospital death described with AF ablation, and we defined these complications by using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. An estimated 93,801 AF ablations were performed from 2000 to 2010. The overall frequency of complications was 6.29% with combined cardiac complications (2.54%) being the most frequent. Cardiac complications were followed by vascular complications (1.53%), respiratory complications (1.3%), and neurological complications (1.02%). The in-hospital mortality was 0.46%. Annual operator (<25 procedures) and hospital volume (<50 procedures) were significantly associated with adverse outcomes. There was a small (nonsignificant) rise in overall complication rates. CONCLUSIONS The overall complication rate was 6.29% in patients undergoing AF ablation. There was a significant association between operator and hospital volume and adverse outcomes. This suggests a need for future research into identifying the safety measures in AF ablations and instituting appropriate interventions to improve overall AF ablation outcomes.
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Affiliation(s)
- Abhishek Deshmukh
- University of Arkansas for Medical Sciences, Little Rock, AR (A.D., S.D., S.V., G.D., A.S., H.P.); Staten Island University Hospital, Staten Island, NY (N.J.P., N.S., M.K.); Medstar Institute, Washington Hospital Center, Washington, DC (A.C.); University of Miami - Miller School Of Medicine, Miami, FL (P.G., V.S., G.T.S., A.B., R.M., J.F.V.-G.); Drexel University College of Medicine, Philadelphia, PA (K.M.); Wayne State University, Detroit, MI (T.T.); Emory University, Atlanta, GA (K.D.); and University of Kansas, Kansas City, KS (Y.M.R.)
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