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Alhuneafat L, Jabri A, Abu Omar Y, Margaria B, Al-abdouh A, Mhanna M, Shahrori Z, Hammad N, Rayyan A, Nasser F, Kondapaneni M, Siraj A. Relationship Between Body Mass Index and Outcomes in Acute Myocardial Infarction. J Clin Med Res 2022; 14:458-465. [PMID: 36578372 PMCID: PMC9765317 DOI: 10.14740/jocmr4818] [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] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022] Open
Abstract
Background The prevalence of obesity in the United States is high. Obesity is one of the leading risk factors in the development of acute myocardial infarction (AMI). Nevertheless, how obesity impacts AMI in-hospital outcomes remains controversial. Methods Using National Inpatient Sample (NIS) database, we identified patients diagnosed with AMI from the year 2015 to 2018. We divided these patients into five subgroups based on their body mass index (BMI). We compared outcomes such as mortality, length of inpatient stay, and inpatient complications between our subgroups. Statistical analysis was done using the program STATA. Our nationally representative analysis included 561,535 patients who had an AMI event across various weight classes. Results Most of our sample was obese (BMI > 30 kg/m2) and male. Obese patients were significantly younger than the rest. Length of stay (LOS) for AMI was highest for those with a BMI of less than 24 kg/m2. In-hospital mortality is highest for those with a BMI of < 30 kg/m2 and lowest for those with a BMI of 30 - 40 kg/m2. Inpatient complications are highest in the lower BMI population (BMI < 24 kg/m2). Conclusion The current analysis of a nationally representative sample showed the clinical implications of BMI in patients with AMI. Patients with a BMI of 30 - 40 kg/m2 had more favorable LOS, inpatient complications, and in-hospital mortality when compared to those with an ideal body weight. Hence, this supports and expands on the concept of the "obesity paradox". Further studies are needed to further investigate the possible mechanism behind this.
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Affiliation(s)
- Laith Alhuneafat
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ahmad Jabri
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA,Corresponding Author: Ahmad Jabri, Heart and Vascular Institute, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA.
| | - Yazan Abu Omar
- Department of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Bryan Margaria
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA
| | - Ahmad Al-abdouh
- Division of hospital medicine, University of Kentucky, Lexington, KY, USA
| | - Mohammed Mhanna
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Zaid Shahrori
- Department of Medicine, Hashemite University Amman, Jordan
| | - Nour Hammad
- Department of Nephrology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Abdallah Rayyan
- Department of Medicine, University of Jordan School of Medicine, Amman, Jordan
| | - Farhan Nasser
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Meera Kondapaneni
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Aisha Siraj
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
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Sallam S, Shahrori Z, Rana M, Sullivan C. A Case of Burnt-Out Cardiac Sarcoidosis Presenting With Sustained Ventricular Tachycardia. Cureus 2022; 14:e28931. [PMID: 36237779 PMCID: PMC9547533 DOI: 10.7759/cureus.28931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/05/2022] Open
Abstract
Cardiac sarcoidosis is a challenging clinical entity in terms of diagnosis and management. Cardiac involvement is the most common cause of death in patients with sarcoidosis. Recently, there have been new advancements in the imaging modalities that aid in the diagnosis of this condition, including cardiac MRI and PET scan. These tools can help identify and determine the extent of the progression of sarcoidosis, which can have diagnostic and therapeutic implications. In this report, we present the case of a 74-year-old man with no history of sarcoidosis who presented with sustained ventricular tachycardia (VT) and was subsequently found to have findings consistent with burnt-out sarcoidosis on imaging. This case highlights the differences in the management of various stages of cardiac sarcoid involvement to reduce adverse outcomes.
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Jabri A, Alhuneafat L, Shahrori Z, Hamade H, Nasser F, Rayyan A, Mhanna M, Al Abdouh A, Haddadin F, Balakumaran K. Impact of Digoxin Use on Guideline-Directed Medical Therapy in Patients With Heart Failure With Reduced Ejection Fraction. J Clin Med Res 2022; 14:315-320. [PMID: 36128010 PMCID: PMC9451555 DOI: 10.14740/jocmr4772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/28/2022] [Indexed: 11/11/2022] Open
Abstract
Background Digoxin was one of the first agents used in the management of heart failure with reduced ejection fraction (HFrEF). Concerns over its safety, efficacy, and the introduction of guideline-directed medical therapy (GDMT) have relegated it to a secondary role. The efficacy of digoxin is still under debate, and its use in patients on GDMT remains unclear. We aim to evaluate whether patients with HFrEF on digoxin can tolerate higher doses of a β-blocker (BB), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blocker (ARB), mineralocorticoid receptor antagonists (MRAs), and angiotensin receptor-neprilysin inhibitor (ARNI). Methods A retrospective chart review was performed on 233 patients with HFrEF managed at a tertiary care center in Cleveland, Ohio. A bivariate analysis was performed to compare patients on digoxin with patients not on digoxin in terms of ability to progress the dosing of BB, ACEI, MRA, ARB, or ARNI. Results Thirty-four (14.6%) of our 233 patients were receiving digoxin at baseline visit. The digoxin group was more likely to have lower initial and last systolic blood pressure, initial diastolic blood pressure, and left ventricular ejection fraction. Mean follow-up duration and baseline sodium level were higher in the digoxin group. There was no significant difference between the two groups in terms of patients receiving higher doses of BB (P = 0.235), ACEI/ARB (P = 0.903), MRA (P = 0.331), or ARNI (P = 0.717). Conclusions There was no significant difference between the doses of BB, ACEI, ARB, MRA, or ARNI among HFrEF patients on digoxin compared to those that were not. Randomized control trials with a larger sample are needed to establish our findings of digoxin not significantly affecting the ability to up titrate GDMT in HFrEF patients.
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Affiliation(s)
- Ahmad Jabri
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
- Corresponding Author: Ahmad Jabri, Heart and Vascular Institute, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44109, USA.
| | - Laith Alhuneafat
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Zaid Shahrori
- Department of Medicine, Hashemite University, Amman, Jordan
| | - Hani Hamade
- Department of Medicine, MetroHealth Medical Center, Cleveland, OH, USA
| | - Farhan Nasser
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Abdallah Rayyan
- Department of Medicine, University of Jordan School of Medicine, Amman, Jordan
| | - Mohammed Mhanna
- Department of Internal Medicine, University of Toledo, Toledo, OH, USA
| | - Ahmad Al Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Faris Haddadin
- Cardiovascular Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Kathir Balakumaran
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
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Raeisi-Giglou P, Jabri A, Shahrori Z, Sallam S, Alhuneafat L, Al-Abdouh A, Mhanna M, Kumar A, Abu Omar Y, Yousaf A, Tarabichi Y, Siraj A, Kondapaneni M. Disparities in the Prescription of Statins in the Primary Care Setting: A Retrospective Observational Study. Curr Probl Cardiol 2022; 47:101329. [PMID: 35870548 DOI: 10.1016/j.cpcardiol.2022.101329] [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: 07/09/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite the high disease burden of atherosclerosis, evidence exists for the disparity in the prescription of guideline-indicated medications between genders, racial groups, socioeconomic groups, and ages. We aim to perform a retrospective study looking at the disparity in statin prescription for primary and secondary prevention in these groups. METHODS Data were collected from a single center and included patients with an LDL level> 190 mg/dL, diagnosis of diabetes mellitus with LDL level >70 mg/dL, and diagnosis of cardiovascular disease regardless of LDL level. Patients older than 75 or younger than 21 were excluded from the study. Complex samples multivariable logistic and linear regression models were used to calculate the adjusted odds ratio and 95% confidence interval. RESULTS The total study population was n=56,995. Of those, 57.89% (n=32,992) were female. Only 59.56 % of these patients for whom statin therapy was indicated received it. Most patients were White (53.21%) followed by African Americans (35.98%), Asians (2.43%), American Indian/Native Alaskans (0.40%), and Native Hawaiian/Pacific Islander (0.18%). There is a clear disparity in statin prescription favoring males, the elderly, and people of white ethnicity. Interestingly, Asians were more likely to be prescribed statins as opposed to whites. Self-pay patients were more likely to receive statins than patients on Medicare. CONCLUSION Despite being indicated, Statins are underprescribed. Disparities based on race, gender, and insurance type mirror previous trends in the literature. Some results have shown a reversal in trends such as the higher prescription for Asian-Americans. Multiple patient-specific, provider-related, institutional factors might explain these disparities and must be investigated.
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Affiliation(s)
- Pejman Raeisi-Giglou
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University. Cleveland, Ohio, USA
| | - Ahmad Jabri
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University. Cleveland, Ohio, USA.
| | - Zaid Shahrori
- Faculty of Medicine, Hashemite University, Amman, Jordan
| | - Sherin Sallam
- Department of Internal Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio 44106
| | - Laith Alhuneafat
- Department of Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Mohammed Mhanna
- Department of Cardiovascular Medicine, University of Iowa, IA, USA
| | - Ashish Kumar
- Department of Medicine, Cleveland Clinic Akron General, OH, USA
| | | | - Adnan Yousaf
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University. Cleveland, Ohio, USA
| | - Yasir Tarabichi
- Center for Clinical Informatics, Division of Pulmonary Critical Care and Sleep Medicine, The MetroHealth System, OH, USA
| | - Aisha Siraj
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University. Cleveland, Ohio, USA
| | - Meera Kondapaneni
- Heart and Vascular Center, MetroHealth Medical Center, Case Western Reserve University. Cleveland, Ohio, USA
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Jabri A, Shahrori Z, Nasser MF, Bullinger K, Alameh A, Haddadin F, Al-Abdouh A. Right Coronary Artery to Right Atrial Fistula: Role of Multi-Modality Imaging and Percutaneous Closure. Cureus 2022; 14:e26716. [PMID: 35959183 PMCID: PMC9360630 DOI: 10.7759/cureus.26716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/13/2022] Open
Abstract
Coronary artery fistula (CAF) is a connection between a coronary artery and a cardiac chamber or nearby vessel. Our case represents a fistula arising from the right coronary artery and terminating in the right atrium, presenting as atrial fibrillation. CAF closure options include surgical and percutaneous approaches.
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Hammad N, Jabri A, Shahrori Z, Haddadin F, Nasser F, Balakumaran K, Kondapaneni M, Heffernan J, Marshall M. Ortner’s syndrome: A rare case of hoarseness secondary to chronic aortic dissection. SAGE Open Med Case Rep 2022; 10:2050313X221108651. [PMID: 36051407 PMCID: PMC9424869 DOI: 10.1177/2050313x221108651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Ortner’s syndrome, also known as cardiovocal syndrome, is a rare presentation of aortic
dissection. Symptoms occur as a result of recurrent laryngeal nerve compression. Our
report describes a case of a patient who complained of hoarseness for a few months and was
eventually diagnosed with chronic aortic dissection.
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Affiliation(s)
- Nour Hammad
- Providence Park Hospital, Southfield, MI, USA
| | - Ahmad Jabri
- Case Western Reserve University, Cleveland, OH, USA
| | - Zaid Shahrori
- Faculty of Medicine, The Hashemite University, Zarqa, Jordan
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Jabri A, Fowler C, Dhamija Y, Alzubi J, Bhatia S, Al-abdouh A, Alameh A, Alfahel H, Haddadin F, Shahrori Z, Nasser F, Ababneh A. Demographic Undertones for Sepsis Mortality in a Community-Based Hospital. J Clin Med Res 2022; 14:28-33. [PMID: 35211214 PMCID: PMC8827221 DOI: 10.14740/jocmr4618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 11/02/2021] [Indexed: 11/29/2022] Open
Abstract
Background Sepsis continues to take main stage in healthcare. Therefore, it remains crucial to elucidate contributors to sepsis mortality. The aim of this study is to determine the impact of race, insurance type, and code status on sepsis mortality in a community health system. Methods We conducted a retrospective cohort study of inpatient adults of any sex, race, and insurance type with a diagnosis of sepsis, severe sepsis, septic shock, or pneumonia. Results We included 913 patients, with an average age of 69 years for expired patients and 62 years for non-expiring patients (P < 0.0001). After controlling for other variables, patients who presented as comfort care arrest were 4.3 (95% confidence interval (CI): 1.8 to 9.9, P = 0.0007) times more likely to have died than full code patients. Those who were comfort care only were 10.6 (95% CI: 0.8 to 140.6, P = 0.0741) times more likely to have died than the full code, although this was not statistically significant. Conclusions The results suggest that patients who are comfort care arrest have an increased risk of sepsis mortality. The results show no impact of insurance type or race on sepsis mortality, which is in contrast to some existing literature. The study suggests that institutions may need to investigate internal variables related to sepsis mortality.
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Affiliation(s)
- Ahmad Jabri
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
- Corresponding Author: Ahmad Jabri, Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH 44109, USA.
| | - Cosmo Fowler
- Department Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Yashu Dhamija
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Jafar Alzubi
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Smriti Bhatia
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA, USA
| | - Ahmad Al-abdouh
- Department of Medicine, Saint Agnes Hospital, Baltimore, MD, USA
| | - Anas Alameh
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Hamzeh Alfahel
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
| | - Faris Haddadin
- Department Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Zaid Shahrori
- Department of Internal Medicine, Hashemite University, Amman, Jordan
| | - Farhan Nasser
- Heart and Vascular Center, Case Western Reserve University/MetroHealth Medical Center, Cleveland, OH, USA
| | - Ahmad Ababneh
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, OH, USA
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Roach JD, Bondaruk MM, Al-Abdulghani A, Shahrori Z. Counterion Binding in Aqueous Solutions of Poly(vinylpyridines) as Assessed by Potentiometric Titration. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ampc.2016.69025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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