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Khan MZ, Nguyen A, Khan MU, Sattar Y, Waleed MD, Gonuguntla K, Sohaib Hayat HM, Mendez M, Nassar S, Abideen Asad ZU, Agarwal S, Raina S, Balla S, Nguyen B, Fan D, Darden D, Munir MB. Association of chronic kidney disease and end-stage renal disease with procedural complications and inpatient outcomes of leadless pacemaker implantations across the United States. Heart Rhythm 2024:S1547-5271(24)02311-7. [PMID: 38574789 DOI: 10.1016/j.hrthm.2024.03.1816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Leadless pacemakers have emerged as a promising alternative to transvenous pacemakers in patients with kidney disease. However, studies investigating leadless pacemaker outcomes and complications based on kidney dysfunction are limited. OBJECTIVE The objective of this study was to evaluate the association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with inpatient complications and outcomes of leadless pacemaker implantations. METHODS National Inpatient Sample and International Classification of Diseases, Tenth Revision codes were used to identify patients with CKD and ESRD who underwent leadless pacemaker implantations in the United States from 2016 to 2020. Study end points assessed included inpatient complications, outcomes, and resource utilization of leadless pacemaker implantations. RESULTS A total of 29,005 leadless pacemaker placements were identified. Patients with CKD (n = 5245 [18.1%]) and ESRD (n = 3790 [13.1%]) were younger than patients without CKD and had higher prevalence of important comorbidities. In crude analysis, ESRD was associated with higher prevalence of major complications, peripheral vascular complications, and inpatient mortality. After multivariable adjustment, CKD and ESRD were associated with inpatient mortality (CKD: adjusted odds ratio [aOR], 1.62 [95% CI, 1.40-1.86]; ESRD: aOR, 1.38 [95% CI, 1.18-1.63]) and prolonged length of stay (CKD: aOR, 1.55 [95% CI, 1.46-1.66]; ESRD: aOR, 1.81 [95% CI 1.67-1.96]). ESRD was also associated with higher hospitalization costs (aOR, 1.63; 95% CI, 1.50-1.77) and major complications (aOR, 1.33; 95% CI, 1.13-1.57) after leadless pacemaker implantation. CONCLUSION Approximately one-third of patients undergoing leadless pacemaker implantation had CKD or ESRD. CKD and ESRD were associated with greater length and cost of stay and inpatient mortality.
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Affiliation(s)
- Muhammad Zia Khan
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
| | - Amanda Nguyen
- Department of Medicine, University of California Davis Medical Center, Sacramento, California
| | | | - Yasar Sattar
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - M D Waleed
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Karthik Gonuguntla
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Hafiz Muhammad Sohaib Hayat
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Melody Mendez
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Sameh Nassar
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | | | - Siddharth Agarwal
- Division of Cardiology, University of Oklahoma, Oklahoma City, Oklahoma
| | - Sameer Raina
- Division of Cardiology, Stanford University, Stanford, California
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Bao Nguyen
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Dali Fan
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Douglas Darden
- Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
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Zahid S, Mohamed MS, Rajendran A, Minhas AS, Khan MZ, Nazir NT, Ocon AJ, Weber BN, Isiadinso I, Michos ED. Rheumatoid arthritis and cardiovascular complications during delivery: a United States inpatient analysis. Eur Heart J 2024:ehae108. [PMID: 38427130 DOI: 10.1093/eurheartj/ehae108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/12/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND AIMS Persons with rheumatoid arthritis (RA) have an increased risk of obstetric-associated complications, as well as long-term cardiovascular (CV) risk. Hence, the aim was to evaluate the association of RA with acute CV complications during delivery admissions. METHODS Data from the National Inpatient Sample (2004-2019) were queried utilizing ICD-9 or ICD-10 codes to identify delivery hospitalizations and a diagnosis of RA. RESULTS A total of 12 789 722 delivery hospitalizations were identified, of which 0.1% were among persons with RA (n = 11 979). Individuals with RA, vs. those without, were older (median 31 vs. 28 years, P < .01) and had a higher prevalence of chronic hypertension, chronic diabetes, gestational diabetes mellitus, obesity, and dyslipidaemia (P < .01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, RA remained an independent risk factor for peripartum CV complications including preeclampsia [adjusted odds ratio (aOR) 1.37 (95% confidence interval 1.27-1.47)], peripartum cardiomyopathy [aOR 2.10 (1.11-3.99)], and arrhythmias [aOR 2.00 (1.68-2.38)] compared with no RA. Likewise, the risk of acute kidney injury and venous thromboembolism was higher with RA. An overall increasing trend of obesity, gestational diabetes mellitus, and acute CV complications was also observed among individuals with RA from 2004-2019. For resource utilization, length of stay and cost of hospitalization were higher for deliveries among persons with RA. CONCLUSIONS Pregnant persons with RA had higher risk of preeclampsia, peripartum cardiomyopathy, arrhythmias, acute kidney injury, and venous thromboembolism during delivery hospitalizations. Furthermore, cardiometabolic risk factors among pregnant individuals with RA rose over this 15-year period.
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Affiliation(s)
- Salman Zahid
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR, USA
| | - Mohamed S Mohamed
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Aardra Rajendran
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Anum S Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Muhammad Zia Khan
- Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
| | - Noreen T Nazir
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL, USA
| | - Anthony J Ocon
- Division of Allergy, Immunology & Rheumatology, Rochester Regional Health, Rochester, NY, USA
| | - Brittany N Weber
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ijeoma Isiadinso
- Division of Cardiology, Center for Heart Disease Prevention, Emory University School of Medicine, Atlanta, GA, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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Zahid S, Agrawal A, Salman F, Khan MZ, Ullah W, Teebi A, Khan SU, Sulaiman S, Balla S. Development and Validation of a Machine Learning Risk-Prediction Model for 30-Day Readmission for Heart Failure Following Transcatheter Aortic Valve Replacement (TAVR-HF Score). Curr Probl Cardiol 2024; 49:102143. [PMID: 37863456 DOI: 10.1016/j.cpcardiol.2023.102143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is the treatment of choice for patients with severe aortic stenosis across the spectrum of surgical risk. About one-third of 30-day readmissions following TAVR are related to heart failure (HF). Hence, we aim to develop an easy-to-use clinical predictive model to identify patients at risk for HF readmission. We used data from the National Readmission Database (2015-2018) utilizing ICD-10 codes to identify TAVR procedures. Readmission was defined as the first unplanned HF readmission within 30-day of discharge. A machine learning framework was used to develop a 30-day TAVR-HF readmission score. The receiver operator characteristic curve was used to evaluate the predictive power of the model. A total of 92,363 cases of TAVR were included in the analysis. Of the included patients, 3299 (3.6%) were readmitted within 30 days of discharge with HF. Individuals who got readmitted, vs those without readmission, had more emergent admissions during index procedure (33.4% vs 19.8%), electrolyte abnormalities (38% vs 16.7%), chronic kidney disease (34.8% vs 21.2%), and atrial fibrillation (60.1% vs 40.7%). Candidate variables were ranked by importance using a parsimony plot. A total of 7 variables were selected based on predictive ability as well as clinical relevance: HF with reduced ejection fraction (25 points), HF preserved EF (20 points), electrolyte abnormalities (17 points), atrial fibrillation (12 points), Charlson comorbidity index (<6 = 0, 6-8 = 9, 9-10 = 13, >10 = 14 points), chronic kidney disease (7 points), and emergent index admission (5 points). On performance evaluation using the testing dataset, an area under the curve of 0.761 (95% CI 0.744-0.778) was achieved. Thirty-day TAVR-HF readmission score is an easy-to-use risk prediction tool. The score can be incorporated into electronic health record systems to identify at-risk individuals for readmissions with HF following TAVR. However, further external validation studies are needed.
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Affiliation(s)
- Salman Zahid
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Fnu Salman
- Department of Cardiovascular Medicine, Mercy St. Vincent Hospital, Toledo, OH
| | - Muhammad Zia Khan
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, WV
| | - Waqas Ullah
- Department of Cardiovascular Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Ahmed Teebi
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Safi U Khan
- Houston Methodist DeBakey Heart & Vascular Institute, Houston, TX
| | - Samian Sulaiman
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, WV
| | - Sudarshan Balla
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, WV.
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Agarwal S, Munir MB, Khan MZ, Bansal A, Deshmukh A, DeSimone CV, Stavrakis S, Asad ZUA. Impact of Psychosocial Risk Factors on Outcomes of Atrial Fibrillation Patients undergoing Left Atrial Appendage Occlusion Device Implantation. J Interv Card Electrophysiol 2023; 66:2031-2040. [PMID: 37016070 DOI: 10.1007/s10840-023-01546-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/30/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND The impact of psychosocial risk factors (PSRFs) on outcomes in patients undergoing percutaneous left atrial appendage occlusion (LAAO) device implantation is unclear. We aimed to analyze the association of psychosocial risk factors with outcomes in patients undergoing LAAO. METHODS Data were extracted from the Nationwide readmissions database for the calendar years 2016-2019. LAAO device implantations were identified using ICD-10-CM code 02L73DK. The outcomes of interest included procedural complications, inpatient mortality, resource utilization, and 30-day readmissions. Patients were divided into two cohorts based on the absence or presence of PSRFs. RESULTS Our cohort included a total of 54,900 patients, of which, 19,984 (36.4%) had ≥ 1 PSRF as compared to 34,916 (63.6%) with no PSRFs. The prevalence of major complications (3.3% vs 2.8%, p=0.03) was significantly higher in patients with ≥ 1 PSRF as compared to no PSRFs. Furthermore, patients with ≥ 1 PSRF had a significantly higher 30-day readmission rate (6.9% vs 6.2%, p=0.02). In the multivariable model, the presence of ≥ 1 PSRF was associated with significantly higher odds of overall complications [adjusted odds ratio (aOR):1.11; 95% confidence interval (CI): 1.01-1.21; p=0.02]. Additionally, the presence of ≥ 1 PSRF was associated with higher odds of prolonged hospital stay for more than one day (aOR: 1.30; 95% CI: 1.21-1.40; p<0.01). CONCLUSION The high prevalence of PSRFs may be associated with poorer outcomes in patients with AF patients undergoing LAAO device implantations. These data merit further study to help in the selection process of patients for LAAO for improved outcomes.
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Affiliation(s)
- Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Muhammad Zia Khan
- Department of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Agam Bansal
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Stavros Stavrakis
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Minhas AMK, Bhopalwala HM, Dewaswala N, Ijaz SH, Khan MS, Khan MZ, Dani SS, Warraich HJ, Greene SJ, Edmonston DL, Lopez RD, Virani SS, Bhopalwala A, Fudim M. Association of Chronic Renal Insufficiency with Inhospital Outcomes in Primary Heart Failure Hospitalizations (Insights from the National Inpatient Sample 2004 to 2018). Am J Cardiol 2023; 202:41-49. [PMID: 37419025 DOI: 10.1016/j.amjcard.2023.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/07/2023] [Accepted: 05/29/2023] [Indexed: 07/09/2023]
Abstract
Chronic kidney disease (CKD) is a major co-morbidity in patients with heart failure (HF). There are limited contemporary data characterizing the clinical profile, inhospital outcomes, and resource use in patients hospitalized for HF with co-morbid CKD. We utilized a nationally representative population to address the knowledge gap. We examined the National Inpatient Sample 2004 to 2018 database to study the co-morbid profile, in-hospital mortality, clinical resource utilization, healthcare cost, and length of stay (LOS) in primary adult HF hospitalizations stratified by presence versus absence of a diagnosis codes of CKD. There were a total of 16,050,301 adult hospitalizations with a primary HF diagnosis from January 1, 2004, to December 31, 2018. Of these, 428,175 (33.81%) had CKD; 1,110,778 (6.92%) had end-stage kidney disease (ESKD); and 9,511,348 (59.25%) had no diagnosis of CKD. Patients with hospitalizations for HF with ESKD were younger (mean age 65.4 years) compared with those without ESKD. In multivariable analysis, those with CKD had higher odds of inhospital mortality (2.82% vs 3.57%, adjusted odds ratio [aOR] 1.30, confidence interval [CI] 1.28 to 1.26, p <0.001), cardiogenic shock (1.01% vs 1.79% aOR 2.00, CI 1.95 to 2.05, p <0.001), and the need for mechanical circulatory support (0.4% vs 0.5%, aOR 1.51, 1.44 to 1.57, p <0.001) compared with those without CKD. In multivariable analysis, those with ESKD had higher odds of inhospital mortality (2.82% vs 3.84%, aOR 2.07, CI 2.01 to 2.12, p <0.001), need for invasive mechanical ventilation use (2.04% vs 3.94%, aOR 1.79, CI 1.75 to 1.84, p <0.001), cardiac arrest (0.72% vs 1.54%, aOR 2.09, CI 2.00 to 2.17, p <0.001), longer LOS (Adjusted mean difference 1.48, 1.44 to 1.53, p <0.001) and higher inflation-adjusted cost (Adjusted mean difference 3,411.63, CI 3,238.35 to 3,584.91, p <0.001) compared with those without CKD. CKD and ESKD affected about 40.7% of all primary HF hospitalizations from 2004 to 2018. The inhospital mortality, clinical complications, LOS, and inflation-adjusted cost were higher in hospitalized patients with ESKD compared with patients with and without CKD. In addition, compared with those without CKD, hospitalized patients with CKD had higher inhospital mortality, clinical complications, LOS, and inflation-adjusted cost compared with patients with no diagnosis of CKD.
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Affiliation(s)
| | - Huzefa M Bhopalwala
- Department of Internal Medicine, Appalachian Regional Health Care, Whitesburg, Kentucky
| | - Nakeya Dewaswala
- Department of Cardiovascular Disease, University of Kentucky, Lexington, Kentucky
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Muhammad Zia Khan
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephen J Greene
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Daniel L Edmonston
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, North Carolina
| | - Renato D Lopez
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Adnan Bhopalwala
- Cardiology, Appalachian Regional Health Care, Whitesburg, Kentucky
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
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Shatla I, Khan MZ, Iskandarani ME, Munir MB, Balla S. In-Hospital Outcomes of Pulmonary Embolism Among Nonagenarians (Insights from the National Inpatient Sample). Am J Cardiol 2023; 200:10-12. [PMID: 37271118 DOI: 10.1016/j.amjcard.2023.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/08/2023] [Accepted: 04/28/2023] [Indexed: 06/06/2023]
Affiliation(s)
- Islam Shatla
- Department of Internal Medicine, Kansas University Medical Center, Kansas City, Kansas
| | - Muhammad Zia Khan
- Division of Cardiovascular Disease, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Mahmoud El Iskandarani
- Department of Internal Medicine, Eastern Connecticut Health Network, Manchester, Connecticut
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Sudarshan Balla
- Division of Cardiovascular Disease, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia.
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Zahid S, Hashem A, Khalouf A, Salman F, Atti L, Altib A, Khan MZ, Balla S. Outcomes of Thirty-Day Readmission in Patients With Heart Failure on Index Hospitalization Undergoing Transcatheter Edge-to-Edge Mitral Repair: Insights from the United States Nationwide Readmission Database. Struct Heart 2023; 7:100187. [PMID: 37520137 PMCID: PMC10382959 DOI: 10.1016/j.shj.2023.100187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 03/21/2023] [Accepted: 04/06/2023] [Indexed: 08/01/2023]
Affiliation(s)
- Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Anas Hashem
- Department of Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Amani Khalouf
- Department of Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Fnu Salman
- Department of Cardiovascular Disease, Mercy St. Vincent Hospital, Toledo, Ohio, USA
| | - Lalitsiri Atti
- Department of Medicine, Sri Venkateswara Medical College, Tirupati, India
| | - Ahmed Altib
- Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
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Khan MZ, Shatla I, Darden D, Neely J, Mir T, Abideen Asad ZU, Agarwal S, Raina S, Balla S, Singh GD, Srivatsa U, Munir MB. Intracranial bleeding and associated outcomes in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion: Insights from National Inpatient Sample 2016-2020. Heart Rhythm O2 2023; 4:433-439. [PMID: 37520018 PMCID: PMC10373143 DOI: 10.1016/j.hroo.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Background Percutaneous left atrial appendage occlusion (LAAO) has proved to be a safer alternative for long-term anticoagulation; however, patients with a history of intracranial bleeding were excluded from large randomized clinical trials. Objective The purpose of this study was to determine outcomes in atrial fibrillation (AF) patients with a history of intracranial bleeding undergoing percutaneous LAAO. Methods National Inpatient Sample and International Classification of Diseases, Tenth Revision, codes were used to identify patients with AF who underwent LAAO during the years 2016-2020. Patients were stratified based on a history of intracranial bleeding vs not. The outcomes assessed in our study included complications, in-hospital mortality, and resource utilization. Result A total of 89,300 LAAO device implantations were studied. Approximately 565 implantations (0.6%) occurred in patients with a history of intracranial bleed. History of intracranial bleeding was associated with a higher prevalence of overall complications and in-patient mortality in crude analysis. In the multivariate model adjusted for potential confounders, intracranial bleeding was found to be independently associated with in-patient mortality (adjusted odds ratio [aOR] 4.27; 95% confidence interval [CI] 1.68-10.82); overall complications (aOR 1.74; 95% CI 1.36-2.24); prolonged length of stay (aOR 2.38; 95% CI 1.95-2.92); and increased cost of hospitalization (aOR 1.28; 95% CI 1.08-1.52) after percutaneous LAAO device implantation. Conclusion A history of intracranial bleeding was associated with adverse outcomes after percutaneous LAAO. These data, if proven in a large randomized study, can have important clinical consequences in terms of patient selection for LAAO devices.
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Affiliation(s)
- Muhammad Zia Khan
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Islam Shatla
- Department of Internal Medicine, Kansas University Medical Center, Kansas City, Kansas
| | - Douglas Darden
- Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Joseph Neely
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Tanveer Mir
- Department of Medicine, Wayne State University, Detroit, Michigan
| | - Zain Ul Abideen Asad
- Department of Internal Medicine, University of Oklahoma, Oklahoma City, Oklahoma
| | - Siddharth Agarwal
- Department of Internal Medicine, University of Oklahoma, Oklahoma City, Oklahoma
| | - Sameer Raina
- Division of Cardiovascular Medicine, Stanford University, Stanford, California
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Gagan D. Singh
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Uma Srivatsa
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
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Krishan S, Munir MB, Khan MZ, Al-Juhaishi T, Nipp R, DeSimone CV, Deshmukh A, Stavrakis S, Barac A, Asad ZUA. Association of atrial fibrillation and outcomes in patients undergoing bone marrow transplantation. Europace 2023; 25:euad129. [PMID: 37208304 PMCID: PMC10198774 DOI: 10.1093/europace/euad129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/14/2023] [Indexed: 05/21/2023] Open
Abstract
AIMS Haematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for several malignant and non-malignant haematologic conditions. Patients undergoing HSCT are at an increased risk of developing atrial fibrillation (AF). We hypothesized that a diagnosis of AF would be associated with poor outcomes in patients undergoing HSCT. METHODS AND RESULTS The National Inpatient Sample (2016-19) was queried with ICD-10 codes to identify patients aged >50 years undergoing HSCT. Clinical outcomes were compared between patients with and without AF. A multivariable regression model adjusting for demographics and comorbidities was used to calculate the adjusted odds ratio (aOR) and regression coefficients with corresponding 95% confidence intervals and P-values. A total of 50 570 weighted hospitalizations for HSCT were identified, out of which 5820 (11.5%) had AF. Atrial fibrillation was found to be independently associated with higher inpatient mortality (aOR 2.75; 1.9-3.98; P < 0.001), cardiac arrest (aOR 2.86; 1.55-5.26; P = 0.001), acute kidney injury (aOR 1.89; 1.6-2.23; P < 0.001), acute heart failure exacerbation (aOR 5.01; 3.54-7.1; P < 0.001), cardiogenic shock (aOR 7.73; 3.17-18.8; P < 0.001), and acute respiratory failure (aOR 3.24; 2.56-4.1; P < 0.001) as well as higher mean length of stay (LOS) (+2.67; 1.79-3.55; P < 0.001) and cost of care (+67 529; 36 630-98 427; P < 0.001). CONCLUSION Among patients undergoing HSCT, AF was independently associated with poor in-hospital outcomes, higher LOS, and cost of care.
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Affiliation(s)
- Satyam Krishan
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | - Muhammad Bilal Munir
- Department of Cardiovascular Medicine, Electrophysiology Section, University of California Davis, Davis, CA, USA
| | - Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, WV, USA
| | - Taha Al-Juhaishi
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | - Ryan Nipp
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | | | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stavros Stavrakis
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
| | - Ana Barac
- Cardio Oncology Program, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L. Young Blvd, AAT 5400, Oklahoma City, OK, 73104, USA
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Zahid S, Khan MZ, Shatla I, Kaur G, Michos ED. Thirty-Day Cardiovascular Readmissions Following Discharge with COVID-19: A US Nationwide Readmission Database Analysis from the Pandemic Year 2020. CJC Open 2023:S2589-790X(23)00113-0. [PMID: 37362314 PMCID: PMC10158170 DOI: 10.1016/j.cjco.2023.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND COVID-19 is known to be associated with a myriad of cardiovascular (CV) complications during acute illness, but the rates of readmissions for CV complications after COVID-19 infection are less well established. METHODS The U.S Nationwide Readmission Database was utilized to identify COVID-19 admissions from April 1st to November 30th, 2020 using ICD-10-CM administrative claims. RESULTS A total of 521,351 admissions for COVID-19 were identified. The all-cause 30-day readmission rate was 11.6% (n=60,262). The incidence of CV readmissions was 5.1% (n=26,725), accounting for 44.3% of all-cause 30-day readmissions. Both CV and non-CV readmissions occurred at a median of 7 days. Patients readmitted with CV causes had a higher comorbidity burden with Charlson comorbidity median score of 6. The most common CV cause of readmission was acute heart failure (HF) (8.5%) followed by acute myocardial infarction (MI) (5.2%). Venous thromboembolism and stroke during 30-day readmission occurred at a rate of 4.6% and 3.6%, respectively. Stress cardiomyopathy and acute myocarditis were less frequent with an incidence of 0.1% and 0.2%, respectively. CV readmissions were associated with higher mortality compared with non-CV readmissions (16.5% vs. 7.5%, p<0.01). Each 30-day CV readmission was associated with greater cost of care than each non-CV readmission ($13,803 vs. $10,310, p=<0.01). CONCLUSIONS Among survivors of index COVID-19 admission, 44.7% of all 30-day readmissions were attributed to CV causes. Acute HF remains the most common cause of readmission after COVID-19, followed closely by acute MI. CV causes of readmissions remain a significant source of mortality, morbidity, and resource utilization.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY, USA
| | - Muhammad Zia Khan
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Islam Shatla
- Department of Medicine, Kansas University Medical Center, Kansas City, MO, USA
| | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Messele LF, Khan MZ, Darden D, Agarwal S, Krishan S, Pasupula DK, Asad ZUA, Balla S, Singh GD, Srivatsa UN, Munir MB. Outcomes of percutaneous left atrial appendage occlusion device implantation in atrial fibrillation patients based on underlying stroke risk. Europace 2023; 25:1415-1422. [PMID: 36881781 PMCID: PMC10105852 DOI: 10.1093/europace/euad049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/01/2023] [Indexed: 03/09/2023] Open
Abstract
AIMS To determine outcomes in atrial fibrillation patients undergoing percutaneous left atrial appendage occlusion (LAAO) based on the underlying stroke risk (defined by the CHA2DS2-VASc score). METHODS AND RESULTS Data were extracted from the National Inpatient Sample for calendar years 2016-20. Left atrial appendage occlusion implantations were identified on the basis of the International Classification of Diseases, 10th Revision, Clinical Modification code of 02L73DK. The study sample was stratified on the basis of the CHA2DS2-VASc score into three groups (scores of 3, 4, and ≥5). The outcomes assessed in our study included complications and resource utilization. A total of 73 795 LAAO device implantations were studied. Approximately 63% of LAAO device implantations occurred in patients with CHA2DS2-VASc scores of 4 and ≥5. The crude prevalence of pericardial effusion requiring intervention was higher with increased CHA2DS2-VASc score (1.4% in patients with a score of ≥5 vs. 1.1% in patients with a score of 4 vs. 0.8% in patients with a score of 3, P < 0.01). In the multivariable model adjusted for potential confounders, CHA2DS2-VASc scores of 4 and ≥5 were found to be independently associated with overall complications [adjusted odds ratio (aOR) 1.26, 95% confidence interval (CI) 1.18-1.35, and aOR 1.88, 95% CI 1.73-2.04, respectively] and prolonged length of stay (aOR 1.18, 95% CI 1.11-1.25, and aOR 1.54, 95% CI 1.44-1.66, respectively). CONCLUSION A higher CHA2DS2-VASc score was associated with an increased risk of peri-procedural complications and resource utilization after LAAO. These findings highlight the importance of patient selection for the LAAO procedure and need validation in future studies.
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Affiliation(s)
- Lydia Fekadu Messele
- Division of Cardiovascular Medicine-Section of Cardiac Electrophysiology, University of California Davis School of Medicine, 4860 Y St. Suite 2800, Sacramento, CA 95817, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Douglas Darden
- Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, KS, USA
| | - Siddharth Agarwal
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Satyam Krishan
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Deepak Kumar Pasupula
- Division of Cardiovascular Medicine, MercyOne North Iowa Medical Center, Mason City, IA, USA
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Gagan D Singh
- Division of Cardiovascular Medicine-Section of Cardiac Electrophysiology, University of California Davis School of Medicine, 4860 Y St. Suite 2800, Sacramento, CA 95817, USA
| | - Uma N Srivatsa
- Division of Cardiovascular Medicine-Section of Cardiac Electrophysiology, University of California Davis School of Medicine, 4860 Y St. Suite 2800, Sacramento, CA 95817, USA
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine-Section of Cardiac Electrophysiology, University of California Davis School of Medicine, 4860 Y St. Suite 2800, Sacramento, CA 95817, USA
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Sattar Y, DeCicco D, Faisaluddin M, Almas T, Yasmin F, Alharbi A, Gonuguntla K, Khan MZ, Almas T, Chobufo MD, Daggubati R, Bianco C. Meta-Analysis on the Impact of Coronary Bypass Graft Markers on Angiographic Procedural Outcomes. Am J Cardiol 2023; 195:23-26. [PMID: 37001240 DOI: 10.1016/j.amjcard.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 03/06/2023]
Abstract
Utilization of radio-opaque coronary artery bypass graft markers is known to decrease the amount of contrast dye required to complete the procedure. The practice of marking bypass grafts varies significantly among surgeons. Limited data exist comparing the outcomes of percutaneous coronary intervention with and without coronary artery bypass graft (CABG) markers. We sought to explore the impact of proximal radio-opaque markers placed during CABG in subsequent percutaneous coronary intervention procedural risks. In our understanding of the current literature, this is the first meta-analysis conducted to evaluate the association between procedural angiographic metrics and CABG radio-opaque markers. We performed a query of MEDLINE and Scopus databases through August 2022 to identify relevant studies evaluating procedural metrics among patients with previous CABG with and without radio-opaque markers who underwent angiography. The primary outcomes of interest were fluoroscopy time, amount of contrast, and duration of angiography. We identified a total of 4 studies with 2,046 patients with CABG (CABG with markers n = 688, CABG without markers n = 1,518).2-5 Total fluoroscopy time was significantly reduced among patients with CABG markers compared with those with no markers (odds ratio [OR] -3.63, p <0.0001). The duration of angiography (OR -36.39, p >0.10) was reduced, although the result was not statistically significant. However, the amount of contrast utilization was significantly reduced (OR -33.41, p <0.0001). In patients who underwent CABG with radio-opaque markers, angiographic procedural metrics were improved, including reduced fluoroscopic time and the amount of contrast agent required compared with no markers.
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13
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Kichloo A, Solanki D, Berger R, Jamal S, Albosta M, Aljadah M, Khan MZ, Kanjwal K. Trends in the Use and Complications of Cardiac Resynchronization Therapy Device Implantation in Chronic Kidney Disease Patients. J Innov Card Rhythm Manag 2023; 14:5339-5347. [PMID: 36874561 PMCID: PMC9983618 DOI: 10.19102/icrm.2023.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/12/2022] [Indexed: 03/07/2023] Open
Abstract
Large-scale multi-hospital data on cardiac resynchronization therapy (CRT) device implantation in patients with chronic kidney disease (CKD) are currently lacking. The purpose of this study was to examine the incidence of CRT device implantation in patients hospitalized with CKD and the impact of CRT device implantation on hospital complications and outcomes. We analyzed the Nationwide Inpatient Sample from 2008-2014 to identify yearly trends in CRT device implantation during CKD hospitalizations. We compared CRT biventricular pacemakers (CRT-Ps) and CRT defibrillators (CRT-Ds). We also obtained rates of comorbidities and complications associated with CRT device implantations. From 2008-2014, the proportion of hospitalized patients with a concurrent diagnosis of CKD receiving CRT-P devices consistently went up from 2008 to 2014 (from 12.3% to 23.8%, P < .0001) compared to the number of hospitalized patients with a concurrent diagnosis of CKD receiving CRT-D devices, which showed a consistent downward trend (from 87.7% to 76.2%, P < .0001). During CKD hospitalizations, most CRT device implantations were performed in patients aged 65-84 years (68.6%) and in men (74.3%). The most common complication of CRT device implantation during hospitalizations involving CKD was hemorrhage or hematoma (2.7%). Patients hospitalized with CKD who developed any complication associated with CRT device implantation had 3.35-fold increased odds of mortality compared to those without complications (odds ratio, 3.35; 95% confidence interval, 2.18-5.16; P < .0001). In summary, this study shows that CRT-P implantations became more common in CKD patients, while the rate of CRT-D implantations decreased over time. Hemorrhage or hematoma was the most common complication (2.7%), and the mortality risk was increased by 3.35 times in patients who developed periprocedural complications.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA.,Department of Internal Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - Dhanshree Solanki
- Department of Health Administration, Rutgers University, New Brunswick, NJ, USA
| | - Ronald Berger
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shakeel Jamal
- Department of Internal Medicine, Central Michigan University, Saginaw, MI, USA
| | - Michael Albosta
- Department of Internal Medicine, University of Miami, Jackson Memorial Hospital, Miami, FL, USA
| | - Michael Aljadah
- Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Muhammad Zia Khan
- Department of Internal Medicine, West Virginia University, Morgantown, WV, USA
| | - Khalil Kanjwal
- Section of Electrophysiology, Michigan State University, McLaren Greater Lansing Hospital, Lansing, MI, USA
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14
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Zahid S, Hashem A, Rai D, Khan MZ, Ullah W, Gowda S, Munir MB, Tan BEX, Velagapudi P, Naidu S, Goel S, Bhatt DL, Depta JP. Same-Day Discharge after Percutaneous Left Atrial Appendage Closure: Insights from the Nationwide Readmission Database 2015-2019. Curr Probl Cardiol 2023; 48:101588. [PMID: 36638903 DOI: 10.1016/j.cpcardiol.2023.101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/13/2023]
Abstract
Data on the feasibility of same-day discharge (SDD) following percutaneous left atrial appendage closure (LAAC) remain limited. We analyzed the US Nationwide Readmission Database from quarter four of 2015 to 2019 to study the safety and feasibility of SDD after LAAC. After excluding non-elective cases and in-hospital deaths, a total of 54,880 cases of LAAC were performed during the study period. Following LAAC, 2% (n=1077) of patients underwent SDD, 88% (n=48,428) underwent next-day discharge (NDD), 5.2% (n=2881) were discharged on the second day (ScD), and 4.5% of patients (n = 2494) were discharged 3 or more days after LAAC. There was no difference in 30-day readmission rates between SDD and NDD (7.3% [n=79] vs 7.4% [n=3585], P=0.94). The hospitalization costs were significantly lower for SDD compared with NDD ($22,963 vs $27,079, P≤0.01). SDD discharge following percutaneous LAAC appears to be safe and is associated with lower hospitalization costs. Further prospective studies are needed to determine the safety and feasibility of SDD with percutaneous LAAC.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY
| | - Anas Hashem
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY
| | - Devesh Rai
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV
| | - Waqas Ullah
- Department of Cardiovascular Medicine, Jefferson University Hospitals, Philadelphia, PA
| | - Smitha Gowda
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California (San Diego) Medical Center, La Jolla, CA
| | - Bryan E-Xin Tan
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY
| | - Poonam Velagapudi
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Srihari Naidu
- Department of Cardiovascular Medicine, Westchester Medical Center, Westchester, NY
| | - Sachin Goel
- Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, NY.
| | - Jeremiah P Depta
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, NY
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15
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Agrawal P, Khan MZ, Mann C, Munir MB, Syed M, Raina S, Balla S, Patel B. Comparison of trends and outcomes of infective endocarditis in patients with versus without leukemia, 2002 to 2017, from a nationwide inpatient sample. Proc AMIA Symp 2023; 36:308-313. [PMID: 37091749 PMCID: PMC10120530 DOI: 10.1080/08998280.2023.2187209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Patients with leukemia are at an increased risk for infective endocarditis secondary to their immunocompromised state, chemotherapy, and specific risk factors such as the presence of indwelling central venous catheters. There is a paucity of data regarding temporal trends and clinical outcomes of infective endocarditis in leukemia patients. Previous studies have shown a high rate of complications related to surgical valve procedures for treatment of infective endocarditis in patients with hematological malignancies. In this study, we aimed to analyze the contemporary trends and clinical outcomes of treatment in infective endocarditis patients with and without leukemia based on data available from the Nationwide Inpatient Sample, which is a publicly accessible, large sample-sized national dataset of hospitalized patients across the US. We present key findings on baseline characteristics, microbiological profile, outcomes, rates of valve surgical procedures, and mortality in infective endocarditis patients with and without leukemia between 2002 and 2017 in the US.
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Affiliation(s)
- Pratik Agrawal
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Muhammad Zia Khan
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Chitsimran Mann
- Internal Medicine Residency, St. Elizabeth’s Youngstown Hospital, Youngstown, Ohio
| | | | - Moinuddin Syed
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Sameer Raina
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Sudarshan Balla
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
| | - Brijesh Patel
- West Virginia University Heart & Vascular Institute, West Virginia University, Morgantown, West Virginia
- Corresponding author: Brijesh Patel, DO, West Virginia University Heart & Vascular Institute, 1 Medicine Center Drive, Box 8003, Morgantown, WV26506 (e-mail: )
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Agarwal S, Asad ZUA, Khan MZ, Messele LF, Darden D, Pasupula DK, Singh GD, Srivatsa UN, Zahid S, Balla S, DeSimone CV, Deshmukh A, Munir MB. Morbid obesity is associated with increased procedural complications and worse in-hospital outcomes after percutaneous left atrial appendage occlusion device implantation. Heart Rhythm 2022; 20:637-639. [PMID: 36581172 DOI: 10.1016/j.hrthm.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Affiliation(s)
- Siddharth Agarwal
- Division of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Lydia Fekadu Messele
- Division of Internal Medicine, University of California Davis, Sacramento, California
| | - Douglas Darden
- Division of Cardiology, Kansas City Heart Rhythm Institute, Overland Park, Kansas
| | - Deepak Kumar Pasupula
- Division of Cardiovascular Medicine, MercyOne North Iowa Medical Center, Mason City, Iowa
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Uma N Srivatsa
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California
| | - Salman Zahid
- Division of Internal Medicine, Rochester General Hospital, Rochester, New York
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Christopher V DeSimone
- Division of Cardiovascular Medicine, Section of Cardiac Electrophysiology, Mayo Clinic, Rochester, Minnesota
| | - Abhishek Deshmukh
- Division of Cardiovascular Medicine, Section of Cardiac Electrophysiology, Mayo Clinic, Rochester, Minnesota
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, California.
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Sattar Y, Faisaluddin M, Almas T, Alhajri N, Shah R, Zghouzi M, Zafrullah F, Sengodon PM, Zia Khan M, Ullah W, Alam M, Balla S, Lakkis N, Kawsara A, Daggubati R, Chadi Alraies M. Cardiovascular outcomes of transradial versus transfemoral percutaneous coronary intervention in End-Stage renal Disease: A Regression-Based comparison. IJC Heart & Vasculature 2022; 43:101110. [PMID: 36051245 PMCID: PMC9424587 DOI: 10.1016/j.ijcha.2022.101110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/14/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022]
Abstract
Background Limited data is available on the comparison of outcomes of transradial (TR) and transfemoral (TF) access for percutaneous coronary intervention (PCI) in patients with end-stage stage renal disease (ESRD). Methods Online databases were queried to compare cardiovascular outcomes among TR. and TF in ESRD patients. The outcomes assessed included differences in mortality, cerebrovascular accidents (CVA), periprocedural myocardial infarction (MI), bleeding, transfusion, and periprocedural cardiogenic shock (CS). Unadjusted odds ratios (OR) were calculated using a random-effect effect model. Results A total of 6 studies including 7,607 patients (TR-PCI = 1,288; TF-PCI = 6,319) were included. The overall mean age was 67.7 years, while the mean age for TR-PCI and TF-PCI was 69.7 years and 67.9 years, respectively. TR-PCI was associated with lower incidence of mortality (OR 0.46 95 % CI 0.30–0.70, p < 0.05, I2 0.00 %), bleeding (OR 0.45 95 % CI 0.29, 0.68, p < 0.05, I2 3.48 %), and transfusion requirement (OR 0.52 95 % CI 0.40, 0.67, p < 0.05, I2 0.00 %) (Fig. 1). There were no differences among TR-PCI and TF-PCI for periprocedural MI, periprocedural CS, and CVA outcomes. Conclusion TR access was associated with lower mortality, bleeding, and transfusion requirement as compared to TF access in patients with ESRD undergoing PCI.
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Affiliation(s)
| | | | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Corresponding authors at: RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin 2, Ireland (T. Almas) and Detroit Medical Center, Detroit, MI, USA (M. Chadi Alraies).
| | - Noora Alhajri
- College of Medicine and Health Science, Khalifa University, Abu Dhabi, United Arab Emirates
| | | | | | | | | | | | - Waqas Ullah
- Thomas Jefferson University, Philadelphia, PA, USA
| | | | | | | | | | | | - M. Chadi Alraies
- Detroit Medical Center, Detroit, MI, USA
- Corresponding authors at: RCSI University of Medicine and Health Sciences, 123 St. Stephen’s Green, Dublin 2, Ireland (T. Almas) and Detroit Medical Center, Detroit, MI, USA (M. Chadi Alraies).
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Zahid S, Ullah W, Hashem AM, Khan MZ, Gowda S, Vishnevsky A, Fischman DL. Transcatheter valve-in-valve implantation versus redo surgical mitral valve replacement in patients with failed mitral bioprostheses. EUROINTERVENTION 2022; 18:824-835. [PMID: 36106346 PMCID: PMC9724889 DOI: 10.4244/eij-d-22-00437] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/03/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Data on the safety of valve-in-valve transcatheter mitral valve replacement (ViV-TMVR) compared with redo surgical mitral valve replacement (SMVR) in patients with a history of bioprosthetic mitral valve (MV) remain limited. AIMS We aimed to evaluate the in-hospital, 30-day and 6-month readmission outcomes of ViV-TMVR compared with redo-SMVR in a real-world cohort. METHODS The Nationwide Readmission Database was utilised, analysing data from 2015 to 2019. To determine the adjusted odds ratio (aOR), we used the propensity-matched analysis for major outcomes at index hospitalisation, 30 days, and 6 months during the episode of readmission. RESULTS A total of 3,691 patients were included, of these, 24.2% underwent ViV-TMVR and 75.8% underwent redo-SMVR. Patients undergoing ViV-TMVR were older with higher rates of comorbidities. The mean length of stay (15 days vs 4 days) and cost of hospitalisation ($76,558 vs $46,743) were significantly higher for redo-SMVR. The rate of in-hospital all-cause mortality was also significantly lower in ViV-TMVR (2.6% vs 7.3%). By contrast, 30-day all-cause mortality during the episode of readmission (aOR 1.01, 95% confidence interval [CI]: 0.40-2.55) and all-cause readmission rates (aOR 0.82, 95% CI: 0.66-1.02) were similar between both groups. The incidence of all-cause readmissions at 6 months (aOR 0.83, 95% CI: 0.65-1.05) and all-cause mortality during the episode of readmission at 6 months (aOR 1.84, 95% CI: 0.54-6.36) were also comparable. The utilisation of the ViV-TMVR procedure increased significantly during our study duration, from 5.2% to 36.8%, (ptrend<0.01). CONCLUSIONS ViV-TMVR is associated with lower odds of in-hospital mortality, complications, and resource utilisation. The all-cause readmissions and 30-day and 6-month mortality during the episode of readmissions were comparable between both groups.
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Affiliation(s)
- Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Waqas Ullah
- Department of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Anas M Hashem
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Smitha Gowda
- Department of Cardiovascular Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Alec Vishnevsky
- Department of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - David L Fischman
- Department of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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Rashid M, Warriach HJ, Lawson C, Alkhouli M, Van Spall HGC, Khan SU, Khan MS, Mohamed MO, Khan MZ, Shoaib A, Diwan M, Gosh R, Bhatt DL, Mamas MA. Palliative Care Utilization Among Hospitalized Patients With Common Chronic Conditions in the United States. J Palliat Care 2022:8258597221136733. [PMID: 36373247 DOI: 10.1177/08258597221136733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Objective: Limited data exist around the receipt of palliative care (PC) in patients hospitalized with common chronic conditions. We studied the independent predictors, temporal trends in rates of PC utilization in patients hospitalized with acute exacerbation of common chronic diseases. Methods: Population-based cohort study of all hospitalizations with an acute exacerbation of heart disease (HD), cerebrovascular accident (CVA), cancer (CA), and chronic lower respiratory disease (CLRD). Patients aged ≥18 years or older between January 1, 2004, and December 31, 2017, referred for inpatient PC were extracted from the National Inpatient Sample. Poisson regression analyses were used to estimate temporal trends. Results: Between 2004 and 2017, of 91,877,531 hospitalizations, 55.2%, 13.9%, 17.2%, and 13.8% hospitalizations were related to HD, CVA, CA, and CLRD, respectively. There was a temporal increase in the uptake of PC across all disease groups. Age-adjusted estimated rates of PC per 100,000 hospitalizations/year were highest for CA (2308 (95% CI 2249-2366) to 10,794 (95% CI 10,652-10,936)), whereas the CLRD cohort had the lowest rates of PC referrals (255 (95% CI 231-278) to 1882 (95% CI 1821-1943)) between 2004 and 2017, respectively. In the subgroup analysis of patients who died during hospitalization, the CVA group had the highest uptake of PC per 100,000 hospitalizations/year (4979 (95% CI 4918-5040)) followed by CA (4241 (95% CI 4189-4292)), HD (3250 (95% CI 3211-3289)) and CLRD (3248 (95% CI 3162-3405)). Conclusion: PC service utilization is increasing but remains disparate, particularly in patients that die during hospital admission from common chronic conditions. These findings highlight the need to develop a multidisciplinary, patient-centered approach to improve access to PC services in these patients.
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Affiliation(s)
- Muhammad Rashid
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Haider J Warriach
- Cardiovascular Division, Department of Medicine, 1861Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, MA, USA
| | - Claire Lawson
- Cardiovascular Research Center, 4488University of Leicester, Leicester, UK
| | - Mohamad Alkhouli
- Division of Cardiology, Department of Medicine, 5631West Virginia University, Morgantown, WV, USA
- Department of Cardiology, 158150Mayo Clinic School of Medicine, Rochester, NY, USA
| | | | - Safi U Khan
- Department of Medicine, 5631West Virginia University, Morgantown, WV, USA
| | - M Shahzab Khan
- Department of Medicine, John H. Stronger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Muhammad Zia Khan
- Department of Medicine, 5631West Virginia University, Morgantown, WV, USA
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
| | - Masroor Diwan
- Department of Medicine, Southport District General Hospital, Southport, UK
| | - Raktim Gosh
- Department of Cardiology, 2546Case Western Reserve University, Metrohealth, Cleveland, OH, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke-on-Trent, UK
- Department of Medicine, Jefferson University, Philadelphia, PA, USA
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Chobufo MD, Singla A, Rahman EU, Osman M, Khan MZ, Noubiap JJ, Aronow WS, Alpert MA, Balla S. Previously undiagnosed angina pectoris in individuals without established cardiovascular disease: Prevalence and prognosis in the United States. Am J Med Sci 2022; 364:547-553. [PMID: 35803308 DOI: 10.1016/j.amjms.2022.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/09/2022] [Accepted: 06/29/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The prevalence and prognosis of previously undiagnosed angina pectoris (AP) in the absence of established cardiovascular disease (CVD) are unknown. This study sought to determine the prevalence and prognosis of previously undiagnosed AP in the absence of established CVD in the United States. METHODS Data derived from the National Health and Nutrition Examination Survey (2001-2018) and the Rose Angina Questionnaire (RAQ) were used to identify AP among participants ≥ 40 years without established CVD. Determinants of previously undiagnosed AP (AP undiagnosed prior to RAQ analysis) and predictors of all-cause mortality were identified using multivariable logistic regression analysis and the Cox proportional hazard model. RESULTS Of the 27,506 participants eligible for analysis, 621 participants had previously undiagnosed AP. Thus, the prevalence of previously undiagnosed AP was 1.99% (95% CI 1.79-2.20). Female gender, poverty, < high school education, hypertension, cigarette smoking, and obesity were independent predictors of previously undiagnosed AP. All-cause mortality rates were 1.71 per 1000 person months for participants with previously undiagnosed AP and were 1.08 per 1000 person months to those without previously undiagnosed AP (p = 0.003). CONCLUSIONS The prevalence of previously undiagnosed AP in the United States is 1.99% in persons ≥ 40 years of age without established CVD. Previously undiagnosed AP in those without established CVD was an independent predictor of all-cause mortality.
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Affiliation(s)
- Muchi Ditah Chobufo
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States
| | - Atul Singla
- Department of Medicine, Tulane University School of Medicine, New Orleans, LA, United States
| | - Ebad Ur Rahman
- Department of Medicine, St. Mary's Medical Center, Huntington, WV, United States
| | - Mohammad Osman
- Division of Cardiology, Oregon Health and Science University, Portland, OR, United States
| | - Muhammad Zia Khan
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States
| | | | - Wilbert S Aronow
- Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY, United States
| | - Martin A Alpert
- Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, MO, United States
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States.
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21
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Ullah W, Zahid S, Muhammadzai H, Khalil F, Kumar A, Minhas AMK, Khan MZ, Virani SS, Fischman DL, Shah P, Bhatt DL. Trends, predictors, and outcomes of transcatheter aortic valve implantation in patients with bicuspid aortic valve related disease: Insights from the Nationwide Inpatient Sample and Nationwide Readmission Database. Catheter Cardiovasc Interv 2022; 100:1119-1131. [PMID: 36183395 PMCID: PMC10092271 DOI: 10.1002/ccd.30407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 09/07/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has increasingly been utilized in patients with bicuspid aortic valve (BAV) related aortic stenosis (AS) with insufficient large-scale data on its safety. METHODS The Nationwide Inpatient Sample and Nationwide Readmission Database (2011-2018) were queried to identify patients undergoing TAVI for BAV versus trileaflet aortic valve (TAV) associated AS. The in-hospital, 30- and 180-day odds of outcomes were assessed using a propensity-matched analysis (PSM) to calculate adjusted odds ratios (aOR) with its 95% confidence interval (CI). RESULTS A total of 216,723 TAVI (TAV: 214,050 and BAV: 2,673) crude and 5,347 matched population (TAV: 2,674 and BAV: 2,673) was included in the final analysis. At index admission, the adjusted odds of in-hospital mortality (aOR: 1.57, 95% CI: 0.67-3.66), stroke (aOR: 0.77, 95% CI: 0.38-1.57), cardiac tamponade (aOR: 0.75, 95% CI: 0.17-3.36), vascular complications (aOR: 0.33, 95% CI: 0.09-1.22), cardiogenic shock (aOR: 1.77, 95% CI: 0.93-3.38), paravalvular leak (aOR: 0.55, 95% CI: 0.26-1.14), need for mechanical circulatory support device, and permanent pacemaker implantation (PPM) (aOR: 1.02, 95% CI: 0.69-1.52) were not significantly different between TAVI for BAV versus TAV. At 30- and 180-day follow-up duration, the risk of stroke and major postprocedural complications remained similar, except that TAVI in BAV had a higher incidence of PPM implantation compared with TAV. The yearly trend showed an increase in the utilization of TAVI for both TAV and BAV and a steady decline in the overall annual rate of in-hospital complications. CONCLUSION TAVI utilization in patients with BAV has increased over the recent years. The relative odds of in-hospital mortality, and all other major complications, were similar between patients undergoing TAVI for BAV- and TAV-related AS.
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Affiliation(s)
- Waqas Ullah
- Division of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Salman Zahid
- Department of Internal Medicine, Rochester Regional Health, Rochester, New York, USA
| | - Hamza Muhammadzai
- Department of Internal Medicine, Abington Jefferson Health, Abington, Pennsylvania, USA
| | - Fouad Khalil
- Department of Internal Medicine, University of South Dakota, Vermillion, South Dakota, USA
| | - Arnav Kumar
- Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts, USA
| | | | - Muhammad Zia Khan
- Division of Cardiology, West Virginia University Hospital, Morgantown, West Virginia, USA
| | - Salim S Virani
- Division of Cardiology, Baylor College of Medicine, Houston, Texas, USA.,Division of Cardiology, Michael E. DeBakey VA Medical Center, Houston, Texas, USA
| | - David L Fischman
- Division of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Pinak Shah
- Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts, USA
| | - Deepak L Bhatt
- Division of Cardiology, Brigham and Women's Hospital Heart & Vascular Center, Boston, Massachusetts, USA
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Sattar Y, Song D, Almas T, Zghouzi M, Talib U, Suleiman ARM, Ahmad B, Arshad J, Ullah W, Zia Khan M, Bianco CM, Bagur R, Rashid M, Mamas MA, Alraies MC. Cardiovascular outcomes and trends of Transcatheter vs. Surgical aortic valve replacement among octogenarians with heart failure: A Propensity Matched national cohort analysis. IJC Heart & Vasculature 2022; 42:101119. [PMID: 36161232 PMCID: PMC9489740 DOI: 10.1016/j.ijcha.2022.101119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/17/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022]
Abstract
Background Methods Results Conclusion
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23
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Zahid S, Din MTU, Khan MZ, Rai D, Ullah W, Sanchez-Nadales A, Elkhapery A, Khan MU, Goldsweig AM, Singla A, Fonarrow G, Balla S. Trends, Predictors, and Outcomes of 30-Day Readmission With Heart Failure After Transcatheter Aortic Valve Replacement: Insights From the US Nationwide Readmission Database. J Am Heart Assoc 2022; 11:e024890. [PMID: 35929464 PMCID: PMC9496292 DOI: 10.1161/jaha.121.024890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data on trends, predictors, and outcomes of heart failure (HF) readmissions after transcatheter aortic valve replacement (TAVR) remain limited. Moreover, the relationship between hospital TAVR discharge volume and HF readmission outcomes has not been established. METHODS AND RESULTS The Nationwide Readmission Database was used to identify 30‐day readmissions for HF after TAVR from October 1, 2015, to November 30, 2018, using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes. A total of 167 345 weighted discharges following TAVR were identified. The all‐cause readmission rate within 30 days of discharge was 11.4% (19 016). Of all the causes of 30‐day rehospitalizations, HF comprised 31.4% (5962) of all causes. The 30‐day readmission rate for HF did not show a significant decline during the study period (Ptrend=0.06); however, all‐cause readmission rates decreased significantly (Ptrend=0.03). HF readmissions were comparable between high‐ and low‐volume TAVR centers. Charlson Comorbidity Index >8, length of stay >4 days during the index hospitalization, chronic obstructive pulmonary disease, atrial fibrillation, chronic HF, preexisting pacemaker, complete heart block during index hospitalization, paravalvular regurgitation, chronic kidney disease, and end‐stage renal disease were independent predictors of 30‐day HF readmission after TAVR. HF readmissions were associated with higher mortality rates when compared with non‐HF readmissions (4.9% versus 3.3%; P<0.01). Each HF readmission within 30 days was associated with an average increased cost of $13 000 more than for each non‐HF readmission. CONCLUSIONS During the study period from 2015 to 2018, 30‐day HF readmissions after TAVR remained steady despite all‐cause readmissions decreasing significantly. All‐cause readmission mortality and HF readmission mortality also showed a nonsignificant downtrend. HF readmissions were comparable across low‐, medium‐, and high‐volume TAVR centers. HF readmission was associated with increased mortality and resource use attributed to the increased costs of care compared with non‐HF readmission. Further studies are needed to identify strategies to decrease the burden of HF readmissions and related mortality after TAVR.
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Affiliation(s)
- Salman Zahid
- Department of Medicine Rochester General Hospital Rochester NY
| | | | - Muhammad Zia Khan
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
| | - Devesh Rai
- Department of Medicine Rochester General Hospital Rochester NY
| | - Waqas Ullah
- Department of Cardiovascular Medicine Jefferson University Hospitals Philadelphia PA
| | | | - Ahmed Elkhapery
- Department of Medicine Rochester General Hospital Rochester NY
| | - Muhammad Usman Khan
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine University of Nebraska Medical Center Omaha NE
| | | | - Greg Fonarrow
- Division of Cardiovascular Medicine University of California Los Angeles Los Angeles CA
| | - Sudarshan Balla
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
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24
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Zahid S, Hashem A, Atti V, Khan MZ, Kawsara M, Balla S. Outcomes of 30-Day Readmission in Patients With Heart Failure on Index Hospitalization Who Underwent Transcatheter Aortic Valve Implantation (from the US Nationwide Readmissions Database). Am J Cardiol 2022; 179:110-111. [PMID: 35853780 DOI: 10.1016/j.amjcard.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/08/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Anas Hashem
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Varunsiri Atti
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Mohammad Kawsara
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
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25
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Munir MB, Khan MZ, Darden D, Asad ZUA, Choubdar PA, Din MTU, Osman M, Singh GD, Srivatsa UN, Balla S, Reeves R, Hsu JC. Association of advanced age with procedural complications and in-hospital outcomes from left atrial appendage occlusion device implantation in patients with atrial fibrillation: insights from the National Inpatient Sample of 36,065 procedures. J Interv Card Electrophysiol 2022; 65:219-226. [PMID: 35731328 PMCID: PMC9550678 DOI: 10.1007/s10840-022-01266-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
Background Age-stratified analyses of atrial fibrillation (AF) patients undergoing percutaneous left atrial appendage occlusion (LAAO) are limited. The purpose of current study was to compare in-hospital outcomes in elderly AF patients (age > 80 years) to a relatively younger cohort (age £ 80 years) after LAAO. Methods Data were extracted from National Inpatient Sample for calendar years 2015–2018. LAAO device implantations were identified on the basis of International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes of 37.90 and 02L73DK. The outcomes assessed in our study included complications, inpatient mortality, and resource utilization with LAAO. Results A total of 36,065 LAAO recipients were included in the final analysis, of which 34.6% (n=12,475) were performed on elderly AF patients. Elderly AF patients had a higher prevalence of major complications (6.7% vs. 5.7%, p < 0.01) and mortality (0.4% vs. 0.1%, p < 0.01) after LAAO device implantation in the crude analysis. After multivariate adjustment of potential confounders, age > 80 years was associated with increased risk of inpatient mortality (adjusted odds ratio [aOR] 4.439, 95% confidence interval [CI] 2.391–8.239) but not major complications (aOR 1.084, 95% CI 0.971–1.211), prolonged length of stay (aOR 0.943, 95% CI 0.88–1.101), or increased hospitalization costs (aOR 0.909, 95% CI 0.865–0.955). Conclusion Over 1 in 3 LAAO device implantations occurred in elderly AF patients. After adjusting for potential confounding variables, advanced age was associated with inpatient mortality, but not with other LAAO procedural–related outcomes including major complications, prolonged length of stay, or increased hospitalization costs.
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Affiliation(s)
- Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, San Diego, CA, USA
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Douglas Darden
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Zain Ul Abideen Asad
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Parnia Abolhassan Choubdar
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, San Diego, CA, USA
| | | | - Mohammed Osman
- Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Uma N Srivatsa
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Ryan Reeves
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Jonathan C Hsu
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, San Diego, CA, USA.
- University of California San Diego, 9452 Medical Center Dr., MC7411, La Jolla, San Diego, CA, 92037, USA.
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Zahid S, Khan MZ, Gowda S, Faza NN, Honigberg MC, Vaught AJ, Guan C, Minhas AS, Michos ED. Trends, Predictors, and Outcomes of Cardiovascular Complications Associated With Polycystic Ovary Syndrome During Delivery Hospitalizations: A National Inpatient Sample Analysis (2002-2019). J Am Heart Assoc 2022; 11:e025839. [PMID: 35708290 PMCID: PMC9496311 DOI: 10.1161/jaha.121.025839] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Women with polycystic ovary syndrome (PCOS) have an increased risk of pregnancy‐associated complications. However, data on peripartum cardiovascular complications remain limited. Hence, we investigated trends, outcomes, and predictors of cardiovascular complications associated with PCOS diagnosis during delivery hospitalizations in the United States. Methods and Results We used data from the National Inpatient Sample (2002–2019). International Classification of Diseases, Ninth Revision (ICD‐9), or International Classification of Diseases, Tenth Revision (ICD‐10), codes were used to identify delivery hospitalizations and PCOS diagnosis. A total of 71 436 308 weighted hospitalizations for deliveries were identified, of which 0.3% were among women with PCOS (n=195 675). The prevalence of PCOS, and obesity among those with PCOS, increased during the study period. Women with PCOS were older (median, 31 versus 28 years; P<0.01) and had a higher prevalence of diabetes, obesity, and dyslipidemia. After adjustment for age, race and ethnicity, comorbidities, insurance, and income, PCOS remained an independent predictor of cardiovascular complications, including preeclampsia (adjusted odds ratio [OR], 1.56 [95% CI, 1.54–1.59]; P<0.01), eclampsia (adjusted OR, 1.58 [95% CI, 1.54–1.59]; P<0.01), peripartum cardiomyopathy (adjusted OR, 1.79 [95% CI, 1.49–2.13]; P<0.01), and heart failure (adjusted OR, 1.76 [95% CI, 1.27–2.45]; P<0.01), compared with no PCOS. Moreover, delivery hospitalizations among women with PCOS were associated with increased length (3 versus 2 days; P<0.01) and cost of hospitalization ($4901 versus $3616; P<0.01). Conclusions Women with PCOS had a higher risk of preeclampsia/eclampsia, peripartum cardiomyopathy, and heart failure during delivery hospitalizations. Moreover, delivery hospitalizations among women with PCOS diagnosis were associated with increased length and cost of hospitalization. This signifies the importance of prepregnancy consultation and optimization for cardiometabolic health to improve maternal and neonatal outcomes.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart Institute Rochester General Hospital Rochester NY
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine West Virginia University Heart and Vascular Institute Morgantown WV
| | - Smitha Gowda
- Division of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Nadeen N Faza
- Division of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Michael C Honigberg
- Cardiology Division, Department of Medicine Massachusetts General Hospital Boston MA
| | - Arthur Jason Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics Johns Hopkins University School of Medicine Baltimore MD
| | - Carolyn Guan
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Anum S Minhas
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | - Erin D Michos
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
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Jamal S, Mughal MS, Kichloo A, Edigin E, Khan MZ, Minhas AMK, Ali M, Kanjwal K. Left atrial appendage closure using WATCHMAN device in chronic kidney disease and end stage renal disease patients. Pacing Clin Electrophysiol 2022; 45:866-873. [PMID: 35633309 DOI: 10.1111/pace.14537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 04/20/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) and End Stage renal Disease are considered independent risk factors for developing atrial fibrillation (AF). Percutaneous occlusion of left atrial appendage (LAAC) using WATCHMAN device is a widely accepted alternative to anticoagulation therapy to prevent ischemic stroke in AF in patients who are not candidates for anticoagulation. There is limited data regarding the utilization and periprocedural safety of this intervention in patients with CKD/ESRD. METHODS We retrospectively reviewed all hospitalization from 2016 to 2017 with (ICD-10) procedure diagnosis code of LAA closure using WATCHMAN procedure with and without a secondary diagnosis of CKD/ESRD in acute-care hospitals across the United States using the national inpatient sample. Demographic variables (gender, race, income, hospital characteristics, medical comorbidities) were collected and compared. The primary outcomes were inpatient mortality, hospital length and cost of stay. RESULTS There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 16,505 hospitalizations were for adult patients with a procedure code for LAA closure via watchman procedure. Of 16,505 patients 3,245 (19.66%) had CKD and ESRD. There was no statistically significant difference in mortality, length and cost of stay in patients with and without CKD/ESRD. There were no statistically significant differences in periprocedural cerebrovascular accidents in both groups. CONCLUSION Patients with and without ESRD/CKD who undergo LAA occlusion with Watchman have similar procedure related, in-hospital mortality and complications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shakeel Jamal
- Department of Internal Medicine, Central Michigan University, College of Medicine, Mount Pleasant, Michigan, USA
| | - Mohsin Sheraz Mughal
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University, College of Medicine, Mount Pleasant, Michigan, USA
| | - Ehizogie Edigin
- Department of Internal Medicine, Cook County Health System, Chicago, Illinois, USA
| | - Muhammad Zia Khan
- Department of Internal Medicine, West Virginia University, Morgantown, West Virginia, USA
| | | | - Muzaffar Ali
- Department of Electrophysiology, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Khalil Kanjwal
- Division of Cardiology, McLaren Greater Lansing, Lansing, Michigan, USA
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Zahid S, Rai D, Tanveer Ud Din M, Khan MZ, Ullah W, Usman Khan M, Thakkar S, Hussein A, Baibhav B, Rao M, Abtahian F, Bhatt DL, Depta JP. Same-Day Discharge After Transcatheter Aortic Valve Implantation: Insights from the Nationwide Readmission Database 2015 to 2019. J Am Heart Assoc 2022; 11:e024746. [PMID: 35621233 PMCID: PMC9238699 DOI: 10.1161/jaha.121.024746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is a paucity of data on the feasibility of same-day discharge (SDD) following transcatheter aortic valve implantation (TAVI) at a national level. Methods and Results This study used data from the Nationwide Readmission Database from the fourth quarter of 2015 through 2019 and identified patients undergoing TAVI using the claim code 02RF3. A total of 158 591 weighted hospitalizations for TAVI were included in the analysis. Of the patients undergoing TAVI, 961 (0.6%) experienced SDD. Non-SDDs included 65 814 (41.5%) patients who underwent TAVI who were discharged the next day, and 91 816 (57.9%) discharged on the second or third day. The 30-day readmission rate for SDD after TAVI was similar to non-SDD TAVI (9.8% versus 8.9%, P=0.31). The cumulative incidence of 30-day readmissions for SDD was higher compared with next-day discharge (log-rank P=0.01) but comparable to second- or third-day discharge (log-rank P=0.66). At 30 days, no differences were observed in major or minor vascular complications, heart failure, or ischemic stroke for SDD compared with non-SDD. Acute kidney injury, pacemaker implantation, and bleeding complications were lower with SDD. Predictors associated with SDD included age <85 years, male sex, and prior pacemaker placement, whereas left bundle-branch block, right bundle-branch block, second-degree heart block, heart failure, prior percutaneous coronary intervention, and atrial fibrillation were negatively associated with SDD. Conclusions SDD following TAVI is associated with similar 30-day readmission and complication rates compared with non-SDD. Further prospective studies are needed to assess the safety and feasibility of SDD after TAVI.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Devesh Rai
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | | | - Muhammad Zia Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | - Waqas Ullah
- Department of Cardiovascular Medicine Jefferson University Hospitals Philadelphia PA
| | - Muhammad Usman Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | | | - Ahmed Hussein
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Bipul Baibhav
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Mohan Rao
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Farhad Abtahian
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center Harvard Medical School Boston MA
| | - Jeremiah P Depta
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
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Munir MB, Khan MZ, Darden D, Asad ZUA, Osman M, Singh GD, Srivatsa UN, Han FT, Reeves R, Hsu JC. Association of heart failure with procedural complications and in-hospital outcomes from left atrial appendage occlusion device implantation in patients with atrial fibrillation: insights from the national inpatient sample of 62 980 procedures. Europace 2022; 24:1451-1459. [PMID: 35613020 DOI: 10.1093/europace/euac043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/08/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS To determine outcomes in atrial fibrillation (AF) patients undergoing percutaneous left atrial appendage occlusion (LAAO) with concomitant heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS Data were extracted from National Inpatient Sample for calendar years 2015-2019. LAAO device implantations were identified on the basis of ICD-10-CM code of 02L73DK. The outcomes assessed in our study included complications, in-patient mortality, and resource utilization. A total of 62 980 LAAO device implantations were studied. HFpEF (14.4%, n = 9040) and HFrEF (11.2%, n = 7100) were associated with a higher prevalence of major complications and in-patient mortality in crude analysis. In the multivariate model adjusted for potential confounders, HFpEF and HFrEF were not associated with major complications [adjusted odds ratio (aOR) 1.04, 95% confidence interval (CI) 0.93-1.16 and aOR 1.07, 95% CI 0.95-1.21] or in-patient mortality (aOR 1.48, 95% CI 0.85-2.55 and aOR 1.26, 95% CI 0.67-2.38). HFpEF and HFrEF were associated with prolonged length of stay (LOS) > 1 day (aOR 1.41, 95% CI 1.31-1.53 and aOR 1.66, 95% CI 1.53-1.80) and increased hospitalization costs > median cost 24 752$ (aOR 1.26, 95% CI 1.19-1.34 and aOR 1.21, 95% CI 1.13-1.29). CONCLUSION The prevalence of HF in AF patients undergoing percutaneous LAAO was approximately 26%. HF was not independently associated with major complications and in-patient mortality but was associated with prolonged LOS and higher hospitalization costs.
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Affiliation(s)
- Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Douglas Darden
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
| | - Zain Ul Abideen Asad
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma, OK, USA
| | - Mohammed Osman
- Division of Cardiovascular Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Gagan D Singh
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Uma N Srivatsa
- Division of Cardiovascular Medicine, University of California Davis, Sacramento, CA, USA
| | - Frederick T Han
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
| | - Ryan Reeves
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
| | - Jonathan C Hsu
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
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Sattar Y, Talib U, Faisaluddin M, Song D, Lak HM, Laghari A, Khan MZ, Ullah W, Elgendy IY, Balla S, Daggubati R, Kawsara A, Jneid H, Alraies CM, Alam M. Meta-Analysis Comparing Distal Radial Versus Traditional Radial Percutaneous Coronary Intervention or Angiography. Am J Cardiol 2022; 170:31-39. [PMID: 35248389 DOI: 10.1016/j.amjcard.2022.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/01/2022]
Abstract
Data comparing outcomes of distal radial (DR) and traditional radial (TR) access of coronary angiography and percutaneous coronary intervention (PCI) are limited. Online databases including Medline and Cochrane Central databases were explored to identify studies that compared DR and TR access for PCI. The primary outcome was the rate of radial artery occlusion (RAO) and access failure. Secondary outcomes included access site hematoma, access site bleeding, access site pain, radial artery spasm, radial artery dissection, and crossover. Unadjusted odds ratios (ORs) with a random-effect model, 95% confidence interval (CI), and p <0.05 were used for statistical significance. Metaregression was performed for 16 studies with 9,973 (DR 4,750 and TR 5,523) patients were included. Compared with TR, DR was associated with lower risk of RAO (OR 0.51, 95% CI 0.29 to 0.90, I2 = 42.6%, p = 0.02). RAO was lower in DR undergoing coronary angiography rather than PCI. Access failure rate (OR 1.77, 95% CI 0.69 to 4.55, I2 87.36%, p = 0.24), access site hematoma (OR 1.11, 95% CI 0.68 to 1.83, I2 0%, p = 0.68), access site pain (OR 2.22, 95% CI 0.28 to 17.38, I2 0%, p = 0.45), access site bleeding (OR 1.11, 95% CI 0.16 to 7.62, I2 85.11%, p = 0.91), radial artery spasm (OR 0.79, 95% CI 0.49 to 1.29, I2 0%, p = 0.35), radial artery dissection (OR 1.63, 95% CI 0.46 to 5.84, I2 0%, p = 0.45), and crossover (OR 1.54, 95% CI 0.64 to 3.70, I2 25.48%, p = 0.33) did not show any significant difference. DR was associated with lower incidence RAO when compared with TR, whereas other procedural-related complications were similar.
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Zahid S, Khan MZ, Bapaye J, Altamimi TS, Elkhapery A, Thakkar S, Nepal M, Rai D, Ullah W, Patel HP, Sattar Y, Khan MU, ur Rahman A, Balla S. Outcomes, Trends, and Predictors of Gastrointestinal Bleeding in Patients Undergoing Transcatheter Aortic Valve Implantation (from the National Inpatient Sample). Am J Cardiol 2022; 170:83-90. [PMID: 35193764 DOI: 10.1016/j.amjcard.2022.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
Major bleeding has been identified as one of the most common complications after transcatheter aortic valve implantation (TAVI) with some suffering gastrointestinal bleeding (GIB). This study aimed at assessing the incidence and predictors of GIB after TAVI in the United States. We performed a retrospective analysis of data from the National Inpatient Sample database from 2011 to 2018. A total of 216,023 hospitalizations for TAVI were included. Of the included patients, 2,188 (1%) patients had GIB, whereas 213,835 (99%) patients did not have GIB. The presence of arteriovenous malformation was associated with the highest odds of having a gastrointestinal bleed (odds ratio (OR) 24.8, 95% confidence interval (CI) 17.13 to 35.92). Peptic ulcer disease was associated with an eightfold increased risk of bleeding (OR 8.74, 95% CI, 6.69 to 11.43) followed closely by colorectal cancer (OR 7.89, 95% CI, 5.33 to 11.70). Other comorbidities that were associated with higher propensity-matched rates of GIB were chronic kidney disease (OR 1.27,95% CI, 1.14 to 1.41), congestive heart failure (OR 1.18, 95% CI,1.06 to 1.32), liver disease (OR1.83, 95% CI,1.53 to 2.19), end-stage renal disease (OR 2.08,95% CI, 1.75 to 2.47), atrial fibrillation (OR1.63,95% CI, 1.49 to 1.78), and lung cancer (OR 2.80, 95% CI,1.77 to 4.41). Patients with GIB had higher propensity-matched rates of mortality than those without GIB, (12.1% vs 3.2%, p <0.01). Patients with GIB had a higher median cost of stay ($68,779 vs $46,995, p <0.01) and a longer length of hospital stay (11 vs 3 days, p <0.01). In conclusion, health care use and mortality are higher in hospitalizations of TAVI with a GIB. Baseline comorbidities like peptic ulcer disease, chronic kidney disease, liver disease, atrial fibrillation and, colorectal cancer are significant predictors of this adverse event.
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Khan SU, Lone AN, Yedlapati SH, Dani SS, Khan MZ, Watson KE, Parwani P, Rodriguez F, Cainzos-Achirica M, Michos ED. Cardiovascular Disease Mortality Among Hispanic Versus Non-Hispanic White Adults in the United States, 1999 to 2018. J Am Heart Assoc 2022; 11:e022857. [PMID: 35362334 PMCID: PMC9075497 DOI: 10.1161/jaha.121.022857] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Life expectancy has been higher for Hispanic versus non‐Hispanic White (NHW) individuals; however, data are limited on cardiovascular disease (CVD) mortality. Method and Results Using the Centers for Disease Control and Prevention’s Wide‐Ranging Online Data for Epidemiologic Research death certificate database (1999–2018), we compared age‐adjusted mortality rates for total CVD and its subtypes (ischemic heart disease, stroke, heart failure, hypertensive heart disease, other CVD), and average annual percentage changes among Hispanic and NHW adults. The age‐adjusted mortality rate per 100 000 was lower for Hispanic than NHW adults for total CVD (186.4 versus 254.6; P<0.001) and its subtypes. Between 1999 and 2018, mortality decline was higher in Hispanic than NHW adults for total CVD (average annual percentage change [AAPC], −2.90 versus −2.41) and ischemic heart disease (AAPC: −4.44 versus −3.82) (P<0.001). In contrast, stroke mortality decline was slower in Hispanic versus NHW adults (AAPC: −2.05 versus −2.60; P<0.05). Stroke mortality increased in Hispanic but stalled in NHW adults since 2011 (AAPC: 0.79 versus −0.09). For ischemic heart disease (AAPC: −0.80 versus −1.85) and stroke (AAPC: −1.32 versus −1.43) mortality decline decelerated more for Hispanic than NHW adults aged <45 years (P<0.05). For heart failure, Hispanic adults aged <45 (3.55 versus 2.16) and 45 to 64 (1.88 versus 1.54) showed greater rise in age‐adjusted mortality rate than NHW individuals (P<0.05). Age‐adjusted heart failure mortality rate also accelerated in Hispanic versus NHW men (1.00 versus 0.67; P<0.001). Conclusions Disaggregating data by CVD subtype and demographics unmasked heterogeneities in CVD mortality between Hispanic and NHW adults. NHW adults had greater CVD mortality rates and slower decline than Hispanic adults, whereas marked demographic differences in mortality signaled concerning trends among the Hispanic versus NHW population.
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Affiliation(s)
- Safi U Khan
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX
| | - Ahmad N Lone
- Department of Cardiovascular Medicine Guthrie Health System/Robert Packer Hospital Sayre PA
| | | | - Sourbha S Dani
- Division of Cardiology Lahey Hospital and Medical CenterBeth Israel Lahey Health Burlington MA
| | - Muhammad Zia Khan
- Department of Cardiovascular Medicine West Virginia University Morgantown WV
| | - Karol E Watson
- Division of Cardiology David Geffen School of Medicine at UCLA Los Angeles CA
| | - Purvi Parwani
- Division of Cardiology Loma Linda University Loma Linda CA
| | - Fatima Rodriguez
- Division of Cardiology and the Cardiovascular Institute Stanford University Stanford CA
| | - Miguel Cainzos-Achirica
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Erin D Michos
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
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Khan SU, Yedlapati SH, Khan MZ, Virani SS, Blaha MJ, Sharma G, Jordan JE, Kash BA, Vahidy FS, Arshad A, Mossialos E, Nasir K. Clinical and Economic Profile of Homeless Young Adults with Stroke in the United States, 2002 - 2017. Curr Probl Cardiol 2022:101190. [PMID: 35346726 DOI: 10.1016/j.cpcardiol.2022.101190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION . Homelessness is a major social determinant of health. We studied the clinical and economic profile of homeless young adults hospitalized with stroke. METHODS . We studied the National Inpatient Sample database (2002-2017) to evaluate trends of stroke hospitalization, clinical outcomes, and health expenditure in homeless vs. non-homeless young adults (<45 years). RESULTS . We identified 3,134 homeless individuals out of 648,944 young adults. Homeless patients were more likely to be men, Black adults and had a higher prevalence of cardiometabolic risk factors and psychiatric disorders than non-homeless adults. Both homeless and non-homeless adults had a similar prevalence of ischemic and hemorrhagic stroke. Between 2002 and 2017, hospitalization rates per million increased for both non-homeless (295.8 to 416.8) and homeless adults (0.5 to 3.6) (P≤0.01). Between 2003 and 2017, the decline in in-hospital mortality was limited to non-homeless adults (11% to 9%), while it has increased in homeless adults (3% to 11%) (P<0.01). The prevalence of acute myocardial infarction (6.8% vs. 3.3%, P<0.01), and acute kidney injury (13.1% vs. 9.4%, P<0.01) was also higher in homeless vs. non-homeless adults. The length of stay and inflation-adjusted care cost were comparable between both study groups. Finally, a higher proportion of homeless patients left the hospital against medical advice than non-homeless adults. CONCLUSIONS . Homeless young stroke patients had significant comorbidities, increased hospitalization rates, and adverse clinical outcomes. Therefore, public health interventions should focus on multidisciplinary care to reduce health care disparities among young homeless adults.
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Affiliation(s)
- Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston TX, US
| | - Siva H Yedlapati
- Department of Medicine, Erie County Medical Center, Buffalo, NY, US
| | - Muhammad Zia Khan
- Department of Cardiology, West Virginia University, Morgantown, WV, US
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Department of Medicine, Baylor College of Medicine, Houston, TX, US
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, US
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, US
| | - John E Jordan
- Chair, American College of Radiology, Commission on Neuroradiology and Health Equity Workgroup, US; Providence Little Company of Mary Medical Center, Torrance, CA, US
| | - Bita A Kash
- Center for Outcomes Research, Houston Methodist, Houston, TX, US
| | - Farhaan S Vahidy
- Center for Outcomes Research, Houston Methodist, Houston, TX, US
| | - Adeel Arshad
- Department of Internal Medicine, The Ohio State Comprehensive Cancer Center, Columbus, OH, US
| | - Elias Mossialos
- London School of Economics and Political Science, London, UK
| | - Khurram Nasir
- Department of Internal Medicine, The Ohio State Comprehensive Cancer Center, Columbus, OH, US; Division of Cardiovascular Prevention and Wellness, Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA; Center for Computational Health & Precision Medicine (C3-PH), Houston Methodist, Houston, TX, USA.
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Zahid S, Khan MZ, Ullah W, Rai D, Din MTU, Abbas S, Ubaid A, Khan MU, Thakkar S, Sheikha MA, Salama A, Baibhav B, Rao M, Balla S, Alkhouli M, Depta JP, Michos ED. Gender Differences in Age-Stratified Inhospital Outcomes After Transcatheter Aortic Valve Implantation (from the National Inpatient Sample 2012 to 2018). Am J Cardiol 2022; 167:83-92. [PMID: 34991843 DOI: 10.1016/j.amjcard.2021.11.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 01/09/2023]
Abstract
Contemporary data on gender differences in outcomes after transcatheter aortic valve implantation (TAVI), after stratification by age, remain limited. We studied age-stratified (60 to 70, 71 to 80, and 81 to 90 years) inhospital outcomes by gender after TAVI from the National Inpatient Sample database between 2012 and 2018. We analyzed National Inpatient Sample data using the International Classification of Diseases, Clinical Modification, Ninth Revision, and Tenth Revision claims codes. Between the years 2012 and 2018, a total of 188,325 weighted hospitalizations for TAVI were included in the analysis. A total of 21,957 patients were included in the 60 to 70 age group (44% females), 60,770 (45% females) in the 71 to 80 age group, and 105,580 (50% females) in the 81 to 90 age groups, respectively. Propensity-matched inhospital mortality rates were significantly higher for females than males for the age group of 81 to 90 years (3.0% vs 2.1%, p <0.01). Vascular complications and a need for blood transfusions remained significantly higher for females on propensity-matched analysis across all categories of ages. Conversely, acute kidney injury and the need for pacemaker implantation remained significantly higher for males across all age groups. In conclusion, we report that mortality is higher in female patients who underwent TAVI between the ages of 81 to 90. Moreover, the female gender was associated with higher vascular complications and bleeding requiring transfusions. Conversely, the male gender was associated with higher rates of pacemaker implantation and acute kidney injury.
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Zahid S, Din MTU, Khan MZ, Rai D, Ullah W, Altamimi TS, Elkhapery A, Khan MU, Balla S. TRENDS, PREDICTORS AND OUTCOMES OF THIRTY DAY READMISSION WITH HEART FAILURE AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT:INSIGHTS FROM THE UNITED STATES NATIONWIDE READMISSION DATABASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01756-9] [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: 11/15/2022]
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Khan SU, Raghu Subramanian C, Khan MZ, Lone AN, Talluri S, Han JK, Isakadze N, Volgman AS, Michos ED. Association of Women Authors With Women Enrollment in Clinical Trials of Atrial Fibrillation. J Am Heart Assoc 2022; 11:e024233. [PMID: 35191324 PMCID: PMC9075084 DOI: 10.1161/jaha.121.024233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Safi U Khan
- Department of Cardiology Houston Methodist Houston TX
| | | | | | - Ahmad N Lone
- Department of Cardiology Guthrie Health System/Robert Packer Hospital Sayre PA
| | - Swapna Talluri
- Department of Medicine Guthrie Health System/Robert Packer Hospital Sayre PA
| | - Janet K Han
- Division of Cardiology VA Greater Los Angeles Healthcare System, and David Geffen School of Medicine at the University of California Los Angeles Los Angeles CA
| | - Nino Isakadze
- Division of Cardiology Department of Medicine Johns Hopkins School of Medicine Baltimore MD
| | | | - Erin D Michos
- Division of Cardiology Department of Medicine Johns Hopkins School of Medicine Baltimore MD
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Zahid S, Ullah W, Zia Khan M, Faisal Uddin M, Rai D, Abbas S, Usman Khan M, Hussein A, Salama A, Bandyopadhyay D, Bhaibhav B, Rao M, Alam M, Alraies C, Balla S, Alkhouli M, Depta JP. Cerebral Embolic Protection during Transcatheter Aortic Valve Implantation: Updated Systemic Review and Meta-Analysis. Curr Probl Cardiol 2022; 48:101127. [PMID: 35124076 DOI: 10.1016/j.cpcardiol.2022.101127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 11/03/2022]
Abstract
In patient undergoing transcatheter aortic valve implantation (TAVI), stroke remains a potentially devastating complication associated with significant morbidity, and mortality. To reduce the risk of stroke, cerebral protection devices (CPD) were developed to prevent debris from embolizing to the brain during TAVI. We performed a systematic review and meta-analysis to determine the safety and efficacy of CPD in TAVI. The MEDLINE (PubMed, Ovid) and Cochrane databases were queried with various combinations of medical subject headings to identify relevant articles. Statistical analysis was performed using a random-effects model to calculate unadjusted odds ratio (OR), including subgroup analyses based on follow-up duration, study design, and type of CPD. Using a pooled analysis, CPD was associated with a significant reduction in major adverse cardiovascular events MACE (OR 0.75, 95% CI 0.70-0.81, P < 0.01), mortality (OR 0.65, 95% CI 0.58-0.74, P < 0.01) and stroke (OR 0.84, 95% CI 0.76-0.93, P < 0.01) in patients undergoing TAVI. Similarly, on MRI volume per lesion were lower for patients with CPD use. No significant difference was observed in acute kidney injury (OR 0.75, 95% CI 0.42-1.37, P = 0.68), bleeding (OR 0.92, 95% CI 0.71-1.20, P = 0.55) or vascular complications (OR 0.90, 95% CI 0.62-1.31, P = 0.6) for patients undergoing TAVI with CPD. In conclusion, CPD device use in TAVI is associated with a reduction of MACE, mortality, and stroke compared with patients undergoing TAVI without CPD. However, the significant reduction in mortality is driven mainly by observational studies.
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Akhlaq A, Ali HF, Sheikh AB, Muhammad H, Ijaz SH, Sattar MH, Nazir S, Ud Din MT, Nasir U, Khan MZ, Muslim MO, Wazir MHK, Dani SS, Fudim M, Minhas AMK. Cardiovascular Diseases in the Patients with Psoriatic Arthritis. Curr Probl Cardiol 2022; 48:101131. [PMID: 35124075 DOI: 10.1016/j.cpcardiol.2022.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
There are limited data regarding the burden and trend of cardiovascular diseases (CVD) in psoriatic arthritis (PsA). We analyzed the National Inpatient Sample database from January 2005 to December 2018 to examine the hospitalization trends amongst adults with PsA primarily for heart failure (HF), acute myocardial infarction (AMI), and stroke. The primary outcomes of interest included in-hospital mortality, length of stay (LOS), and inflation-adjusted cost. The age-adjusted percentage of HF hospitalizations among PsA patients decreased from 2.5% (2005/06) to 1.4% (2011/12; P-trend 0.013) and subsequently increased to 2.0% (2017/18; P-trend 0.044). The age-adjusted percentage of AMI hospitalizations among PsA patients showed a non-statistically significant decreasing trend from 2.1% (2005/06) to 1.7% (2011/12; P-trend 0.248) and showed a non-statistically significant increase to 2.3% (2017/18; P-trend 0.056). The age-adjusted stroke hospitalizations increased from 1.1% (2005/06) to 1.3% (2017/18; P-trend 0.036). Apart from a decrease in adjusted inflation-adjusted cost among heart failure hospitalizations, there was no significant change in inpatient mortality, length of stay or hospital cost, during the study period. We found an increasing trend of cardiovascular hospitalizations in patients with PsA. These findings will raise awareness and inform further research and clinical practice for PSA patients with CVD.
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Affiliation(s)
- Anum Akhlaq
- Department of Internal Medicine, University of Mississippi Medical Center, MS, USA
| | | | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Hafiz Muhammad
- Department of Internal Medicine, Agha Khan University Hospital, Karachi, Pakistan
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | | | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Mian Tanveer Ud Din
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Usama Nasir
- Department of Internal Medicine, Reading Hospital, Reading, PA, USA
| | | | | | | | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
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Jamal S, Ijaz SH, Minhas AMK, Kichloo A, Khan MZ, Albosta M, Aljadah M, Banga S, Baloch ZQ, Aboud H, Haji AQ, Sheikh A, Kanjwal K. Outcomes of Hospitalizations with Acute Respiratory Distress Syndrome with and without Atrial Fibrillation - Analyses from the National Inpatient Sample (2004-2014). Am J Med Sci 2022; 364:289-295. [DOI: 10.1016/j.amjms.2022.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/17/2021] [Accepted: 01/31/2022] [Indexed: 11/01/2022]
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Ullah W, Zghouzi M, Sattar Z, Ahmad B, Zahid S, Suleiman AM, Sattar Y, Khan MZ, Paul T, Bagur R, Qureshi MI, Fischman DL, Banerjee S, Prasad A, Alraies MC. Safety and efficacy of drug‐coated balloon for peripheral artery revascularization—A systematic review and meta‐analysis. Catheter Cardiovasc Interv 2022; 99:1319-1326. [PMID: 35043555 DOI: 10.1002/ccd.30074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/07/2021] [Revised: 12/17/2021] [Accepted: 12/25/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Waqas Ullah
- Department of Cardiology Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Mohammad Zghouzi
- Department of Cardiology, Detroit Medical Center Heart Hospital Detroit Michigan USA
| | - Zeeshan Sattar
- Department of Internal Medicine SUNY Downstate Medical Center Brooklyn New York USA
| | - Bachar Ahmad
- Department of Cardiology, Detroit Medical Center Heart Hospital Detroit Michigan USA
| | - Salman Zahid
- Department of Internal Medicine Rochester General Hospital Rochester New York USA
| | | | - Yasar Sattar
- Department of Cardiology West Virginia University Morgantown West Virginia USA
| | - Muhammad Zia Khan
- Department of Cardiology West Virginia University Morgantown West Virginia USA
| | - Timir Paul
- Department of Cardiology The University of Tennessee Nashville Tennessee USA
| | - Rodrigo Bagur
- Department of Cardiology London Health Science Centre Western University London Ontario Canada
| | | | - David L. Fischman
- Department of Cardiology Thomas Jefferson University Philadelphia Pennsylvania USA
| | - Subhash Banerjee
- Department of Cardiology University of Texas Southwestern Medical Center Dallas Texas USA
| | - Anand Prasad
- Department of Cardiology UT Health San Antonio San Antonio Texas USA
| | - M. Chadi Alraies
- Department of Cardiology, Detroit Medical Center Heart Hospital Detroit Michigan USA
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Ullah W, Gul S, Saleem S, Syed MA, Khan MZ, Zahid S, Minhas AMK, Virani SS, Mamas MA, Fischman DL. Trend, predictors, and outcomes of combined mitral valve replacement and coronary artery bypass graft in patients with concomitant mitral valve and coronary artery disease: a National Inpatient Sample database analysis. Eur Heart J Open 2022; 2:oeac002. [PMID: 35919659 PMCID: PMC9242072 DOI: 10.1093/ehjopen/oeac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/09/2021] [Accepted: 01/05/2022] [Indexed: 04/16/2023]
Abstract
Aims Combined mitral valve replacement (MVR) and coronary artery bypass graft (CABG) procedures have been the norm for patients with concomitant mitral valve disease (MVD) and coronary artery disease (CAD) with no large-scale data on their safety and efficacy. Methods and results The National Inpatient Sample database (2002-18) was queried to identify patients undergoing MVR and CABG. The major adverse cardiovascular events (MACE) and its components were compared using a propensity score-matched (PSM) analysis to calculate adjusted odds ratios (OR). A total of 6 145 694 patients (CABG only 3 971 045, MVR only 1 933 459, MVR + CABG 241 190) were included in crude analysis, while a matched cohort of 724 237 (CABG only 241 436, MVR only 241 611 vs. MVR + CABG 241 190) was selected in PSM analysis. The combined MVR + CABG procedure had significantly higher adjusted odds of MACE [OR 1.13, 95% confidence interval (CI) 1.11-1.14 and OR 1.96, 95% CI 1.93-1.99] and in-hospital mortality (OR 1.29, 95% CI 1.27-1.31 and OR 2.1, 95% CI 2.05-2.14) compared with CABG alone and MVR alone, respectively. Similarly, the risk of post-procedure bleeding, major bleeding, acute kidney injury, cardiogenic shock, sepsis, need for intra-aortic balloon pump, mean length of stay, and total charges per hospitalization were significantly higher for patients undergoing the combined procedure. These findings remained consistent on yearly trend analysis favouring the isolated CABG and MVR groups. Conclusion Combined procedure (MVR + CABG) in patients with MVD and CAD appears to be associated with worse in-hospital outcomes, increased mortality, and higher resource utilization compared with isolated CABG and MVR procedures. Randomized controlled trials are needed to determine the relative safety of these procedures in the full spectrum of baseline valvular and angiographic characteristics.
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Affiliation(s)
- Waqas Ullah
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
- Corresponding author. Tel: 215-955-6000,
| | | | | | | | | | | | | | - Salim S Virani
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Mamas A Mamas
- Thomas Jefferson University Hospitals, Philadelphia, PA, USA
- Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
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Khan MZ, Munir MB, Khan MU, Balla S. Sudden Cardiac Arrest in Patients With Chronic Obstructive Pulmonary Disease: Trends and Outcomes From the National Inpatient Sample. Am J Med Sci 2022; 363:502-510. [DOI: 10.1016/j.amjms.2021.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/23/2020] [Accepted: 10/21/2021] [Indexed: 11/30/2022]
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Bilal Munir M, Zia Khan M, Agrawal P, Abideen Asad ZU, Syed M, Patel K, Ghaffarlal BA, U Khan M, U Khan S, Balla S, C Hsu J. Catheter Ablation for Hospitalized Atrial Fibrillation Patients with Reduced Systolic Function: Analysis of Inpatient Mortality, Resource Utilization and Complications. J Atr Fibrillation 2021; 13:2480. [PMID: 34950341 DOI: 10.4022/jafib.2480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/15/2021] [Accepted: 01/27/2021] [Indexed: 11/10/2022]
Abstract
Background Randomized trials have shown improvement in hard clinical end points when catheter ablation (CA) is employed as a management strategy for certain atrial fibrillation (AF) patients with heart failure and reduced ejection fraction (HFrEF). Limited data, however, exist in this realm outside the controlled clinical trial settings. We sought to determine real-world data on mortality and complications after utilization of CA in such patients. Methods and Results Data were derived from National Inpatient Sample from January 2008 to August 2015. Patients were identified using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Baseline characteristics and outcomes were compared among HFrEF and AF patients undergoing CA or not. Propensity matching was done to mitigate selection bias and balance confounding variables. Various CA related complications were assessed. Logistic regression was done to determine predictors of mortality in our study cohort. A total of 2,569,919 patients were analyzed and a total of 7773 patients underwent CA. Mortality was significantly better in CA group in both unmatched (1.2% vs. 4.9%, p < 0.01) and propensity matched cohorts (1.2% vs. 3.6%, p < 0.01). Overall complication rate was 10.2% in CA cohort and primarily driven by cardiac and neurological etiologies. In regression analysis, CA remained a strong predictor of reduced mortality (OR 0.301, 95% CI 0.184-0.494). Conclusions CA is associated with improved mortality in admitted AF patients with concomitant HFrEF. Overall complication rate after CA was modest at 10.2%. Consideration can be given to the utilization of this therapeutic modality in hospitalized AF patients with concomitant HFrEF.
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Affiliation(s)
- Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Pratik Agrawal
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Zain Ul Abideen Asad
- Division of Cardiology, University of Oklahoma School of Medicine, Oklahoma City, OK, USA
| | - Moinuddin Syed
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Kinjan Patel
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - BilYasir Abdul Ghaffarlal
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Safi U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Jonathan C Hsu
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, CA, USA
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Dani SS, Lone AN, Javed Z, Khan MS, Zia Khan M, Kaluski E, Virani SS, Shapiro MD, Cainzos-Achirica M, Nasir K, Khan SU. Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019. J Am Heart Assoc 2021; 11:e021682. [PMID: 34935456 PMCID: PMC9075205 DOI: 10.1161/jaha.121.021682] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Evaluating premature (<65 years of age) mortality because of acute myocardial infarction (AMI) by demographic and regional characteristics may inform public health interventions. Methods and Results We used the Centers for Disease Control and Prevention’s WONDER (Wide‐Ranging Online Data for Epidemiologic Research) death certificate database to examine premature (<65 years of age) age‐adjusted AMI mortality rates per 100 000 and average annual percentage change from 1999 to 2019. Overall, the age‐adjusted AMI mortality rate was 13.4 (95% CI, 13.3–13.5). Middle‐aged adults, men, non‐Hispanic Black adults, and rural counties had higher mortality than young adults, women, NH White adults, and urban counties, respectively. Between 1999 and 2019, the age‐adjusted AMI mortality rate decreased at an average annual percentage change of −3.4 per year (95% CI, −3.6 to −3.3), with the average annual percentage change showing higher decline in age‐adjusted AMI mortality rates among large (−4.2 per year [95% CI, −4.4 to −4.0]), and medium/small metros (−3.3 per year [95% CI, −3.5 to −3.1]) than rural counties (−2.4 per year [95% CI, −2.8 to −1.9]). Age‐adjusted AMI mortality rates >90th percentile were distributed in the Southern states, and those with mortality <10th percentile were clustered in the Western and Northeastern states. After an initial decline between 1999 and 2011 (−4.3 per year [95% CI, −4.6 to −4.1]), the average annual percentage change showed deceleration in mortality since 2011 (−2.1 per year [95% CI, −2.4 to −1.8]). These trends were consistent across both sexes, all ethnicities and races, and urban/rural counties. Conclusions During the past 20 years, decline in premature AMI mortality has slowed down in the United States since 2011, with considerable heterogeneity across demographic groups, states, and urbanicity. Systemic efforts are mandated to address cardiovascular health disparities and outcomes among nonelderly adults.
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Affiliation(s)
- Sourbha S Dani
- Division of Cardiology Lahey Hospital, and Medical CenterBeth Israel Lahey Health Burlington MA
| | - Ahmad N Lone
- Department of Cardiology Guthrie Health System/Robert Packer Hospital Sayre PA
| | - Zulqarnain Javed
- Division of Health Equity & Disparities Research, Center for Outcomes Research Houston Methodist Houston TX
| | - Muhammad S Khan
- Department of Cardiovascular Medicine Duke University Durham NC
| | - Muhammad Zia Khan
- Department of Cardiovascular Medicine West Virginia University Morgantown WV
| | - Edo Kaluski
- Department of Cardiology Guthrie Health System/Robert Packer Hospital Sayre PA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research Department of Medicine Baylor College of Medicine Houston TX
| | - Michael D Shapiro
- Section on Cardiovascular Medicine Wake Forest University School of Medicine Winston-Salem NC
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research Houston Methodist Houston TX.,Department of CardiologyHouston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Khurram Nasir
- Division of Health Equity & Disparities Research, Center for Outcomes Research Houston Methodist Houston TX.,Department of CardiologyHouston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Safi U Khan
- Center for Outcomes Research Houston Methodist Houston TX
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Kichloo A, Dahiya DS, Shaka H, Jamal S, Khan MZ, Wani F, Mehboob A, Kanjwal K. Impact of atrial fibrillation on inflammatory bowel disease hospitalizations-a nationwide retrospective study. Proc AMIA Symp 2021; 34:673-677. [PMID: 34732983 DOI: 10.1080/08998280.2021.1951071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Systemic inflammation seen in inflammatory bowel disease (IBD) may cause electrophysiological changes in the atria leading to atrial fibrillation (AF). We analyzed data from the National Inpatient Sample for 2018 to identify all adult hospitalizations with a primary diagnosis of IBD, which were further divided based on the presence or absence of AF. The primary outcome was inpatient mortality while the secondary outcomes included inpatient complications, mean length of stay, and mean total hospital charge. We identified 92,055 IBD hospitalizations, of which 3900 (4.2%) had AF and 88,155 (95.8%) served as controls. IBD hospitalizations with AF were older (70.9 vs. 45.0 years, P < 0.001) and had a higher association with comorbidities compared to the non-AF cohort. Furthermore, the AF cohort had significantly higher adjusted odds of inpatient mortality (2.05% vs. 0.24%; adjusted odds ratio 2.07; 95% confidence interval [CI] 1.09-3.90; P = 0.025), longer length of stay (6.5 vs. 4.9 days; incidence rate ratio 1.23; 95% CI 1.14-1.33; P < 0.001), and higher total hospital charge ($14,587 vs. $11,475; incidence rate ratio 1.26; 95% CI 1.15-1.38; P < 0.001). Additionally, complications such as acute respiratory failure, pulmonary embolism, and necessity of blood product transfusion were more common for IBD hospitalizations with AF than those without.
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Affiliation(s)
- Asim Kichloo
- Department of Internal Medicine, Samaritan Medical Center , Watertown , New York
| | - Dushyant Singh Dahiya
- Department of Internal Medicine, Central Michigan University College of Medicine , Saginaw , Michigan
| | - Hafeez Shaka
- Department of Internal Medicine, John H. Stroger Hospital of Cook County , Chicago , Illinois
| | - Shakeel Jamal
- Department of Internal Medicine, Samaritan Medical Center , Watertown , New York
| | - Muhammad Zia Khan
- Department of Cardiology, West Virginia University , Morgantown , West Virginia
| | - Farah Wani
- Department of Family Medicine, Samaritan Medical Center , Watertown , New York
| | - Asad Mehboob
- Department of Gastroenterology, Covenant Healthcare , Saginaw , Michigan
| | - Khalil Kanjwal
- Department of Electrophysiology, McLaren Greater Lansing, Michigan State University , Lansing , Michigan
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Munir MB, Khan MZ, Darden D, Nishimura M, Vanam S, Pasupula DK, Asad ZUA, Bhagat A, Zahid S, Osman M, Balla S, Han FT, Reeves R, Hsu JC. Association of chronic kidney disease and end-stage renal disease with procedural complications and in-hospital outcomes from left atrial appendage occlusion device implantation in patients with atrial fibrillation: Insights from the national inpatient sample of 36,065 procedures. Heart Rhythm O2 2021; 2:472-479. [PMID: 34667962 PMCID: PMC8505197 DOI: 10.1016/j.hroo.2021.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Left atrial appendage occlusion (LAAO) has emerged as an alternative strategy to oral anticoagulation for mitigating ischemic stroke risk in selected patients with atrial fibrillation (AF), but safety data in patients with significant kidney disease are limited. Objective To determine the association of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with procedural complications and in-hospital outcomes after LAAO in AF patients. Methods Data were extracted from National Inpatient Sample for calendar years 2015–2018. Watchman implantations were identified on the basis of International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes of 37.90 and 02L73DK. The outcomes assessed in our study included complications, inpatient mortality, and resource utilization with LAAO. Results A total of 36,065 Watchman recipients were included in the final analysis. CKD (9.8%, n = 3545) and ESRD (3%, n = 1155) were associated with a higher prevalence of major complications and mortality in crude analysis compared to no CKD. After multivariate adjustment for potential confounders, CKD was associated with length of stay (LOS) >1 day (adjusted odds ratio [aOR] 1.355; 95% confidence interval [CI] 1.234–1.488), median cost >$24,663 (aOR 1.267; 95% CI 1.176–1.365), and acute kidney injury (aOR 4.134; 95% CI 3.536–4.833), while ESRD was associated with in-patient mortality (aOR 7.156; 95% CI 3.294–15.544). Conclusion The prevalence of CKD and ESRD was approximately 13% in AF patients undergoing Watchman LAAO implantations. CKD was independently associated with prolonged LOS, higher hospitalization costs, and acute kidney injury, while ESRD was independently associated with in-patient mortality.
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Affiliation(s)
- Muhammad Bilal Munir
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Douglas Darden
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Marin Nishimura
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Sai Vanam
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | | | - Zain Ul Abideen Asad
- Division of Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Abhishek Bhagat
- Division of Cardiology, University of Arizona College of Medicine, Phoenix, Arizona
| | - Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Mohammed Osman
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Frederick T. Han
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Ryan Reeves
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
| | - Jonathan C. Hsu
- Section of Electrophysiology, Division of Cardiology, University of California San Diego, La Jolla, California
- Address reprint requests and correspondence: Dr Jonathan C. Hsu, Associate Professor of Medicine, University of California San Diego, 9452 Medical Center Dr, MC7411, La Jolla, CA 92037.
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Khan MZ, Zahid S, Khan MU, Kichloo A, Jamal S, Minhas AMK, Ullah W, Sattar Y, Mir T, Balla S, Munir MB. Outcomes of transcatheter aortic valve replacement in patients with and without atrial fibrillation: Insight from national inpatient sample. Expert Rev Cardiovasc Ther 2021; 19:939-946. [PMID: 34605353 DOI: 10.1080/14779072.2021.1988852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is one of the most frequent rhythm disturbance encountered in the population in general. Our study aims to evaluate the in-hospital outcomes of TAVR with AF. METHODS We used National Inpatient Sample database from 2011 to 2018. Baseline characteristics and in-hospital outcomes were evaluated in TAVR based on AF status or not in both unmatched and propensity-matched cohorts. RESULTS A total of 215,938 patients underwent TAVR during our study period and out of these AF was encountered in 89,587 (41.5%) patients. AF patients undergoing TAVR had a higher mean age and had an increased burden of key co-morbidities in the unmatched cohort. With propensity matched 1:1 analysis, AF had higher mortality as compared to no-AF group (2.4% vs. 2.1%, p < 0.01). The rate of cardiogenic shock (2.9% vs 2.1%), respiratory complications (9.9% vs 8.2%), acute kidney injury (15.6% vs 12.0%), vascular complications (5.0% vs 4.7%), and blood transfusion (10.4% vs 8.6%) was higher in TAVR patients with AF. A lower proportion of patients had routine discharge to home for TAVR with AF (80.8% vs 74.4%). Cost of hospitalization (23,0171[SD, 20,5242] vs 210,608[28,4203]) and length of stay (5.7[SD, 11.8] vs 4.29[7.2] days) were considerably higher in patients undergoing TAVR with AF. CONCLUSION Patients undergoing TAVR with concomitant AF tended to have increased mortality, complications, length, and cost of stay compared to non-AF patients.
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Affiliation(s)
- Muhammad Zia Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Asim Kichloo
- Department of Medicine, St. Mary's of Saginaw Hospital, Saginaw, MI, USA
| | - Shakeel Jamal
- Department of Medicine, St. Mary's of Saginaw Hospital, Saginaw, MI, USA
| | | | - Waqas Ullah
- Department of Medicine, Abington Jefferson Health, PA, USA
| | - Yasar Sattar
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA.,Department of Medicine, Icahn School of Medicine, Mount Sinai Elmhurst Hospital Queens, New York, NY, USA
| | - Tanveer Mir
- Division of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA, USA
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Minhas AMK, Sagheer S, Shekhar R, Sheikh AB, Nazir S, Ullah W, Khan MZ, Shahid I, Dani SS, Michos ED, Fudim M. Trends and Inpatient Outcomes of Primary Atrial Fibrillation Hospitalizations with Underlying Iron Deficiency Anemia: An Analysis of The National Inpatient Sample Database from 2004 -2018. Curr Probl Cardiol 2021; 47:101001. [PMID: 34571106 DOI: 10.1016/j.cpcardiol.2021.101001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/14/2021] [Indexed: 12/25/2022]
Abstract
Atrial fibrillation (AF) is the most prevalent arrhythmia in the United States. However, studies evaluating the impact of iron deficiency anemia on AF outcomes are limited. Therefore, we aimed to evaluate the association of iron deficiency anemia (IDA) on clinical outcomes in patients hospitalized with AF. A retrospective analysis of adult hospital discharges from the National Inpatient Sample (NIS) between 2004 and 2018 was conducted. Multivariable logistic regression was used to assess the association of IDA and other clinical outcomes ie inpatient mortality, acute myocardial infarction, cardiogenic shock, acute kidney injury, vasopressors use, length of stay, and other resource utilization. These models were adjusted for patient and hospital-level characteristics. A total of 5,975,241 weighted primary AF hospitalizations were identified. Out of these, 152,059 (2.5%) had diagnosis of IDA. After adjustment of variables, admissions with IDA were associated with higher rates of acute myocardial infarction (adjusted odds ratio [aOR] = 1.10, 95% CI 1.01-1.19 P = 0.026), use of vasopressors (aOR = 1.30, CI 1.27-1.32, P <0.001), invasive mechanical ventilation (aOR = 1.26, CI 1.14-1.40 P <0.001) and acute kidney injury (aOR = 1.72, CI 1.66-1.79 P <0.001). There was no significant difference in all-cause mortality (aOR = 0.97, CI 0.87-1.07, P = 0.513), cardiogenic shock, in-hospital cardiac arrest or use of mechanical circulatory support. Adjusted mortality in patients with AF and IDA decreased from 1.09% to 0.54% from 2004 to2018 (P -trend < 0.001). Among hospitalized patients with AF, our study did not show any difference in all-cause mortality between those with and without IDA.
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Affiliation(s)
| | - Shazib Sagheer
- Department of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Rahul Shekhar
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH
| | - Waqas Ullah
- Division of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, PA
| | | | - Izza Shahid
- Department of Medicine, Dow University of Health Sciences, Karachi
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Marat Fudim
- Division of Cardiology, Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Duke University Medical Center, Durham, NC
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Zia Khan M, Zahid S, Khan MU, Kichloo A, Jamal S, Mannan Khan Minhas A, Ullah W, Sattar Y, Balla S. Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample. J Am Heart Assoc 2021; 10:e020948. [PMID: 34459226 PMCID: PMC8649266 DOI: 10.1161/jaha.121.020948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Redo mitral valve surgery is required in up to one-third of patients and is associated with significant mortality and morbidity. Valve-in-valve transcatheter mitral valve replacement (ViV TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comparative outcomes of ViV TMVR and redo surgical mitral valve replacement (SMVR) remain limited. Our study aimed to investigate the real-world outcomes of the above procedures using the National Inpatient Sample database. Methods and Results We analyzed National Inpatient Sample data using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) from September 2015 to December 2018. A total of 495 and 2250 patients underwent redo ViV TMVR and SMVR, respectively. The patients who underwent ViV TMVR were older (77 versus 68 years, P<0.01). Adjusted mortality was higher in the redo SMVR group compared with the ViV TMVR group (7.6% versus <2.8%, P<0.01). Perioperative complications were higher among patients undergoing redo SMVR including blood transfusions (38% versus 7.6%, P<0.01) and acute kidney injury (36.7% versus 13.9%, P<0.01). Cost of care was higher (USD$57 172 versus USD$52 579, P<0.01), length of stay was longer (10 versus 3 days, P<0.01), and discharge to home was lower (20.3% versus 64.6%, P<0.01) in the SMVR group compared with the ViV TMVR group. Conclusions ViV TMVR is associated with lower mortality, periprocedural morbidity, and resource use compared with patients undergoing redo SMVR. ViV TMVR may be a viable option for some patients with mitral prosthesis dysfunction. Studies evaluating long-term outcomes and durability of ViV TMVR are needed. A patient-centered approach by the heart team, local institutional expertise, and careful preprocedure planning can help decision-making about the choice of intervention for the individual patient.
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Affiliation(s)
- Muhammad Zia Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | - Salman Zahid
- Department of Medicine Rochester General Hospital Rochester NY
| | - Muhammad U Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | | | | | | | | | - Yasar Sattar
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | - Sudarshan Balla
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
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Khan MZ, Zahid S, Khan MU, Kichloo A, Jamal S, Khan AM, Ullah W, Sattar Y, Munir MB, Balla S. Comparison of In-Hospital Outcomes of Transcatheter Mitral Valve Repair in Patients With vs Without Pulmonary Hypertension (From the National Inpatient Sample). Am J Cardiol 2021; 153:101-108. [PMID: 34210502 DOI: 10.1016/j.amjcard.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/04/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022]
Abstract
Pulmonary hypertension (PH) is common in patients with left heart disease and is present in varying degrees in patients with severe mitral valve disease. There is paucity of data regarding outcomes following transcatheter mitral valve repair (TMVr) in patients with PH. For this study, we analyzed NIS data from 2014 to 2018 using the ICD-9-CM and 10-CM codes. Baseline characteristics were compared using a Pearson chi-squared test for categorical variables and independent samples t-test for continuous variables. To account for selection bias, a 1:1 propensity match cohort was derived using logistic regression. Trend analysis was- done using linear regression. Of 21,505 encounters, 6780 encounters had PH. 6610 PH encounters were matched with 6610 encounters without PH. In-hospital mortality (3.3% versus 1.9%, p <0.01) was higher in PH population. Complications such as blood transfusion (3.6% versus 1.7%, p <0.01), GI bleed (1.4% versus 1%, p = 0.04), vascular complications (5.3% versus 3.3%, p <0.01), vasopressors use (2.9% versus 1.7%, p <0.01) and pacemaker placement (1.3% versus 0.8%, p = 0.01) remained significantly higher for encounters with PH. Multiple Logistic regression showed PH was associated with higher mortality (adjusted odds ratio [AOR], 1.68 [95% confidence interval [CI], 1.39-2.05], p <0.01). The mean length of stay (6.2 versus 5.3 days, p <0.01) and cost per hospitalization ($53,780 versus $50,801, p <0.01) remained significantly higher in the PH group when compared to group without PH. In conclusion, TMVr in PH as compared to without PH is associated with higher mortality, post-procedure complication rates, length of stay, and cost of stay.
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Affiliation(s)
- Muhammad Zia Khan
- Department of Medicine, West Virginia University, Morgantown, West Virginia.
| | - Salman Zahid
- Department of Medicine, Rochester General Hospital, Rochester, New York
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
| | - Asim Kichloo
- St. Mary's of Saginaw Hospital, Saginaw, Michigan
| | | | | | | | - Yasar Sattar
- Icahn school of Medicine at Mount Sinai Elmhurst Hospital Queens New York
| | - Muhammad Bilal Munir
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia
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