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Gonuguntla K, Chobufo MD, Shaik A, Patel N, Penmetsa M, Sattar Y, Thyagaturu H, Sama C, Alharbi A, Chan PS, Balla S. Impact of Social Vulnerability on Cardiac Arrest Mortality in the United States, 2016 to 2020. J Am Heart Assoc 2024:e033411. [PMID: 38686873 DOI: 10.1161/jaha.123.033411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/16/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Cardiac arrest is 1 of the leading causes of morbidity and mortality, with an estimated 340 000 out-of-hospital and 292 000 in-hospital cardiac arrest events per year in the United States. Survival rates are lower in certain racial and socioeconomic groups. METHODS AND RESULTS We performed a county-level cross-sectional longitudinal study using the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research multiple causes of death data set between 2016 and 2020 among individuals of all ages whose death was attributed to cardiac arrest. The Social Vulnerability Index is a composite measure that includes socioeconomic vulnerability, household composition, disability, individuals from racial and ethnic minority groups status and language, and housing and transportation domains. We examined the impact of social determinants on cardiac arrest mortality stratified by age, race, ethnicity, and sex in the United States. All age-adjusted mortality rate (cardiac arrest AAMRs) are reported as per 100 000. Overall cardiac arrest AAMR during the study period was 95.6. The cardiac arrest AAMR was higher for men compared with women (119.6 versus 89.9) and for the Black population compared with the White population (150.4 versus 92.3). The cardiac arrest AAMR increased from 64.8 in counties in quintile 1 of Social Vulnerability Index to 141 in quintile 5, with an average increase of 13% (95% CI, 9.8%-16.9%) in AAMR per quintile increase. CONCLUSIONS Mortality from cardiac arrest varies widely, with a >2-fold difference between the counties with the highest and lowest social vulnerability, highlighting the differential burden of cardiac arrest deaths throughout the United States based on social determinants of health.
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Affiliation(s)
- Karthik Gonuguntla
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Muchi Ditah Chobufo
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Ayesha Shaik
- Department of Cardiology Hartford Hospital Hartford CT
| | - Neel Patel
- Department of Medicine New York Medical College/Landmark Medical Center Woonsocket RI
| | - Mouna Penmetsa
- Department of Medicine University of Connecticut Farmington CT
| | - Yasar Sattar
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Harshith Thyagaturu
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Carlson Sama
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Anas Alharbi
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
| | - Paul S Chan
- Department of Cardiology Saint Luke's Mid-America Heart Institute Kansas City MO
| | - Sudarshan Balla
- Division of Cardiology West Virginia University Heart and Vascular Institute Morgantown WV
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Khan MZ, Nguyen A, Khan MU, Sattar Y, Alruwaili W, 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
| | - Waleed Alruwaili
- 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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Khan MZ, Sattar Y, Alruwaili W, Nassar S, Alhajji M, Alyami B, Nguyen AT, Neely J, Abideen Asad ZU, Agarwal S, Raina S, Balla S, Nguyen B, Fan D, Darden D, Munir MB. Pericardial effusion requiring intervention in patients undergoing leadless pacemaker implantation: A real-world analysis from the National Inpatient Sample database. Heart Rhythm O2 2024; 5:217-223. [PMID: 38690142 PMCID: PMC11056447 DOI: 10.1016/j.hroo.2024.02.004] [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: 05/02/2024] Open
Abstract
Background Pericardial effusion requiring percutaneous or surgical-based intervention remains an important complication of a leadless pacemaker implantation. Objective The study sought to determine real-world prevalence, risk factors, and associated outcomes of pericardial effusion requiring intervention in leadless pacemaker implantations. Methods The National Inpatient Sample and International Classification of Diseases-Tenth Revision codes were used to identify patients who underwent leadless pacemaker implantations during the years 2016 to 2020. The outcomes assessed in our study included prevalence of pericardial effusion requiring intervention, other procedural complications, and in-hospital outcomes. Predictors of pericardial effusion were also analyzed. Results Pericardial effusion requiring intervention occurred in a total of 325 (1.1%) leadless pacemaker implantations. Patient-level characteristics that predicted development of a serious pericardial effusion included >75 years of age (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.08-1.75), female sex (OR 2.03, 95% CI 1.62-2.55), coagulopathy (OR 1.50, 95% CI 1.12-1.99), chronic pulmonary disease (OR 1.36, 95% CI 1.07-1.74), chronic kidney disease (OR 1.53, 95% CI 1.22-1.94), and connective tissue disorders (OR 2.98, 95% CI 2.02-4.39). Pericardial effusion requiring intervention was independently associated with mortality (OR 5.66, 95% CI 4.24-7.56), prolonged length of stay (OR 1.36, 95% CI 1.07-1.73), and increased cost of hospitalization (OR 2.49, 95% CI 1.92-3.21) after leadless pacemaker implantation. Conclusion In a large, contemporary, real-world cohort of leadless pacemaker implantations in the United States, the prevalence of pericardial effusion requiring intervention was 1.1%. Certain important patient-level characteristics predicted development of a significant pericardial effusion, and such effusions were associated with adverse outcomes after leadless pacemaker implantations.
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Affiliation(s)
- Muhammad Zia Khan
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Yasar Sattar
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Waleed Alruwaili
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Sameh Nassar
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Mohamed Alhajji
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Bandar Alyami
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Amanda T. Nguyen
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | - Joseph Neely
- Section of Electrophysiology, Division of Cardiology, University of California Davis, Sacramento, California
| | | | - 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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Gonuguntla K, Sattar Y, Iqbal K, Sharma A, Yadav R, Alharbi A, Chobufo MD, Naeem M, Shaik A, Balla S. Trends in Premature Mortality from Acute Myocardial Infarction in American Indians/Alaska Natives in the United States from 1999 to 2020. Am J Cardiol 2024; 213:72-75. [PMID: 38110025 DOI: 10.1016/j.amjcard.2023.12.019] [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: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023]
Abstract
Cardiovascular disease is the leading cause of mortality in American Indian and Alaska Native (AI/AN) groups. They are disproportionately found to have a higher rate of premature myocardial infarction (MI). The Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research were queried to identify premature MI deaths (female <65 years and male <55 years) occurring within the United States between 1999 and 2020. We investigated proportionate mortality trends related to premature MI in AI/ANs stratified by gender. Deaths attributed to acute MI (AMI) were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes I21 to I22. We compared the proportional mortality rate because of premature MI with that of a non-AI/AN racial group, which comprised all other races (Blacks, Whites, and Asian/Pacific Islander populations). In AI/ANs, we analyzed a total of 14,055 AMI deaths, of which 3,211 were premature MI deaths corresponding to a proportionate mortality rate of 22.8% (male 20.8%, female 26.2%). The non-AI/AN population had a lower proportionate mortality of 14.8% (male 13.7%, female 16%), p <0.01). On trend analysis, there was no significant improvement over time in the proportionate mortality of AI/ANs (19.8% in 1999 to 21.7% in 2020, p = 0.09). Upon comparison of gender, proportionate mortality of premature MI in women showed a statistically nonsignificant increase from 21.6% in 1999 to 27.3% in 2020 [average annual percent change of 0.7, p = 0.06)]. However, men had a statistically significant decrease in proportionate mortality of premature MI from 18.5% in 1999 to 18.2% in 2020 [average annual percent change of -0.8, p = 0.01)]. AI/ANs have an alarmingly higher rate of proportionate mortality of premature MI than that of other races, with no improvement in the proportionate mortality rates over 20 years, despite an overall downtrend in AMI mortality. Further research to address the reasons for the lack of improvement in premature MI is needed to improve outcomes in this patient population.
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Affiliation(s)
- Karthik Gonuguntla
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Kinza Iqbal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Aakanksha Sharma
- Department of Internal Medicine, Icahn School of Medicine, New York City, New York
| | - Ritu Yadav
- Midwestern University Graduate Medical Education Consortium/Verde Valley Medical Center, Cottonwood, Arizona
| | - Anas Alharbi
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Muchi Ditah Chobufo
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Minahil Naeem
- Department of Internal Medicine, King Edward Medical University, Lahore, Pakistan
| | - Ayesha Shaik
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut
| | - Sudarshan Balla
- Department of Cardiology, West Virginia University, Morgantown, West Virginia.
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Mir T, Shafi O, Balla S, Munir MB, Qurehi WT, Kakouros N, Bhat Z, Koul P, Rab T. Intensive Care Admissions and Outcome of Cardiac Arrests; A National Cohort Study From the United States. J Intensive Care Med 2024; 39:118-124. [PMID: 37528646 DOI: 10.1177/08850666231192844] [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] [Indexed: 08/03/2023]
Abstract
OBJECTIVE Outcomes of cardiac arrest among patients who had cardiopulmonary resuscitation (CPR) in intensive care units (ICU) has limited data on the national level basis in the United States. We aimed to study the outcomes of ICU CPRs. METHODS Data from the national readmissions database (NRD) sample that constitutes 49.1% of the stratified sample of all hospitals in the United States were analyzed for ICU-related hospitalizations for the years 2016 to 2019. ICU CPR was defined by procedure codes. RESULTS A total of 4,610,154 ICU encounters were reported for the years 2016 to 2019 in the NRD. Of these patients, 426,729 (9.26%) had CPR procedure recorded during the hospital encounter (mean age 65 ± 17.81; female 42.4%). And 167,597 (39.29%) patients had CPR on the day of admission, of which 63.16% died; while 64,752 (15.18%) patients had CPR on the day of ICU admission, of which 72.85% died. And 36,002 (8.44%) had CPR among patients with length of stay 2 days, of which 73.34% died. A total of 1,222,799 (26.5%) admitted to ICU died, and patients who had ICU CPR had higher mortality, 291,391(68.3%). Higher complication rates were observed among ICU CPR patients, especially who died. Over the years from 2016 to 2019, ICU CPR rates increased from 8.18% (2016) to 8.66% (2019); p-trend = 0.001. The mortality rates among patients admitted to ICU increased from 22.1% (2016) to 24.1% (2019); p-trend = 0.005. CONCLUSION The majority of ICU CPRs were done on the first day of ICU admission. The trend for ICU CPR was increasing. The mortality trend for overall ICU admissions has increased, which is concerning and would suggest further research to improve the high mortality rates in the CPR group.
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Affiliation(s)
- Tanveer Mir
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
- Department of Internal Medicine, Baptist Health System, Montgomery, AL, USA
| | - Obeid Shafi
- Department of Clinical Informatics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University, Morgantown, WV, USA
| | | | - Waqas T Qurehi
- Cardiology Division, University of Massachusetts, Amherst, MA, USA
| | | | - Zeenat Bhat
- Nephrology Division, University of Michigan, Ann Arbor, MI, USA
| | - Parvaiz Koul
- Department of Internal Medicine, Sheri-Kashmir Institute of Medical Sciences SKIMS, Srinagar, Kashmir, India
| | - Tanveer Rab
- Division of Cardiology, Emory University, Atlanta, GA, 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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Sama C, Abdelhaleem A, Velu D, Ditah Chobufo M, Fongwen NT, Budoff MJ, Roberts M, Balla S, Mills JD, Njim TN, Greathouse M, Zeb I, Hamirani YS. Non-calcified plaque in asymptomatic patients with zero coronary artery calcium score: A systematic review and meta-analysis. J Cardiovasc Comput Tomogr 2024; 18:43-49. [PMID: 37821352 DOI: 10.1016/j.jcct.2023.10.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND There is growing interest in understanding the coronary atherosclerotic burden in asymptomatic patients with zero coronary artery calcium score (CACS). In this population, we aimed to investigate the prevalence and severity of non-calcified coronary plaques (NCP) as detected by coronary CT angiography (CCTA), and to analyze the associated clinical predictors. METHODS This was a systematic review with meta-analysis of studies indexed in PubMed/Medline and Web of Science from inception of the database to March 31st, 2023. Using the random-effects model, separate Forest and Galbraith plots were generated for each effect size assessed. Heterogeneity was assessed using the I2 statistics whilst Funnel plots and Egger's test were used to assess for publication bias. RESULTS From a total of 14 studies comprising 37808 patients, we approximated the pooled summary estimates for the overall prevalence of NCP to be 10% (95%CI: 6%-13%). Similarly, the pooled prevalence of obstructive NCP was estimated at 1.1% (95%CI: 0.7%-1.5%) from a total of 10 studies involving 21531 patients. Hypertension [OR: 1.46 (95%CI:1.31-1.62)] and diabetes mellitus [OR: 1.69 (95%CI: 1.41-1.97)] were significantly associated with developing any NCP, with male gender being the strongest predictor [OR: 3.22 (95%CI: 2.17-4.27)]. CONCLUSION There is a low burden of NCP among asymptomatic subjects with zero CACS. In a subset of this population who have clinical predictors of NCP, the addition of CCTA has a potential to provide a better insight about occult coronary atherosclerosis, however, a risk-benefit approach must be factored in prior to CCTA use given the low prevalence of NCP.
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Affiliation(s)
- Carlson Sama
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA
| | - Ahmed Abdelhaleem
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Dhivya Velu
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Muchi Ditah Chobufo
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Noah T Fongwen
- London School of Hygiene and Tropical Medicine & Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Matthew J Budoff
- Division of Cardiology, Harbor-UCLA Medical Center and the Lundquist Institute for Biomedical Innovation, Torrance, CA, USA
| | - Melissa Roberts
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA
| | - Sudarshan Balla
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - James D Mills
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Tsi N Njim
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mark Greathouse
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Irfan Zeb
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Yasmin S Hamirani
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA.
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Fakhra S, Faisaluddin M, Sattar Y, DeCicco D, Ahmed A, Patel N, Balasubramanian S, Ludhwani D, Masood H, Raina S, Gonuguntla K, Feitell SC, Tarun T, Balla S. Trends and cardiovascular outcomes of Takotsubo syndrome with cardiogenic shock vs. mixed cardiogenic and septic shock: a nationwide propensity matched analysis. Expert Rev Cardiovasc Ther 2024; 22:103-109. [PMID: 38105722 DOI: 10.1080/14779072.2023.2295378] [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: 07/17/2023] [Accepted: 12/12/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION Takotsubo syndrome (TTS), also known as stress-induced cardiomyopathy, can be complicated by shock. The outcomes of patients with TTS complicated with cardiogenic shock (CS) versus mixed cardiogenic and septic shock (MS) is not known. METHODS We queried Nationwide Inpatient Sample (NIS) from 2009-2020 to compare TTS patients with CS and MS using International Classification of Disease, Ninth & Tenth Edition, Clinical Modification (ICD- 9 & 10-CM) coding. In-hospital outcomes were compared using one: one propensity score matched (PSM) analysis. The primary outcome was in-hospital mortality. RESULTS Of 23,126 patients with TTS 17,132 (74%) had CS, and 6,269 (26%) had MS. The mean age was 67 years in CS and 66 years in MS, and majority of patients were female (n = 17,775, 77%). On adjusted multivariate analysis, MS patients had higher odds of in-hospital mortality (aOR 1.44, 95% CI 1.36-1.52), AKI (aOR 1.53, 95% CI 1.48-1.58), pressor requirement (aOR 1.37, 95% CI 1.25-1.50). However, had lower odds of MCS use (aOR 0.44, 95% CI 0.40-0.48) and cardiac arrest (aOR: 0.81, 95% CI 0.73-0.90) (p-value <0.0001). Mean LOS and inflation-adjusted hospital charges were higher in MS. CONCLUSION MS in the setting of TTS have higher rates of in-hospital mortality, AKI, and pressor requirements.
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Affiliation(s)
- Sadaf Fakhra
- Department of Internal Medicine, University of Nevada, Reno, NV, USA
| | | | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Danielle DeCicco
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Asmaa Ahmed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Neel Patel
- Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI, USA
| | - Senthil Balasubramanian
- Division of Cardiovascular Medicine, NorthShore University Health System-Metro Chicago, Evanston, IL, USA
| | - Dipesh Ludhwani
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | - Hassan Masood
- Department of Critical Care, Pakistan Railway Hospital, Rawalpindi, Pakistan
| | - Sameer Raina
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
| | | | - Scott C Feitell
- Department Of Cardiology, Rochester General Hospital, Rochester, NY, USA
| | - Tushar Tarun
- Division of cardiovascular medicine, University of Arkansas School of Medicine, Little Rock, AR, USA
| | - Sudarshan Balla
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
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9
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Chobufo MD, Atti V, Vasudevan A, Bhandari R, Badhwar V, Baddour LM, Balla S. Trends in Infective Endocarditis Mortality in the United States: 1999 to 2020: A Cause for Alarm. J Am Heart Assoc 2023; 12:e031589. [PMID: 38088249 PMCID: PMC10863783 DOI: 10.1161/jaha.123.031589] [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: 06/28/2023] [Accepted: 10/04/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Data on national trends in mortality due to infective endocarditis (IE) in the United States are limited. METHODS AND RESULTS Utilizing the multiple causes of death data from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2020, IE and substance use were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification codes. Between 1999 and 2020, the IE-related age-adjusted mortality rates declined. IE-related crude mortality accelerated significantly in the age groups 25-34 years (average annual percentage change, 5.4 [95% CI, 3.1-7.7]; P<0.001) and 35-44 years (average annual percentage change, 2.3 [95% CI, 1.3-3.3]; P<0.001), but remained stagnant in those aged 45-54 years (average annual percentage change, 0.5 [95% CI, -1.9 to 3]; P=0.684), and showed a significant decline in those aged ≥55 years. A concomitant substance use disorder as multiple causes of death in those with IE increased drastically in the 25-44 years age group (P<0.001). The states of Kentucky, Tennessee, and West Virginia showed an acceleration in age-adjusted mortality rates in contrast to other states, where there was predominantly a decline or static trend for IE. CONCLUSIONS Age-adjusted mortality rates due to IE in the overall population have declined. The marked acceleration in mortality in the 25- to 44-year age group is a cause for alarm. Regional differences with acceleration in IE mortality rates were noted in Kentucky, Tennessee, and West Virginia. We speculate that this acceleration was likely due mainly to the opioid crisis that has engulfed several states and involved principally younger adults.
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Affiliation(s)
- Muchi Ditah Chobufo
- Division of CardiologyWest Virginia University Heart & Vascular InstituteMorgantownWVUSA
| | - Varunsiri Atti
- Division of CardiologyWest Virginia University Heart & Vascular InstituteMorgantownWVUSA
| | | | - Ruchi Bhandari
- Department of Epidemiology and Biostatistics, School of Public HealthWest Virginia UniversityMorgantownWVUSA
| | - Vinay Badhwar
- Department of Cardiothoracic SurgeryWest Virginia University Heart & Vascular InstituteMorgantownWVUSA
| | - Larry M. Baddour
- Division of Infectious Diseases, Department of Internal Medicine, Mayo ClinicRochesterMNUSA
| | - Sudarshan Balla
- Division of CardiologyWest Virginia University Heart & Vascular InstituteMorgantownWVUSA
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10
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Sama C, Fongwen NT, Chobufo MD, Hamirani YS, Mills JD, Roberts M, Greathouse M, Zeb I, Kazienko B, Balla S. A systematic review and meta-analysis of the prevalence, incidence, and predictors of atrial fibrillation in cardiac sarcoidosis. Int J Cardiol 2023; 391:131285. [PMID: 37619882 DOI: 10.1016/j.ijcard.2023.131285] [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: 06/20/2023] [Revised: 08/06/2023] [Accepted: 08/20/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The occurrence of atrial arrhythmias, in particular, atrial fibrillation (AF) in patients with cardiac sarcoidosis (CS) are of growing interest in the field of infiltrative cardiomyopathies. Via a systematic review with meta-analysis, we sought to synthesize data on the prevalence, incidence, and predictors of atrial arrhythmias as well as outcomes in patients with CS. METHODS PubMed/Medline, Web of Science, and Scopus were systematically queried from inception until April 26th, 2023. Using the random-effects model, separate plots were generated for each effect size assessed. RESULTS From a total of 8 studies comprising 978 patients with CS, the pooled summary estimates for the prevalence of AF was 23% (95% CI: 13%-34%). Paroxysmal AF was the most common subtype of AF (83%; 95% CI: 77%-90%), followed by persistent AF (17%; 95% CI: 10%-23%). In 9 studies involving 545 patients with CS, the pooled incidence of AF was estimated at 5%, 13.1%, and 8.9% at <2 years, 2-4 years, and > 4 years of follow-up respectively, with an overall cumulative incidence of 10.6% (95% CI: 4.9%-17.8%) over a 6-year follow-up period. Increased left atrial size and atrial 18F-fluorodeoxyglucose uptake were identified as strong independent predictors for the development of atrial arrhythmias on qualitative synthesis. CONCLUSION The burden of AF and related arrhythmias in CS patients is considerable. This necessitates close follow-up and predictive risk-stratification tools to guide the initiation of appropriate strategies, including therapeutic interventions for prevention of AF-related embolic phenomenon, especially in those with known clinical predictors.
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Affiliation(s)
- Carlson Sama
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA.
| | - Noah T Fongwen
- London School of Hygiene and Tropical Medicine, London, United Kingdom; Africa Centres for Disease Control and Prevention (Africa CDC), Addis Ababa, Ethiopia
| | - Muchi Ditah Chobufo
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Yasmin S Hamirani
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - James D Mills
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Melissa Roberts
- Department of Medicine, Section of Internal Medicine, West Virginia University School of Medicine, WV, USA
| | - Mark Greathouse
- Department of Cardiology, Allegheny Health Network, Pittsburgh, PA, USA
| | - Irfan Zeb
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Brian Kazienko
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
| | - Sudarshan Balla
- Department of Medicine, Division of Cardiovascular Diseases, West Virginia University School of Medicine, WV, USA
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11
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Hashem A, Khalouf A, Mohamed MS, Nayfeh T, Elkhapery A, Elbahnasawy M, Rai D, Deshwal H, Feitell S, Balla S. COVID-19 Infection Is Associated With Increased In-Hospital Mortality and Complications in Patients With Acute Heart Failure: Insight From National Inpatient Sample (2020). J Intensive Care Med 2023; 38:1068-1077. [PMID: 37350092 PMCID: PMC10291223 DOI: 10.1177/08850666231182380] [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: 02/02/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023]
Abstract
Introduction: Patients with acute heart failure (AHF) exacerbation are susceptible to complications in the setting of COVID-19 infection. Data regarding the clinical outcomes of COVID-19 in patients admitted with AHF is limited. Methods: We used the national inpatient sample database by utilizing ICD-10 codes to identify all hospitalizations with a diagnosis of AHF in 2020. We classified the sample into AHF with COVID-19 infection versus those without COVID-19. Primary outcome was in-hospital mortality. Secondary outcomes were acute myocardial infarction, need for pressors, mechanical cardiac support, cardiogenic shock, and cardiac arrest. Also, we evaluated for acute pulmonary embolism (PE), bacterial pneumonia, need for a ventilator, and acute kidney injury (AKI). Results: We identified a total of 694,920 of AHF hospitalizations, 660,463 (95.04%) patients without COVID-19 and 34,457 (4.96%) with COVID-19 infection. For baseline comorbidities, diabetes mellitus, chronic heart failure, ESRD, and coagulopathy were significantly higher among AHF patients with COVID-19 (P < .01). While CAD, prior MI, percutaneous coronary intervention, and coronary artery bypass graft, atrial fibrillation, chronic obstructive pulmonary disease, and peripheral vascular disease were higher among those without COVID-19. After adjustment for baseline comorbidities, in-hospital mortality (aOR 5.08 [4.81 to 5.36]), septic shock (aOR 2.54 [2.40 to 2.70]), PE (aOR 1.75 [1.57 to 1.94]), and AKI (aOR 1.33 [1.30 to 1.37]) were significantly higher among AHF with COVID-19 patients. The mean length of stay (5 vs 7 days, P < .01) and costs of hospitalization ($42,143 vs $60,251, P < .01) were higher among AHF patients with COVID-19 infection. Conclusion: COVID-19 infection in patients with AHF is associated with significantly higher in-hospital mortality, need for mechanical ventilation, septic shock, and AKI along with higher resource utilization. Predictors for mortality in AHF patients during the COVID-19 pandemic, COVID-19 infection, patients with end-stage heart failure, and atrial fibrillation. Studies on the impact of vaccination against COVID-19 in AHF patients are needed.
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Affiliation(s)
- Anas Hashem
- Internal Medicine Department, Rochester General Hospital, Rochester, NY, USA
| | - Amani Khalouf
- Internal Medicine Department, Rochester General Hospital, Rochester, NY, USA
| | | | - Tarek Nayfeh
- Evidence-based medicine, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Ahmed Elkhapery
- Internal Medicine Department, Rochester General Hospital, Rochester, NY, USA
| | | | - Devesh Rai
- Department of Cardiology, Rochester General Hospital, Sands-Constellation Heart Institute, Rochester, NY, USA
| | - Himanshu Deshwal
- Department of Pulmonary, Sleep and Critical Care Medicine, West Virginia University, Morgantown, WV, USA
| | - Scott Feitell
- Department of Cardiology, Rochester General Hospital, Sands-Constellation Heart Institute, Rochester, NY, USA
| | - Sudarshan Balla
- Department of Cardiovascular Disease, West Virginia University – Health Sciences Campus, Morgantown, WV, USA
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12
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Ludhwani D, Chobufo MD, Gonuguntla K, Shaik A, Sattar Y, Foryoung JB, Balla S. Mortality due to Peripartum Cardiomyopathy in the United States. Curr Probl Cardiol 2023; 48:101914. [PMID: 37392978 DOI: 10.1016/j.cpcardiol.2023.101914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Affiliation(s)
- Dipesh Ludhwani
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV
| | - Muchi Ditah Chobufo
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV
| | - Karthik Gonuguntla
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV
| | - Ayesha Shaik
- Department of Cardiology, Hartford hospital, Hartford, CT
| | - Yasar Sattar
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV
| | - Joyce Bei Foryoung
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV
| | - Sudarshan Balla
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV.
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13
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Hashem A, Khalouf A, Mohamed MS, Ismayl M, Kashou A, Chaaya RGB, Nayfeh T, Rai D, Sulaiman S, Balla S. Outcomes of Percutaneous Atrial Septal Defect Closure With Mitral Transcatheter Edge-to-Edge Repair and Transseptal Mitral Valve Replacement (2015 to 2020). Am J Cardiol 2023; 204:92-95. [PMID: 37541153 DOI: 10.1016/j.amjcard.2023.07.062] [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: 04/14/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 08/06/2023]
Abstract
Patients who underwent transcatheter edge-to-edge repair (TEER) or transcatheter mitral valve replacement (TMVR) have a transeptal access created by an iatrogenic atrial septal defect (ASD) which leads to significant complications requiring closure. Given limited data, we used the National Inpatient Sample between 2015 and 2020 to evaluate the clinical outcomes of percutaneous closure of ASD (PC-ASD) in TEER/TMVR hospitalizations. A total of 44,065 eligible weighted hospitalizations with either TEER (n = 39,625, 89.9%) or TMVR (n = 4,440, 10.1%) with a higher rate of PC-ASD in the TMVR group (10.7% vs 2.0%, p <0.01). The TEER with PC-ASD group were more likely to experience acute heart failure and right ventricular failure and had longer hospital stays but there was no difference in in-hospital mortality compared with the no PC-ASD group. In the TMVR group, there was no difference in the odds of acute heart failure, right ventricular failure, cardiogenic shock, or acute hypoxic respiratory failure, but the odds of mechanical circulatory support, in-hospital mortality, and length of stay were significantly higher in patients with PC-ASD in the TMVR group. In conclusion, rates of percutaneous closure of ASD after TEER were lower than after TMVR and associated with worse in-hospital mortality in TMVR but not in TEER. Further prospective clinical trials are needed to identify patients who would benefit from the closure of iatrogenic ASD.
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Affiliation(s)
- Anas Hashem
- Department of Medicine, Sands-Constellation, Rochester General Hospital, Rochester, New York
| | - Amani Khalouf
- Department of Medicine, Sands-Constellation, Rochester General Hospital, Rochester, New York
| | - Mohamed Salah Mohamed
- Department of Medicine, Sands-Constellation, Rochester General Hospital, Rochester, New York
| | - Mahmoud Ismayl
- Cardiovascular Disease Department, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Anthony Kashou
- Cardiovascular Disease Department, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Rody G Bou Chaaya
- Cardiovascular Disease Department, Houston Methodist Hospital, Houston, Texas
| | - Tarek Nayfeh
- Evidence-Based Medicine Department, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Devesh Rai
- Cardiovascular Disease Department, Sands-Constellation, Rochester General Hospital, Rochester, New York
| | - Samian Sulaiman
- Cardiovascular Disease Department, West Virginia University, Morgantown, West Virginia
| | - Sudarshan Balla
- Cardiovascular Disease Department, West Virginia University, Morgantown, West Virginia.
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14
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Lacoste JL, Avalon JC, Ludhwani D, Conte J, Perkowski G, Patel B, Courser A, Balla S. Comparative Effectiveness of Direct Current Cardioversion in Patients With Atrial Fibrillation and Obesity With Body Mass Index ≥50 kg/m 2. Am J Cardiol 2023; 203:234-239. [PMID: 37506669 DOI: 10.1016/j.amjcard.2023.06.121] [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: 03/17/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023]
Abstract
Atrial fibrillation is one of the most frequently encountered arrhythmia, with obesity being an independent risk factor. There are sparse data on the success rates of direct current cardioversion (DCCV) in patients with severe obesity. We compared the effectiveness of DCCV in patients with a body mass index (BMI) >50 kg/m2 with those with a BMI <30 kg/m2. A retrospective chart review of 111 patients was performed between January 1, 2011 and January 1, 2022. The study cohort was stratified into 2 groups: BMI ≥50 kg/m2 and BMI <30 kg/m2. The primary outcome was successful achievement of normal sinus rhythm after DCCV. The secondary outcomes included number of attempted shocks, number of successful shocks on first attempts, and energy of successful shock. The primary outcome occurred in 94.6% of patients with a BMI <30 kg/m2 group compared with 81.8% in the patients with a BMI ≥50 kg/m2 (p = 0.042). Patients in the higher BMI cohort had a higher median energy during a successful shock than the lower BMI cohort (250 J [200 to 360 J] vs 200 J [150 to 200 J], p <0.001). There was no difference in the number of shocks used between the 2 groups or in the success of the first shock delivered between BMI ≥50 kg/m2 and BMI <30 kg/m2 (75% vs 58.2%, p = 0.093). In conclusion, patients with a BMI ≥50 kg/m2 had lower rates of successful DCCV than patients with a BMI <30 kg/m2; therefore, clinicians must be aware of the alternative strategies to improve DCCV success and the possibility of DCCV failure in patients with higher BMIs.
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Affiliation(s)
- Jordan L Lacoste
- Department of Pharmacy, WVU Medicine, Morgantown, West Virginia.
| | - Juan Carlo Avalon
- Department of Internal Medicine, WVU Medicine, Morgantown, West Virginia
| | - Dipesh Ludhwani
- Department of Internal Medicine, WVU Medicine, Morgantown, West Virginia
| | - Justin Conte
- Department of Internal Medicine, WVU Medicine, Morgantown, West Virginia
| | - Gregory Perkowski
- Department of Internal Medicine, WVU Medicine, Morgantown, West Virginia
| | - Bansari Patel
- Department of Internal Medicine, WVU Medicine, Morgantown, West Virginia
| | - Andrew Courser
- Department of Internal Medicine - Cardiology, WVU Medicine, Morgantown, West Virginia
| | - Sudarshan Balla
- Department of Cardiovascular and Thoracic Surgery, WVU Medicine, Morgantown, West Virginia
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15
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Hamza M, Sattar Y, Manasrah N, Patel NN, Rashdi A, Khanal R, Naveed H, Zafar M, Khan AM, Alharbi A, Aamir M, Gonuguntla K, Raina S, Balla S. Meta-Analysis of Efficacy and Safety of Intravenous Iron in Patients With Iron Deficiency and Heart Failure With Reduced Ejection Fraction. Am J Cardiol 2023; 202:119-130. [PMID: 37429060 DOI: 10.1016/j.amjcard.2023.06.066] [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: 03/12/2023] [Revised: 06/11/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Abstract
Iron deficiency is an independent risk factor for heart failure (HF) exacerbation. We aim to study the safety and efficacy of intravenous (IV) iron therapy in patients with HF with reduced ejection fraction (HFrEF). A literature search was conducted on MEDLINE (Embase and PubMed) using a systematic search strategy by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) until October 2022. CRAN-R software (The R Foundation for Statistical Computing, Vienna, Austria) was used for statistical analysis. The quality assessment was performed using the Cochrane Risk of Bias and Newcastle-Ottawa Scale. We included 12 studies with a total of 4,376 patients (IV iron n = 1,985 [45.3%]; standard of care [SOC] n = 2,391 [54.6%]). The mean age was 70.37 ± 8.14 years and 71.75 ± 7.01 years in the IV iron and SOC groups, respectively. There was no significant difference in all-cause mortality and cardiovascular mortality (risk ratio [RR] 0.88, 95% confidence interval [CI] 0.74 to 1.04, p <0.15). However, HF readmissions were significantly lower in the IV iron group (RR 0.73, 95% CI 0.56 to 0.96, p = 0.026). Non-HF cardiac readmissions were not significantly different between the IV iron and SOC groups (RR 0.92, 95% CI 0.82 to 1.02, p = 0.12). In terms of safety, there was a similar rate of infection-related adverse events in both arms (RR 0.86, 95% CI 0.74 to 1, p = 0.05). IV iron therapy in patients with HFrEF is safe and shows a significant reduction in HF hospitalizations compared with SOC. There was no difference in the rate of infection-related adverse events. The changing landscape of HFrEF pharmacotherapy in the last decade may warrant a re-demonstration of the benefit of IV iron with current SOC. The cost-effectiveness of IV iron use also needs further study.
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Affiliation(s)
- Mohammad Hamza
- Department of Internal Medicine, Albany Medical Center, Albany, New York
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Nouraldeen Manasrah
- Department of Internal Medicine, Detroit Medical Center, Sinai Grace Hospital, Wayne State University, Detroit, Michigan
| | - Neel Navinkumar Patel
- Neel Navinkumar Patel Department of Internal Medicine, New York Medical College/Landmark Medical Center, Woonsocket, Rhode Island
| | - Amna Rashdi
- Department of Cardiology, Windsor Heart Institute, Windsor, Ontario, Canada
| | - Resha Khanal
- Department of Internal Medicine, Promedica Physician Group, Toledo, Ohio
| | - Hamza Naveed
- Department of Internal Medicine HCA Houston Healthcare/ University of Houston, Kingwood Medical Center, Houston, Texas
| | - Maha Zafar
- Department of Internal Medicine, Arkansas College of Osteopathic Medicine Mercy Program, Mercy Hospital Fort Smith, Arkansas
| | - Ahsan Mahmood Khan
- Department of Internal Medicine, Pakistan Ordnance Factories Hospital, Wah Cantonment, Pakistan
| | - Anas Alharbi
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Muhammad Aamir
- Department of Cardiology, Lehigh Valley Hospital, Allentown, Pennsylvania
| | - Karthik Gonuguntla
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Sameer Raina
- Department of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Sudarshan Balla
- Department of Cardiology, West Virginia University, Morgantown, West Virginia.
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16
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Miller T, Hana D, Patel B, Conte J, Velu D, Avalon JC, Thyagaturu H, Sankaramangalam K, Shotwell M, Guzman DB, Kadiyala M, Balla S, Kim C, Zeb I, Patel B, Budoff M, Mills J, Hamirani YS. Predictors of non-calcified plaque presence and future adverse cardiovascular events in symptomatic rural Appalachian patients with a zero coronary artery calcium score. J Cardiovasc Comput Tomogr 2023; 17:302-309. [PMID: 37543447 DOI: 10.1016/j.jcct.2023.07.003] [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: 04/14/2023] [Revised: 07/19/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Coronary artery calcium (CAC) scoring is a proven predictor for future adverse cardiovascular events (CVE) in asymptomatic individuals. Data is emerging regarding the usefulness of non-calcified plaque (NCP) assessment on cardiac computed tomography (CCT) angiography in symptomatic patients with a zero CAC score for further risk assessment. METHODS A retrospective review from January 2019 to January 2022 of 696 symptomatic patients with no known CAD and a zero CAC score identified 181 patients with NCP and 515 patients without NCP by a visual assessment on CCT angiography. The primary endpoint was to identify predictors for NCP presence and adverse CVEs (death, myocardial infarction, or cerebrovascular accident) within two years. RESULTS Based on logistic regression, age (OR 1.039, 95% CI [1.020-1.058], p < 0.001), diabetes mellitus (OR 2.192, 95% CI [1.307-3.676], p < 0.003), tobacco use (OR 1.748, 95% CI [1.157-2.643], p < 0.008), low-density lipoprotein cholesterol level (OR 1.009, 95% CI [1.003-1.015], p < 0.002), and hypertension (OR 1.613, 95% CI [1.024-2.540], p < 0.039) were found to be predictors of NCP presence. NCP patients had a higher pretest probability for CAD using the Morise risk score (p < 0.001∗), with NCP detection increasing as pretest probability increased from low to high (OR 55.79, 95% CI [24.26-128.26], p < 0.001∗). 457 patients (66%) reached a full two-year period after CCT angiography completion, with NCP patients noted to have shorter follow-up times and higher rates of elective coronary angiography, intervention, and CVEs. The presence of NCP (aOR 2.178, 95% CI [1.025-4.627], p < 0.043) was identified as an independent predictor for future adverse CVEs when adjusted for diabetes mellitus, age, and hypertension. CONCLUSION NCP was identified at high rates (26%) in our symptomatic Appalachian population with no known CAD and a zero CAC score. NCP was identified as an independent predictor of future adverse CVEs within two years.
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Affiliation(s)
- Tyler Miller
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - David Hana
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Bansari Patel
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Justin Conte
- Department of Medicine, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Dhivya Velu
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Juan Carlo Avalon
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Harshith Thyagaturu
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Kesavan Sankaramangalam
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Matthew Shotwell
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Daniel Brito Guzman
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Madhavi Kadiyala
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Sudarshan Balla
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Cathy Kim
- Department of Radiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Irfan Zeb
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Brijesh Patel
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Matthew Budoff
- Department of Cardiology, University of California Los Angeles David Geffen School of Medicine, Torrance, CA 90502, USA
| | - James Mills
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Yasmin S Hamirani
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA.
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17
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Balla S, Alkhouli M. Moore's Law and the Quest for Minimalist LAAO. JACC Cardiovasc Interv 2023; 16:1899-1901. [PMID: 37587598 DOI: 10.1016/j.jcin.2023.07.002] [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: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Sudarshan Balla
- Division of Cardiology, West Virginia University, Morgantown, West Virginia, USA.
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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18
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Gonuguntla K, Chobufo MD, Shaik A, Patel N, Penmetsa M, Sattar Y, Thyagaturu H, Chan PS, Balla S. Impact of social vulnerability on cardiac arrest mortality in the United States, 2016-2020. medRxiv 2023:2023.08.02.23293573. [PMID: 37577503 PMCID: PMC10418559 DOI: 10.1101/2023.08.02.23293573] [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] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Importance Cardiac arrest is one of the leading causes of morbidity and mortality, with an estimated 340,000 out-of-hospital and 292,000 in-hospital cardiac arrest events per year in the U.S. Survival rates are lower in certain racial and socioeconomic groups. Objective To examine the impact of social determinants on cardiac arrest mortality among adults stratified by age, race, and sex in the U.S. Design A county-level cross-sectional longitudinal study using death data between 2016 and 2020 from the Centers for Disease Control and Prevention's (CDC) Wide-Ranging Online Data for Epidemiologic Research (WONDER) database. Setting Using the multiple causes of death dataset from the CDC's WONDER database, cardiac arrests were identified using the International Classification of Diseases (ICD), tenth revision, clinical modification codes. Participants Individuals aged 15 years or more whose death was attributed to cardiac arrest. Exposures Social vulnerability index (SVI), reported by the CDC, is a composite measure that includes socioeconomic vulnerability, household composition, disability, minority status and language, and housing and transportation domains. Main outcomes and measures Cardiac arrest mortality per 100,000 adults. Results Overall age-adjusted cardiac arrest mortality (AAMR) during the study period was 95.6 per 100,000 persons. The AAMR was higher for men as compared with women (119.6 vs. 89.9 per 100,000) and for Black, as compared with White, adults (150.4 vs. 92.3 per 100,000). The AAMR increased from 64.8 per 100,000 persons in counties in Quintile 1 (Q1) of SVI to 141 per 100,000 persons in Quintile 5, with an average increase of 13% (95% CI: 9.8-16.9) in AAMR per quintile increase. Conclusion and relevance Mortality from cardiac arrest varies widely, with a more than 2-fold difference between the counties with the highest and lowest social vulnerability, highlighting the differential burden of cardiac arrest deaths throughout the U.S. based on social determinants of health.
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Affiliation(s)
- Karthik Gonuguntla
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Muchi Ditah Chobufo
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Ayesha Shaik
- Department of Cardiology, Hartford Hospital, Hartford, CT, USA
| | - Neel Patel
- Department of Medicine, New York Medical College/Landmark Medical Center, Woonsocket, RI, USA
| | - Mouna Penmetsa
- Department of Medicine, University of Connecticut, Farmington, CT, USA
| | - Yasar Sattar
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Harshith Thyagaturu
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
| | - Paul S. Chan
- Department of Cardiology, Saint Luke’s Mid-America Heart Institute, Kansas City, MO
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University Heart & Vascular Institute, Morgantown, WV, USA
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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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20
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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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21
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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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22
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Taha A, Badu I, Sandhyavenu H, Victor V, Duhan S, Atti L, Qureshi HM, Goni TS, Keisham B, Sandhya Venu V, Thyagaturu H, Gonuguntla K, Ullah W, Deshwal H, Balla S. Contemporary outcomes of long-term anticoagulation in COVID-19 patients: a regression matched sensitivity analysis of the national inpatient sample. Expert Rev Cardiovasc Ther 2023; 21:601-608. [PMID: 37409406 DOI: 10.1080/14779072.2023.2234282] [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: 03/14/2023] [Accepted: 07/05/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The role of oral anticoagulation during the COVID-19 pandemic has been debated widely. We studied the clinical outcomes of COVID-19 hospitalizations in patients who were on long-term anticoagulation. RESEARCH DESIGN AND METHODS The Nationwide Inpatient Sample (NIS) database from 2020 was queried to identify COVID-19 patients with and without long-term anticoagulation. Multivariate regression analysis was used to calculate the adjusted odds ratio (aOR) of in-hospital outcomes. RESULTS Of 1,060,925 primary COVID-19 hospitalizations, 102,560 (9.6%) were on long-term anticoagulation. On adjusted analysis, COVID-19 patients on anticoagulation had significantly lower odds of in-hospital mortality (aOR 0.61, 95% CI 0.58-0.64, P < 0.001), acute myocardial infarction (aOR 0.72, 95% CI 0.63-0.83, P < 0.001), stroke (aOR 0.79, 95% CI 0.66-0.95, P < 0.013), ICU admissions, (aOR 0.53, 95% CI 0.49-0.57, P < 0.001) and higher odds of acute pulmonary embolism (aOR 1.47, 95% CI 1.34-1.61, P < 0.001), acute deep vein thrombosis (aOR 1.17, 95% CI 1.05-1.31, P = 0.005) compared to COVID-19 patients who were not on anticoagulation. CONCLUSIONS Compared to COVID-19 patients not on long-term anticoagulation, we observed lower in-hospital mortality, stroke and acute myocardial infarction in COVID-19 patients on long-term anticoagulation. Prospective studies are needed for optimal anticoagulation strategies in hospitalized patients.
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Affiliation(s)
- Amro Taha
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - Irisha Badu
- Department of Internal Medicine, Onslow Memorial Hospital, Jacksonville, NC, USA
| | | | - Varun Victor
- Department of Internal Medicine, Canton Medical Education Foundation, Canton, Ohio, USA
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Lalitsiri Atti
- Department of Internal Medicine, Sparrow Hospital- Michigan State University, Lansing, MI, USA
| | | | | | - Bijeta Keisham
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD, USA
| | - Vasantha Sandhya Venu
- Department of Computer Science and Engineering, Vardhaman College of Engineering, Hyderabad, India
| | | | | | - Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Himanshu Deshwal
- Department of Medicine, Section of Pulmonary, Critical Care & Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Sudarshan Balla
- Department of Cardiology, West Virginia University, Morgantown, WV, USA
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23
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Sattar Y, Taha A, Patel N, Victor V, Titus A, Aziz S, Gonuguntla K, Thyagaturu H, Atti L, Micho T, Almas T, Alraies MC, Balla S. Cardiovascular outcomes of type 2 myocardial infarction among COVID-19 patients: a propensity matched national study. Expert Rev Cardiovasc Ther 2023; 21:365-371. [PMID: 37038300 DOI: 10.1080/14779072.2023.2200933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Myocardial infarction Type II (T2MI) is a prevalent cause of troponin elevation secondary to a variety of conditions causing stress/demand mismatch. The impact of T2MI on outcomes in patients hospitalized with COVID-19 is not well studied. METHODS The Nationwide Inpatient Sample database from the year 2020 was queried to identify COVID-19 patients with T2MI during the index hospitalization. Clinical Modification (ICD-10-CM) codes "U07.1" and "I21.A1" were used as disease identifiers for COVID-19 and T2MI respectively. Multivariate adjusted Odds ratio (aOR) and propensity score matching (PSM) was done to compare outcomes among COVID patients with and without T2MI. The primary outcome was in-hospital mortality. RESULTS A total of 1,678,995 COVID-19-weighted hospitalizations were identified in the year 2020, of which 41,755 (2.48%) patients had T2MI compared to 1,637,165 (97.5%) without T2MI. Patients with T2MI had higher adjusted odds of in-hospital mortality (aOR 1.44, PSM 32.27%, 95% CI 1.34-1.54) sudden cardiac arrest (aOR 1.29, PSM 6.6 %, 95% CI 1.17-1.43) and CS (aOR 2.16, PSM 2.73%, 95% CI 1.85-2.53) compared to patients without T2MI. The rate of coronary angiography (CA) in T2MI with COVID was 1.19 %, with significant use of CA among patients with T2MI complicated by CS compared to those without CS (4% vs 1.1%, p<0.001). Additionally, COVID-19 patients with T2MI had an increased prevalence of sepsis compared to COVID-19 without T2MI (48% vs 24.1%, p<0.001). CONCLUSION COVID-19 patients with T2MI had worse cardiovascular outcomes with significantly higher in-hospital mortality, SCA, and CS compared to those without T2MI. Long-term mortality and morbidity among COVID-19 patients who had T2MI will need to be clarified in future studies.
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Affiliation(s)
| | - Amro Taha
- Weiss Memorial Hospital, Chicago, IL, USA
| | - Neel Patel
- New York Medical College/Landmark Medical Center, Woonsocket, RI, USA
| | | | - Anoop Titus
- Canton Medical Education Foundation, Canton, Ohio, USA
| | - Shazia Aziz
- Carle Foundation Hospital, Urbana, Illinois, USA
| | | | | | - Lalitsiri Atti
- Sri Venkateswara Medical College, Dr. NTR University of Health Sciences, India
| | - Tarec Micho
- Department of Internal Medicine, Div of Hospitalist Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
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24
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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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25
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Mir T, Rawasia WF, Uddin M, Sheikh M, Munir MB, Balla S. Left atrial appendage closure device outcomes among cirrhosis patients with atrial fibrillation: a United States National Cohort Study. Europace 2023; 25:1408-1414. [PMID: 36857522 PMCID: PMC10105884 DOI: 10.1093/europace/euad004] [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: 09/10/2022] [Accepted: 12/15/2022] [Indexed: 03/03/2023] Open
Abstract
AIMS Literature regarding outcomes associated with atrial fibrillation among cirrhosis patients who had left atrial appendage occlusion (LAAO) device procedure is limited. We aim to evaluate the in-hospital clinical outcomes and 30-day readmissions among LAAO with and without cirrhosis. METHODS AND RESULTS We performed a retrospective study of all hospitalizations associated with the LAAO procedure, using the Nationwide Readmissions Database for the years 2016-19. Primary outcomes were in-hospital clinical outcomes and 30-day readmissions. A total of 54 897 index hospitalizations for LAAO (female 41.8%) were reported. Of these, 905(1.65%) had cirrhosis. Gastrointestinal (GI) bleeding was reported in 44 (4.9%) vs. 1606 (2.97%) and coagulopathy in 21 (2.3%) vs. 521 (0.96%) in cirrhosis and without-cirrhosis groups, respectively. A total of 872 (1.59%) patients needed blood transfusion, 24 (2.7%) vs. 848(1.57%) in cirrhosis vs. without-cirrhosis groups (P = 0.047). Fresh frozen plasma (FFP) transfusion was reported among 888 (1.62%), with cirrhosis 26 (3%) vs. without cirrhosis 862 (1.6%) (P = 0.05). On adjusted multivariate logistic regression analysis, acute kidney injury, coagulopathy, FFP transfusion, and blood transfusion were strongly associated with cirrhosis, and GI bleeding, ischaemic stroke, and intracranial haemorrhage were not associated with cirrhosis. Readmissions in 30 days were 5028 (9.18%), 167 (18.5%) in the cirrhosis group and 4861 (9%) without-cirrhosis group (P = 0.01). On multivariate Cox regression, CHA2DS2-Vasc score of six was significantly associated with 30-day readmission compared with other scores [hazard ratio 2.24; 95% confidence interval (1.58-3.16); P < 0.001]. CONCLUSION Left atrial appendage occlusion procedure in patients with cirrhosis had relatively similar GI bleeding and stroke rates, however, had higher rates of 30-day readmission. A higher CHA2DS2-Vasc score was more likely to be associated with 30-day readmissions and hence would help in discharge planning. The long-term safety and efficacy of LAAO in the cirrhosis population need to be demonstrated.
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Affiliation(s)
- Tanveer Mir
- Internal Medicine, Wayne State University, St Antoine street, Detroit, MI 48201, USA.,Internal Medicine, Baptist Health System, 400 Taylor Road Montgomery, AL 36117, USA
| | - Wasiq F Rawasia
- Clinical & Translational Science Institute, West Virginia University, Morgantown, WV 26506, USA
| | - Mohammed Uddin
- Internal Medicine, Wayne State University, St Antoine street, Detroit, MI 48201, USA
| | - Mujeeb Sheikh
- Division of Cardiology, Promedica Toledo Hospital, 2142 N Cove Blvd, Toledo, OH 43699, USA
| | - Muhammad Bilal Munir
- Division of Cardiology, University of California-Davis, 3941 J St, Sacramento, CA 95819, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University. Morgantown, WV 26506, USA
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Chobufo MD, Ludhwani D, Adeniyi AR, Gonuguntla K, Skaff P, Enoru S, Gabriel A, Sattar Y, Balla S. TRENDS IN ACUTE MYOCARDIAL INFARCTION AGE ADJUSTED MORTALITY RATES BY RACE IN THE USA: 1999-2020. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01585-1] [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: 03/06/2023]
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27
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Titus A, Patel NN, Haroon DM, Saji AM, Minhas SA, Titus A, Baburaj A, Sharma A, Gaikwad P, Roumia M, Balla S. COMPARISON OF CATHETER BASED TECHNIQUES FOR ACUTE PULMONARY EMBOLISM WITH COR PULMONALE: NATIONAL INPATIENT SAMPLE 2016-2019. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01358-x] [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: 03/06/2023]
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28
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Khan M, Zahid S, Ullah W, 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). J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01269-x] [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: 03/06/2023]
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29
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Chobufo MD, Regner SR, Skaff P, Rahman EU, Patel BD, Alyami B, Balla S. TRENDS AND GENDER DISPARITIES IN MEAN AGE AT DEATH FROM HEART FAILURE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)00973-7] [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: 03/06/2023]
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30
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Titus A, Sattar Y, Patel N, Taha A, Sandhyavenu H, Gonuguntla K, Thyagaturu H, Almas T, Balla S. In-Hospital Outcomes of Takotsubo Cardiomyopathy During the COVID-19 Pandemic: Propensity Matched National Cohort. Curr Probl Cardiol 2023; 48:101598. [PMID: 36681214 DOI: 10.1016/j.cpcardiol.2023.101598] [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: 01/07/2023] [Accepted: 01/12/2023] [Indexed: 01/20/2023]
Abstract
Takotsubo Cardiomyopathy (TTS) is an acute reversible left ventricular dysfunction with regional ballooning secondary to various physical or psychological triggers, including COVID-19. The impact of TTS on outcomes in COVID-19 patients is not well studied. The Nationwide in-patient sample database from 2019 to 2020 was utilized to identify TTS patients with and without COVID-19. Clinical Modification (ICD-10-CM) codes U07.1 and I51.81 were used as disease identifiers for COVID-19 and TTS, respectively. Multivariate logistic regression was performed to report adjusted odds ratios (aOR) and propensity score match (PSM) was done to compare outcomes among TTS patients with and without COVID. The primary outcome was in-hospital mortality. A total of 83,215 TTS patients for the period 2019-2020 were included in our study, of which 1665 (2%) had COVID-19. COVID-19 with TTS group had higher adjusted odds of in-hospital mortality (aOR 7.23, PSM 32.7% vs 10.16%, p = <0.001), cardiogenic shock; (aOR 2.32, PSM 16.7% vs 9.5%, P < 0.001) and acute kidney injury; (aOR 2.30, PSM 47.5% vs 33.1%, P< 0.001) compared to TTS without COVID-19. TTS hospitalizations with COVID-19 were associated with longer lengths of stay (12 ± 12 vs 7 ± 9 days) and higher total cost ($47,702 ± $67,940 vs $26,957 ± $44,286) compared to TTS without COVID. TTS with COVID-19 group had a higher proportion of males compared to TTS without COVID-19 group (37.8% vs 18.5%). TTS with COVID-19 group had a greater proportion of non-white race. The proportion of Blacks, Hispanics, and Asian/Pacific Islander was higher in the COVID-19 TTS group compared to TTS without COVID-19 group (12.9% vs 8.4%, 20.4% vs 6.5%, 5 vs 2.2%, respectively). TTS in the setting of COVID-19 illness has worse outcomes in terms of in-hospital mortality, cardiogenic shock, and acute kidney injury. Male sex and non-white race were more likely to be affected by TTS in the setting of COVID-19. The out-of-hospital morbidity and mortality in patients who suffered TTS during COVID-19 illness need further study. Studies are needed to provide mechanistic insights into the interaction between COVID-19 and TTS.
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Affiliation(s)
- Anoop Titus
- Department of Medicine, Saint Vincent Hospital, Worcester, MA
| | - Yasar Sattar
- Department of Cardiology, West Virginia University, Morgantown, WV
| | - Neel Patel
- Department of Medicine, New York Medical College/ Landmark Medical Center, Woonsocket, RI
| | - Amro Taha
- Department of Medicine, Weiss Memorial Hospital, Chicago, IL
| | | | | | | | | | - Sudarshan Balla
- Department of Cardiology, West Virginia University, Morgantown, WV.
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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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Chobufo MD, Singla A, Rahman EU, Michos ED, Whelton PK, Balla S. Temporal trends in atherosclerotic cardiovascular disease risk among U.S. adults. Analysis of the National Health and Nutrition Examination Survey, 1999-2018. Eur J Prev Cardiol 2022; 29:2289-2300. [PMID: 35919951 DOI: 10.1093/eurjpc/zwac161] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 05/23/2022] [Revised: 07/25/2022] [Accepted: 07/29/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Atherosclerotic cardiovascular diseases are a significant cause of disability and mortality. Study of trends in cardiovascular risk at a population level helps understand the overall cardiovascular health and the impact of primary prevention efforts. AIMS To assess trends in the estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk among U.S. adults from 1999-2000 to 2017-18 with no established cardiovascular disease (CVD). METHODS AND RESULTS Serial cross-sectional analysis of National Health and Nutrition Examination Survey (NHANES) data from 1999-2000 to 2017-18 (10 cycles), including 24 022 US adults aged 40-79 years with no reported ASCVD. ASCVD risk was assessed using the pooled cohort equations (PCEs). There was a significant temporal decline in the mean 10-year ASCVD risk from 13.5% (95% CI, 12.5-14.4) in 1999-2000 to 11.1% (10.5-11.7) in 2011-12 (Ptrend < 0.001) and to 12.0% (11.3-12.7) in 2017-2018 (overall Ptrend = 0.001), with the mean ASCVD risk score remaining stable from 2013-14 through 2017-2018 (Ptrend = 0.056). A declining trend in ASCVD risk was noted in females, non-Hispanic Blacks and those with income <3 times the poverty threshold with Ptrend of <0.001, 0.002, and 0.007, respectively. Mean total cholesterol and prevalence of smokers showed a downward trend (Ptrend <0.001 for both), whereas type 2 diabetes and mean BMI showed an upward trend (Ptrend < 0.001 for both). CONCLUSIONS The 20-year trend of ASCVD risk among NHANES participants 40-79 years, as assessed by the use of PCE, showed a non-linear downward trend from 1999-2000 to 2017-18. The initial and significant decline in estimated ASCVD risk from 1999-2000 to 2011-12 subsequently stabilized, with no significant change from 2013-14 to 2017-18. Mean BMI and prevalence of diabetes mellitus increased while mean serum cholesterol levels and prevalence of smoking declined during the study period. Our findings support invigoration of efforts aimed at prevention of CVD, including primordial prevention of CVD risk factors.
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Affiliation(s)
- Muchi Ditah Chobufo
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV 26505, USA
| | - Atul Singla
- Department of Medicine, Kaweah Health Medical Center, Visalia, CA 93291, USA
| | - Ebad Ur Rahman
- Department of Medicine, St. Mary's Medical Center, Huntington, WV 25702, USA
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Paul K Whelton
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV 26505, 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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Thyagaturu HS, Bolton A, Thangjui S, Kumar A, Shah K, Bondi G, Naik R, Sornprom S, Balla S. Effect of leaving against medical advice on 30-day infective endocarditis readmissions. Expert Rev Cardiovasc Ther 2022; 20:773-781. [PMID: 35984240 DOI: 10.1080/14779072.2022.2115358] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND : The burden of against medical advice (AMA) discharges on the readmission rate of infective endocarditis (IE) patients has been largely ignored. METHODS We used the National Readmissions Database, years 2016 to 2019, to identify IE patients and categorized them into those who left AMA (IE AMA) and those who were discharged to home or skilled nursing facility (SNF)/other facility (IE non-AMA). The primary outcome was 30-day all-cause readmissions difference per AMA status. RESULTS Of 26,481 patients with IE who met the inclusion criteria, 4,310 (16.3%) left the hospital AMA. IE AMA patients were younger (mean years; 43.7 vs 34.2; p < 0.01) and had a higher prevalence of injection drug use (IDU) (89.4% vs 45.2%; p < 0.01) but fewer comorbidities compared to IE non-AMA. In adjusted analyses, IE AMA had higher hazards for 30-day readmissions compared to IE non-AMA [hazards ratio (HR): 3.1 (2.9 - 3.5); p < 0.01]. CONCLUSION IE AMA are at increased risk of 30-day readmissions and higher resource utilization at the time of readmission compared to IE non-AMA. Considering the high prevalence of IDU in IE AMA, the role of mental health to curb the burden of IE readmissions is an area of further research.
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Affiliation(s)
- Harshith S Thyagaturu
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Alexander Bolton
- University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Sittinun Thangjui
- Department of Internal Medicine and *Department of Infectious Diseases, Bassett Medical Center, Cooperstown, New York, USA
| | - Amudha Kumar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kashyap Shah
- Department of Internal Medicine, St Luke's University Hospitals, Allentown, Pennsylvania, USA
| | - Gayatri Bondi
- Department of Internal Medicine and *Department of Infectious Diseases, Bassett Medical Center, Cooperstown, New York, USA
| | - Riddhima Naik
- Department of Internal Medicine and *Department of Infectious Diseases, Bassett Medical Center, Cooperstown, New York, USA
| | - Suthanya Sornprom
- Department of Internal Medicine and *Department of Infectious Diseases, Bassett Medical Center, Cooperstown, New York, USA
| | - Sudarshan Balla
- Department of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, West Virginia, USA
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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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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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Zahid S, Khan MZ, Ullah W, Tanveer Ud Din M, Abbas S, Ubaid A, Khan MU, Rai D, Baibhav B, Rao M, Singla A, Goldsweig AM, Depta JP, Balla S. In-hospital outcomes of TAVR patients with a bundle branch block: Insights from the National Inpatient Sample 2011-2018. Catheter Cardiovasc Interv 2022; 100:424-436. [PMID: 35842779 DOI: 10.1002/ccd.30341] [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: 12/23/2021] [Revised: 04/18/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Data on the outcomes following transcatheter aortic valve replacement (TAVR) in patients with a bundle branch block (BBB) remains limited. METHODS We studied the outcomes of TAVR patients with a BBB from the National Inpatient Sample (NIS) database between 2011 and 2018 using ICD-9-CM and ICD-10-CM codes. RESULTS Between 2011 and 2018, 194,237 patients underwent TAVR, where 1.7% (n = 3,232) had a right BBB (RBBB) and 13.7% (n = 26,689) had a left BBB (LBBB). Patients with a RBBB and LBBB had a higher rate of new permanent pacemaker (PPM) implantation (31.5% - RBBB, 15.7% LBBB vs. 10.2% - no BBB). RBBB was associated with a significantly longer median length of stay (5 days) and total hospitalization cost ($53,669) compared with LBBB (3 days and $47,552) and no BBB (3 days and $47,171). Trend analysis revealed lower rates of PPM implantation and reduced lengths of stay and costs across all comparison groups. CONCLUSION In conclusion, patients undergoing TAVR with a BBB are associated with higher new rates of PPM implantation. RBBB is the strongest independent predictor for new PPM implantation following TAVR. Rates of new PPM implantation in TAVR patients with and without a BBB have improved over time including reductions in length of stay and hospital costs. Further study is needed to reduce the risks of PPM implantation in TAVR patients.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Muhammad Z Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Waqas Ullah
- Department of Cardiovascular Medicine, Jefferson University Hospitals, Philadelphia, Pennsylvania, USA
| | - Mian Tanveer Ud Din
- Department of Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Sakina Abbas
- Department of Medicine, Dow Medical College, Karachi, Pakistan
| | - Aamer Ubaid
- Department of Medicine, University of Missouri-Kansas City, Kansas city, Missouri, USA
| | - Muhammad U Khan
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
| | - Devesh Rai
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Bipul Baibhav
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Mohan Rao
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Atul Singla
- Division of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jeremiah P Depta
- Sands-Constellation Heart Institute, Rochester General Hospital, Rochester, New York, USA
| | - Sudarshan Balla
- Division of Cardiovascular Medicine, West Virginia University Heart & Vascular Institute, Morgantown, West Virginia, USA
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Bhandari R, Alexander T, Annie FH, Kaleem U, Irfan A, Balla S, Wiener RC, Cook C, Nanjundappa A, Bates M, Thompson E, Smith GS, Feinberg J, Fisher MA. Steep rise in drug use-associated infective endocarditis in West Virginia: Characteristics and healthcare utilization. PLoS One 2022; 17:e0271510. [PMID: 35839224 PMCID: PMC9286279 DOI: 10.1371/journal.pone.0271510] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Life-threatening infections such as infective endocarditis (IE) are increasing simultaneously with the injection drug use epidemic in West Virginia (WV). We utilized a newly developed, statewide database to describe epidemiologic characteristics and healthcare utilization among patients with (DU-IE) and without (non-DU-IE) drug use-associated IE in WV over five years. Materials and methods This retrospective, observational study, incorporating manual review of electronic medical records, included all patients aged 18–90 years who had their first admission for IE in any of the four university-affiliated referral hospitals in WV during 2014–2018. IE was identified using ICD-10-CM codes and confirmed by chart review. Demographics, clinical characteristics, and healthcare utilization were compared between patients with DU-IE and non-DU-IE using Chi-square/Fisher’s exact test or Wilcoxon rank sum test. Multivariable logistic regression analysis was conducted with discharge against medical advice/in-hospital mortality vs. discharge alive as the outcome variable and drug use as the predictor variable. Results Overall 780 unique patients had confirmed first IE admission, with a six-fold increase during study period (p = .004). Most patients (70.9%) had used drugs before hospital admission, primarily by injection. Compared to patients with non-DU-IE, patients with DU-IE were significantly younger (median age: 33.9 vs. 64.1 years; p < .001); were hospitalized longer (median: 25.5 vs. 15 days; p < .001); had a higher proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates (42.7% vs. 29.9%; p < .001), psychiatric disorders (51.2% vs. 17.3%; p < .001), cardiac surgeries (42.9% vs. 26.6%; p < .001), and discharges against medical advice (19.9% vs. 1.4%; p < .001). Multivariable regression analysis showed drug use was an independent predictor of the combined outcome of discharge against medical advice/in-hospital mortality (OR: 2.99; 95% CI: 1.67–5.64). Discussion and conclusion This multisite study reveals a 681% increase in IE admissions in WV over five years primarily attributable to injection drug use, underscoring the urgent need for both prevention efforts and specialized strategies to improve outcomes.
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Affiliation(s)
- Ruchi Bhandari
- School of Public Health, West Virginia University, Morgantown, West Virginia, United States of America
- * E-mail:
| | - Talia Alexander
- School of Public Health, West Virginia University, Morgantown, West Virginia, United States of America
| | - Frank H. Annie
- Health Education and Research Institute, Charleston Area Medical Center, Charleston, West Virginia, United States of America
| | - Umar Kaleem
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, United States of America
| | - Affan Irfan
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, United States of America
| | - Sudarshan Balla
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - R. Constance Wiener
- School of Dentistry, West Virginia University, Morgantown, West Virginia, United States of America
| | - Chris Cook
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Aravinda Nanjundappa
- Department of Cardiovascular Medicine, Charleston Area Medical Center, Charleston, West Virginia, United States of America
| | - Mark Bates
- Department of Cardiovascular Medicine, Charleston Area Medical Center, Charleston, West Virginia, United States of America
| | - Ellen Thompson
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia, United States of America
| | - Gordon S. Smith
- School of Public Health, West Virginia University, Morgantown, West Virginia, United States of America
| | - Judith Feinberg
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
| | - Melanie A. Fisher
- School of Medicine, West Virginia University, Morgantown, West Virginia, United States of America
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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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Chobufo MD, Regner SR, Zeb I, Lacoste JL, Virani SS, Balla S. Burden and predictors of statin use in primary and secondary prevention of atherosclerotic vascular disease in the US: From the National Health and Nutrition Examination Survey 2017-2020. Eur J Prev Cardiol 2022; 29:1830-1838. [PMID: 35653373 DOI: 10.1093/eurjpc/zwac103] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 11/13/2022]
Abstract
AIM To assess the current state of statin use, factors associated with nonuse, and estimate the burden of potentially preventable ASCVD events. METHODS Using nationally representative data from the 2017-2020 NHANES survey, statin use was assessed in primary prevention groups: high ASCVD risk >=20%, low-density lipoprotein-cholesterol (LDL-C) >= 190 mg/dL, diabetes aged 40-75 years, intermediate ASCVD risk (7.5 to <20%) with >= 1 ASCVD risk enhancer and secondary prevention group: established ASCVD. ASCVD risk was estimated using pooled cohort equations. RESULTS We estimated 70 million eligible individuals (2.3 million with LDL-C>=190 mg/dL; 9.4 million with ASCVD>=20%; 15 million with diabetes and age 40-75years; 20 million with intermediate ASCVD risk and >=1 risk enhancers; and 24.6 million with established ASCVD), about 30 million were on statin therapy. The proportion of individuals not on statin therapy was highest in the isolated LDL-C>=190 mg/dl group (92.8%) and those with intermediate ASCVD risk plus enhancers (74.6%) followed by 59.4% with high ASCVD risk, 54.8% with diabetes, and 41.5% of those with established ASCVD groups. Increasing age and those with health insurance were more likely to be on statin therapy in both the primary and secondary prevention categories. Individuals without a routine place of care were less likely to be on statin therapy. A total of 385,000 (high-intensity statin) and 647,000 (moderate-intensity statin) ASCVD events could be prevented if all statin-eligible individuals were treated (and adherent) for primary prevention over a 10-year period. CONCLUSION Statin use for primary and secondary prevention of ASCVD remains suboptimal. Bridging the therapeutic gap can prevent approximately one million ASCVD events over the subsequent ten years for the primary prevention group. Social determinants of health such as access to care and healthcare coverage were associated with less statin treatment. Novel interventions to improve statin prescription and adherence are needed.
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Affiliation(s)
| | - Sean R Regner
- Division of Cardiology, West Virginia University, Morgantown WV 26506
| | - Irfan Zeb
- Division of Cardiology, West Virginia University, Morgantown WV 26506
| | | | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine and Section of Cardiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University, Morgantown WV 26506
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42
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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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Osman M, Syed M, Kheiri B, Bianco C, Kalra A, Cigarroa JE, Mamas MA, Dawn Abbott J, Grines CL, Fonarow GC, Balla S. Age stratified sex-related differences in incidence, management, and outcomes of cardiogenic shock. Catheter Cardiovasc Interv 2022; 99:1984-1995. [PMID: 35391503 DOI: 10.1002/ccd.30177] [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: 06/21/2021] [Revised: 11/24/2021] [Accepted: 03/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND There is a lack of data on age-stratified sex differences in the incidence, treatment, and outcomes of cardiogenic shock (CS). We sought to study these differences from a contemporary database. METHODS Patients admitted with CS (2004-2018) were identified from the United States National Inpatient Sample. We compared CS (acute myocardial infarction-related cardiogenic shock [AMI-CS] and non-acute myocardial infarction-related cardiogenic shock [Non-AMI-CS]) incidence, management, and outcomes in males and females, stratified into four age groups (20-44, 45-64, 65-84, and ≥85 years of age). Propensity score matching (PSM) was used for adjustment. RESULTS A total of 1,506,281 weighted hospitalizations for CS were included (AMI-CS, 39%; Non-AMI-CS, 61%). Across all age groups, females had a lower incidence of CS compared with males. After PSM and among the AMI-CS cohort, higher mortality among females compared with males was observed in the age groups 45-64 (28.5% vs. 26.3%) and 65-84 years (39.3% vs. 37.9%) (p < 0.01, for all). Among the Non-AMI-CS cohort, higher mortality among females compared with males was observed in the age groups 20-44 (33.5% vs. 30.5%), 45-64 (35.1% vs. 31.9%), and 65-84 years (41.7% vs. 40.3%) (p < 0.01, for all). Similar age-dependent differences in the management of CS were also observed between females and males. CONCLUSIONS Females have a lower incidence of CS regardless of age. Significant disparities in the management and outcomes of CS were observed based on sex. However, these disparities varied by age and etiology of CS (AMI-CS vs. Non-AMI-CS) with pronounced disparity among females in the age range of 45-84 years.
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Affiliation(s)
- Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA.,Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Moinuddin Syed
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Babikir Kheiri
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Christopher Bianco
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Ankur Kalra
- Division of Cardiovascular Medicine, Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joaquin E Cigarroa
- Division of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, Keele, UK.,Division of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Jinnette Dawn Abbott
- Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Cindy L Grines
- Division of Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Sudarshan Balla
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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Lacoste JL, Szymanski TW, Avalon JC, Kabulski G, Kohli U, Marrouche N, Singla A, Balla S, Jahangir A. Atrial Fibrillation Management: A Comprehensive Review with a Focus on Pharmacotherapy, Rate, and Rhythm Control Strategies. Am J Cardiovasc Drugs 2022; 22:475-496. [PMID: 35353353 DOI: 10.1007/s40256-022-00529-6] [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] [Accepted: 02/24/2022] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation (AF) is an increasingly common arrhythmia encountered in clinical practice that leads to a substantial increase in utilization of healthcare services and a decrease in the quality of life of patients. The prevalence of AF will continue to increase as the population ages and develops cardiac comorbidities; thus, prompt and effective treatment is important to help mitigate systemic resource utilization. Treatment of AF involves two tenets: prevention of stroke and systemic embolism and symptom control with either a rate or a rhythm control strategy. Historically, due to the safe nature of medications like beta-blockers and non-dihydropyridine calcium channel blockers, used in rate control, it has been the initial strategy used for symptom control in AF. Newer data suggest that a rhythm control strategy with antiarrhythmic medications with or without catheter ablation may lead to a reduction in major adverse cardiovascular events, particularly in patients newly diagnosed with AF. Modulation of factors that promote AF or its complications is another important aspect of the overall holistic management of AF. This review provides a comprehensive focus on the management of patients with AF and an in-depth review of pharmacotherapy of AF in the rate and rhythm control strategies.
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Affiliation(s)
- Jordan L Lacoste
- Department of Pharmacy, WVU Medicine, 1 Medical Center Drive, Morgantown, WV, 26505, USA.
| | - Thomas W Szymanski
- Department of Pharmacy, WVU Medicine, 1 Medical Center Drive, Morgantown, WV, 26505, USA
| | - Juan Carlo Avalon
- Department of Internal Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Galen Kabulski
- Department of Pharmacy, WVU Medicine, 1 Medical Center Drive, Morgantown, WV, 26505, USA
| | - Utkarsh Kohli
- Department of Pediatrics, WVU School of Medicine, Morgantown, WV, USA
| | - Nassir Marrouche
- Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Atul Singla
- Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | - Sudarshan Balla
- Department of Cardiovascular and Thoracic Surgery, WVU School of Medicine, Morgantown, WV, USA
| | - Arshad Jahangir
- Center for Advanced Atrial Fibrillation Therapies at Aurora St. Luke's Medical Center, Milwaukee, WI, 53215, 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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Atti V, Narayanan MA, Patel B, Balla S, Siddique A, Lundgren S, Velagapudi P. A Comprehensive Review of Mechanical Circulatory Support Devices. Heart Int 2022; 16:37-48. [PMID: 36275352 PMCID: PMC9524665 DOI: 10.17925/hi.2022.16.1.37] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/07/2021] [Indexed: 08/08/2023] Open
Abstract
Treatment strategies to combat cardiogenic shock (CS) have remained stagnant over the past decade. Mortality rates among patients who suffer CS after acute myocardial infarction (AMI) remain high at 50%. Mechanical circulatory support (MCS) devices have evolved as novel treatment strategies to restore systemic perfusion to allow cardiac recovery in the short term, or as durable support devices in refractory heart failure in the long term. Haemodynamic parameters derived from right heart catheterization assist in the selection of an appropriate MCS device and escalation of mechanical support where needed. Evidence favouring the use of one MCS device over another is scant. An intra-aortic balloon pump is the most commonly used short-term MCS device, despite providing only modest haemodynamic support. Impella CP® has been increasingly used for CS in recent times and remains an important focus of research for patients with AMI-CS. Among durable devices, Heartmate® 3 is the most widely used in the USA. Adequately powered randomized controlled trials are needed to compare these MCS devices and to guide the operator for their use in CS. This article provides a brief overview of the types of currently available MCS devices and the indications for their use.
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Affiliation(s)
- Varunsiri Atti
- Division of Cardiovascular Diseases, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | | | - Brijesh Patel
- Division of Cardiovascular Diseases, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Sudarshan Balla
- Division of Cardiovascular Diseases, West Virginia University Heart and Vascular Institute, Morgantown, WV, USA
| | - Aleem Siddique
- Division of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Scott Lundgren
- Division of Cardiovascular Diseases, University of Nebraska Medical Center, Omaha, NE, USA
| | - Poonam Velagapudi
- Division of Cardiovascular Diseases, University of Nebraska Medical Center, Omaha, NE, USA
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Shotwell M, Sankaramangalam K, Potluri S, Balla S, Pandian NG, Kadiyala M. Garden-Hose Mitral Regurgitation: A Variant That Can Result in Underestimation of Severity: A Multimodality Imaging Case Study. J Cardiothorac Vasc Anesth 2022; 36:2232-2236. [PMID: 35397959 DOI: 10.1053/j.jvca.2022.02.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 11/11/2022]
Abstract
The quantitative assessment of mitral regurgitation (MR) by echocardiography has limitations. Cardiac magnetic resonance (CMR) imaging has an emerging role in the quantitation of MR, and preliminary studies indicate that CMR assessment may more accurately quantify MR and better correlate with postsurgical left ventricular reverse remodeling. The authors here report a case of MR in which multimodality imaging with CMR and transesophageal echocardiography was crucial in accurately diagnosing the severity of MR when transthoracic and provocative supine bike echocardiography underestimated the degree of MR in a unique variant known as "garden-hose" MR.
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Affiliation(s)
| | | | | | | | - Natesa G Pandian
- Cardiovascular Imaging and Academic Programs, Hoag Hospital and Heart valve center, Newport Beach, CA; Department of Cardiology, Tufts University School of Medicine, Boston, MA
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Gonuguntla K, Shaik A, Thyagaturu H, Sattar Y, Patil S, Balla S. IN-HOSPITAL OUTCOMES OF PATIENTS WITH TAKOTSUBO CARDIOMYOPATHY AND PSYCHIATRIC ILLNESS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01514-5] [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: 11/16/2022]
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50
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Thyagaturu HS, Bolton AR, Li S, Gonuguntla K, Kumar A, Bianco C, Balla S. Effect of Cocaine, Amphetamine and Cannabis Use Disorders on 30-day Readmissions of Patients with Heart Failure. Curr Probl Cardiol 2022:101189. [DOI: 10.1016/j.cpcardiol.2022.101189] [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: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/03/2022]
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