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IMPACT OF CHRONIC KIDNEY DISEASE ON SHORT- AND INTERMEDIATE -TERM OUTCOMES IN PATIENTS WITH TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01675-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Catheter Ablation for Atrial Fibrillation in Patients With Concurrent Heart Failure. Am J Cardiol 2020; 137:45-54. [PMID: 33002464 DOI: 10.1016/j.amjcard.2020.09.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 11/17/2022]
Abstract
Due to limited real-world data, the aim of this study was to explore the impact of catheter ablation (CA) for atrial fibrillation (AF) in heart failure (HF). This retrospective cohort study identified 119,694 patients with AF and HF from the Nationwide Readmissions Database (NRD) from 2016 to 2017. Propensity-matching was generated using demographics, comorbidities, hospital and other characteristics through multivariate logistic regression. Greedy's propensity score match (1:15) algorithm was used to create matched data. The primary end point was a composite of HF readmission and mortality at 1 year. Secondary outcomes include HF readmission, mortality, AF readmission, and any-cause readmission at 1 year. Of the 119,694 patients, 63,299 had HF with reduced ejection fraction (HFrEF), and 56,395 had HF with preserved ejection fraction (HFpEF). In the overall HFrEF cohort, the primary outcome was similar (HR, 95% confidence interval, p-value) (1.01, 0.91 to 1.13, 0.811). AF readmission (0.41, 0.33 to 0.49, <0.001) and any readmission (0.87, 0.82 to 0.93, <0.001) were reduced with CA. In the propensity-matched HFrEF cohort, results were unchanged (primary outcome: 1.10, 0.95 to 1.27, 0.189; AF readmission: 0.46, 0.36 to 0.59, <0.001; any readmission: 0.89, 0.82 to 0.98, 0.015). In the overall HFpEF cohort, the primary outcome was similar (0.90, 0.78 to 1.04, 0.154). AF readmission was reduced with CA (0.54, 0.44 to 0.65, <0.001). In the propensity-matched HFpEF cohort, results were unchanged (primary outcome 1.10, 0.92 to 1.31, 0.289; AF readmission 0.44, 0.33 to 0.57, <0.001). CA did not reduce mortality and HF readmission at one year irrespective of the type of HF, but significantly reduce readmission due to AF.
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Abstract
Background No studies assessed impact of atrial flutter (AFL) ablation on outcomes in patients with AFL and concurrent heart failure (HF). Objectives To assess the effect of AFL ablation on mortality and HF readmissions in patients with AFL and HF. Methods This retrospective cohort study identified 15,952 patients with AFL and HF from the 2016–17 Nationwide Readmissions Database. The primary outcome was a composite of all-cause mortality and/or HF readmission at 1 year. Secondary outcomes included HF readmission, all-cause mortality, and atrial fibrillation (AF) readmission at 1 year. Propensity score match (1:2) algorithm was used to adjust for confounders. Cox proportional hazard regression was used to generate hazard ratios. Results Of the 15,952 patients, 9889 had heart failure with reduced ejection fraction (HFrEF) and 6063 had heart failure with preserved ejection fraction (HFpEF). In the matched HFrEF cohort (n = 5421), the primary outcome was significantly lower in patients undergoing ablation (HR 0.72, 95% CI 0.61–0.85, P < .001). HF readmission (HR 0.73, 95% CI 0.61–0.89, P = .001), all-cause mortality (HR 0.62, 95% CI 0.46–0.85, P = .003), and AF readmission (HR 0.63, 95% CI 0.48–0.82, P = .001) were also significantly reduced. In the matched HFpEF cohort (n = 2439), the primary outcome was lower in the group receiving ablation but was not statistically significant (HR 0.80, 95% CI 0.63–1.01, P = .065). Conclusion In patients with AFL and HFrEF, AFL ablation was associated with lower mortality and HF readmissions at 1 year. Patients with AFL and HFpEF did not show a similar significant reduction in the primary outcome.
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Transcatheter aortic valve replacement in aortic regurgitation: The U.S. experience. Catheter Cardiovasc Interv 2020; 98:E153-E162. [DOI: 10.1002/ccd.29379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/17/2020] [Accepted: 10/23/2020] [Indexed: 11/09/2022]
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Short‐term outcomes associated with inpatient ventricular tachycardia catheter ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:444-455. [DOI: 10.1111/pace.13905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/27/2020] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
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IMPACT OF ATRIAL FIBRILLATION ABLATION IN PATIENTS WITHOUT HEART FAILURE. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31137-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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EFFECT OF CATHETER ABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30909-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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IMPACT OF CATHETER ABLATION FOR ATRIAL FIBRILLATION ON MORTALITY AND HOSPITAL READMISSION RATES IN PATIENTS WITH HEART FAILURE AND REDUCED EJECTION FRACTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30900-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Temporary Mechanical Circulatory Support for Refractory Cardiogenic Shock Before Left Ventricular Assist Device Surgery. J Am Heart Assoc 2019; 7:e010193. [PMID: 30571481 PMCID: PMC6404446 DOI: 10.1161/jaha.118.010193] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background There are limited data on the role of temporary mechanical circulatory support (MCS) devices for cardiogenic shock before left ventricular assist device (LVAD) surgery. This study sought to evaluate the trends of use and outcomes of MCS in cardiogenic shock before LVAD surgery. Methods and Results This was a retrospective cohort study from 2005 to 2014 using the National Inpatient Sample (20% stratified sample of US hospitals). This study identified admissions undergoing LVAD surgery with preoperative cardiogenic shock. Admissions for other cardiac surgery and heart transplant were excluded. Temporary MCS was identified using administrative codes. The primary outcome was hospital mortality and secondary outcomes were hospital costs and lengths of stay in admissions with and without MCS use. In this 10‐year period, 9753 admissions were identified with 40.6% requiring pre‐LVAD MCS. There was a temporal increase in the frequency of cardiogenic shock associated with an increase in non–intra‐aortic balloon pump MCS devices. The cohort receiving MCS had greater in‐hospital myocardial infarction, ventricular arrhythmias, and use of coronary angiography. On multivariable analysis, older age, myocardial infarction, and need for MCS devices were independently predictive of higher in‐hospital mortality. In 696 propensity‐matched pairs, use of MCS was predictive of higher in‐hospital mortality (odds ratio 1.4 [95% confidence interval 1.1–1.6]; P=0.02) and higher hospital costs, but similar lengths of stay. Conclusions In patients with cardiogenic shock bridged to LVAD therapy, there was a steady increase in preoperative MCS use. Use of MCS identified patients at higher risk for in‐hospital mortality and greater resource utilization.
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Burden and trends of arrhythmias in hypertrophic cardiomyopathy and its impact of mortality and resource utilization. J Arrhythm 2019; 35:612-625. [PMID: 31410232 PMCID: PMC6686349 DOI: 10.1002/joa3.12215] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 05/25/2019] [Accepted: 06/09/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) accounts for significant morbidity and mortality worldwide. Arrhythmias are considered the main cause of mortality, however, there is paucity of data relating to trends of arrhythmia and associated outcomes in HCM patients. METHODS Nationwide Inpatient Sample from 2003 to 2014 was analyzed. HCM related hospitalizations were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM) code 425.1 and 425.11 in all diagnosis fields. RESULTS Overall, there was an increase in number of hospitalizations related to arrhythmias among HCM patients from 7784 in 2003 to 8380 in 2014 (relative increase 10.5%, P < 0.001). The increase was most significant in patients ≥ 80 years and those with higher comorbidity burden. Atrial fibrillation (AF) was the most frequently occurring arrhythmia however atrial flutter (AFL) witnessed the highest rise during the study period. In general, there was a down trend in mortality with the greatest reduction occurring in patients with ventricular fibrillation/flutter (VF/VFL). The mean length of stay was higher if patients had arrhythmia, which led to increased cost of care from $16105 in 2003 to $19310 in 2014 (relative increase 22.9%, P < 0.001). CONCLUSION There is overall decline in HCM related hospitalizations but rise in hospitalization among HCM patients with arrhythmias. HCM with arrhythmia accounts for significant inpatient mortality coupled with prolonged hospital stay and increased cost of care. However, there is an encouraging downtrend in the mortality most likely because of improved clinical practice, cardiac screening and primary and secondary prevention strategies.
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Heart failure: Same-hospital vs. different-hospital readmission outcomes. Int J Cardiol 2019; 278:186-191. [DOI: 10.1016/j.ijcard.2018.12.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/22/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022]
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Trends, Predictors, and Outcomes of Temporary Mechanical Circulatory Support for Postcardiac Surgery Cardiogenic Shock. Am J Cardiol 2019; 123:489-497. [PMID: 30473325 DOI: 10.1016/j.amjcard.2018.10.029] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/30/2022]
Abstract
Postcardiac surgery cardiogenic shock (PCCS) is seen in 2% to 6% of patients who undergo cardiac surgery. There are limited large-scale data on the use of mechanical circulatory support (MCS) in these patients. This study sought to evaluate the in-hospital mortality, trends, and resource utilization for PCCS admissions with and without MCS. A retrospective cohort of PCCS between 2005 and 2014 with and without the use of temporary MCS was identified from the National Inpatient Sample. Admissions for permanent MCS and heart transplant were excluded. Propensity-matching for baseline characteristics was performed. The primary outcome was in-hospital mortality and secondary outcomes included trends in use, hospital costs and lengths of stay. In the period between 2005 and 2014, there were 132,485 admissions with PCCS, with 51.3% requiring MCS. The intra-aortic balloon pump was the predominant device used with a steady increase in other devices. MCS use for more frequent in younger patients, males and those with higher co-morbidity. There was a decrease in MCS use across all demographic categories and hospital characteristics over time. Older age, female sex, previous cardiovascular morbidity and MCS use were independently predictive of higher in-hospital mortality. In 6,830 propensity-matched pairs, PCCS admissions that required MCS use, had higher in-hospital mortality (odds ratio 2.4; p<0.001), higher hospital costs ($98,759 ± 907 vs $81,099 ± 698; p<0.001) but not a longer length of stay compared with those without MCS use. In conclusion, in patients with PCCS, this study noted a steady decrease in MCS use. Use of MCS identified PCCS patients at higher risk for in-hospital mortality and greater resource utilization.
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Hospital Complications and Causes of 90-Day Readmissions After Implantation of Left Ventricular Assist Devices. Am J Cardiol 2018; 122:420-430. [PMID: 29960661 DOI: 10.1016/j.amjcard.2018.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 04/01/2018] [Accepted: 04/03/2018] [Indexed: 11/26/2022]
Abstract
Left ventricular assist devices (LVADs) have emerged as an attractive option in patients with advance heart failure. Nationwide readmission database 2013 to 2014 was utilized to identify LVAD recipients using ICD-9 procedure code 37.66. The primary outcome was 90-day readmission. Readmission causes were identified using ICD-9 codes in primary diagnosis field. The secondary outcomes were LVAD associated with hospital complications. Hierarchic 2-level logistic models were used to evaluate study outcomes. We identified 4,693 LVAD recipients (mean age 57 years, 76.2% males). Of which 53.9% were readmitted in first 90 days of discharge. Cardiac causes (33.3%), bleeding (21.3%), and infections (12.4%) were leading etiologies of 90-day readmissions. Significant predictors (odds ratio, 95% confidence interval, p value) of readmission were disposition to nursing facilities (1.33, 1.09 to 1.63, p = 0.01) and longer length of stay (1.01, 1.00 to 1.01, p <0.01). Although private insurance (0.75, 0.66 to 0.86, p <0.01), and self-pay (0.58, 0.42 to 0.81, p <0.01) predicted lower readmissions. Cardiac complications (36.3%), major bleeding (29.8%), and postoperative infections (10.4%) were most common LVAD-related complications. In conclusion, high early readmission rate was observed among LVAD recipients with Cardiac complications, bleeding complications, and infections were driving force for major complications and most of readmissions.
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Causes and Predictors of Readmission in Patients With Atrial Fibrillation Undergoing Catheter Ablation: A National Population-Based Cohort Study. J Am Heart Assoc 2018; 7:JAHA.118.009294. [PMID: 29907655 PMCID: PMC6220533 DOI: 10.1161/jaha.118.009294] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Reducing readmission after catheter ablation (CA) in atrial fibrillation (AF) is important. Methods and Results We utilized National Readmission Data (NRD) 2010–2014. AF was identified by International Classification of Diseases, Ninth Edition, Clinical Modification (ICD‐9‐CM) diagnostic code 427.31 in the primary field, while first CA of AF was identified via ICD‐9‐procedure code 37.34. Any admission within 30 or 90 days of index admission was considered a readmission. Cox proportional hazard regression was used to adjust for confounders. The primary outcomes were 30‐ and 90‐day readmissions and the secondary outcome was AF recurrence. In total, 1 128 372 patients with AF were identified from January 1, 2010 to September 30, 2014. Of which 37 360 (3.3%) underwent CA. Patients aged ≥65 years and female sex were less likely to receive CA for AF. Overall, 10.9% and 16.5% of CA patients were readmitted within 30 and 90 days post‐CA, respectively. Most common causes of readmissions were arrhythmia (AF, atrial flutter), heart failure, pulmonary causes (pneumonia, chronic obstructive pulmonary disease) and bleeding complications (gastrointestinal bleed, intracranial hemorrhage). Patients with diabetes mellitus, heart failure, coronary artery disease (CAD), chronic pulmonary and kidney disease, prior stroke/transient ischemic attack (TIA), female sex, length of stay ≥2 and disposition to the facility were prone to higher 30‐ and 90‐day readmissions post‐CA. Predictors of increase in AF recurrence post‐CA were female sex, diabetes mellitus, chronic pulmonary disease, and length of stay ≥2. Trends of 90‐day readmission and AF recurrence were found to improve over the study period. Conclusions We identified several demographic and clinical factors associated with the use of CA in AF, and short‐term outcomes of the same, which could potentially help in the patient selection and improve outcomes.
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Temporal trends of in-hospital complications associated with catheter ablation of atrial fibrillation in the United States: An update from Nationwide Inpatient Sample database (2011-2014). J Cardiovasc Electrophysiol 2018; 29:715-724. [DOI: 10.1111/jce.13471] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/11/2018] [Accepted: 01/31/2018] [Indexed: 01/08/2023]
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NATIONWIDE TRENDS AND OUTCOMES OF TEMPORARY MECHANICAL CIRCULATORY SUPPORT FOR CARDIOGENIC SHOCK AFTER LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31287-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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AMPHETAMINE ABUSE AND ACUTE MYOCARDIAL INFARCTION IN THE UNITED STATES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30723-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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ANALYSIS OF OUTCOMES IN ACUTE MYOCARDIAL INFARCTION IN SETTING OF COCAINE ABUSE. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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TRENDS IN RESOURCE UTILIZATION AND OUTCOMES IN HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY PATIENTS WITH ARRYTHMIAS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30824-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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NATIONWIDE TRENDS AND OUTCOMES OF TEMPORARY MECHANICAL CIRCULATORY SUPPORT FOR CARDIOGENIC SHOCK AFTER CARDIAC SURGERY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31225-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Comparison of In-Hospital Outcomes and Readmission Rates in Acute Pulmonary Embolism Between Systemic and Catheter-Directed Thrombolysis (from the National Readmission Database). Am J Cardiol 2017; 120:1653-1661. [PMID: 28882336 DOI: 10.1016/j.amjcard.2017.07.066] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/07/2017] [Accepted: 07/21/2017] [Indexed: 12/14/2022]
Abstract
There are sparse comparative data on in-hospital outcomes and readmission rates in patients with acute pulmonary embolism (PE) who receive systemic thrombolytics versus catheter-directed thrombolysis (CDT). The study cohort was derived from the National Readmission Database 2013 to 2014, subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. Systemic and CDT were identified using appropriate International Classification of Diseases, 9th Revision, Clinical Modification codes. The co-primary outcomes were in-hospital mortality and 30-day readmissions and secondary outcome was combined in-hospital mortality + gastrointestinal bleed + intracranial hemorrhage. We used propensity score match analysis without replacement using Greedy's algorithm to adjust for possible confounders. We identified a total of 4,426 patients (3,107: systemic thrombolysis and 1,319: CDT) with acute PE who were treated with thrombolysis. In our 2:1 propensity score algorithm, in-hospital mortality was lower in the CDT group (6.12%) versus systemic thrombolytics (14.94%) (odds ratio 0.37, 95% confidence interval 0.28 to 0.49, p <0.001). There was also a lower composite secondary outcome (in-hospital mortality + gastrointestinal bleed + intracranial hemorrhage) in patients who received CDT (8.42%) versus those who received systemic thrombolytics (18.13%) (odds ratio 0.41, 95% confidence interval 0.33 to 0.53, p <0.001). Thirty-day readmission was lower in patients with CDT group (7.65%) compared with systemic thrombolytics (10.58%, p = 0.009). In conclusion, in-hospital mortality, as well as bleeding during primary admission was significantly lower with CDT compared with systemic thrombolytics for patients with acute PE. There was also significant decrease in rate of readmissions among patients receiving CDT compared with systemic thrombolytics.
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Atrial fibrillation: Utility of CHADS 2 and CHA 2 DS 2 -VASc scores as predictors of readmission, mortality and resource utilization. Int J Cardiol 2017; 245:162-167. [DOI: 10.1016/j.ijcard.2017.06.090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/20/2017] [Accepted: 06/23/2017] [Indexed: 01/26/2023]
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Abstract
An estimated half of all heart failure (HF) populations has been categorized to have diastolic HF (DHF), but sparse data are available describing etiologies and predictors of 30-day readmission in DHF population. The study cohort was derived from the National Readmission Database 2013 to 2014, a subset of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. DHF was identified using International Classification of Diseases, 9th Revision code 428.3x in primary diagnosis field. Readmission etiologies were identified by International Classification of Diseases, 9th Revision code in primary diagnosis field. The primary outcome was 30-day readmission. Hierarchical multivariable logistic regression was used to adjust for confounders. In total, 192,394 patients with DHF were included, of which 40,927 (21.27%) patients were readmitted with total readmissions of 47,056 within 30 days. Predictors of increased readmissions were age (odds ratio [OR] 1.002, 95% confidence interval [CI] 1.001 to 1.0003, p <0.001), diabetes (OR 1.08, 95% CI 1.05 to 1.11, p <0.001), chronic pulmonary disease (OR 1.18, 95% CI 1.15 to 1.21, p <0.001), renal failure (OR 1.21, 95% CI 1.17 to 1.25, p <0.001), peripheral vascular disease (OR 1.05, 95% CI 1.02 to 1.09, p = 0.002), anemia (OR 1.12, 95% CI 1.10 to 1.15, p <0.001), transfusion during index admission (OR 1.18, 95% CI 1.13 to 1.23, p <0.001), discharge to the facility (OR 1.13, 95% CI 1.10 to 1.16, p <0.001), length of stay >2 days, and Charlson comorbidity index ≥3, whereas obesity (OR 0.82, 95% CI 0.80 to 0.85, p <0.001), elective admissions (OR 0.88, 95% CI 0.83 to 0.94, p <0.001), and non-Medicare/Medicaid primary payer were predictors of lower readmission rate. Most common etiologies of readmission were acute HF (28.01%), infections (9.54%), acute kidney injury (5.35%), acute respiratory failure (4.86%), and pneumonia (3.92%). In conclusion, DHF population with higher comorbidity burden, longer length of stay, and discharge to facility were prone to increased readmissions, with most common etiologies of readmission being HF, infections, and acute kidney injury.
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Short-term outcomes of atrial flutter ablation. J Cardiovasc Electrophysiol 2017; 28:1275-1284. [PMID: 28800179 DOI: 10.1111/jce.13311] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/15/2017] [Accepted: 07/25/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Understanding the factors associated with early readmissions following atrial flutter (AFL) ablation is critical to reduce the cost and improving the quality of life in AFL patients. METHOD The study cohort was derived from the national readmission database 2013-2014. International Classification of Diseases, 9th Revision (ICD-9-CM) diagnosis code 427.32 and procedure code 37.34 were used to identify AFL and catheter ablation, respectively. The primary and secondary outcomes were 90-day readmission and complications including in-hospital mortality. Cox proportional regression and hierarchical logistic regression were used to generate the predictors of primary and secondary outcomes respectively. Readmission causes were identified by ICD-9-CM code in primary diagnosis field of readmissions. RESULT Readmission rate of 18.19% (n = 1,010 with 1,396 readmissions) was noted among AFL patients (n = 5552). Common etiologies for readmission were heart failure (12.23%), atrial fibrillation (11.13%), atrial flutter (8.93%), respiratory complications (9.42%), infections (7.4%), bleeding (7.39%, including GI bleed-4.09% and intracranial bleed-0.79%) and stroke/TIA (1.89%). Multivariate predictors of 90-day readmission (hazard ratio, 95% confidence interval, P value) were preexisting heart failure (1.30, 1.13-1.49, P < 0.001), chronic pulmonary disease (1.37, 1.18-1.58, P < 0.001), anemia (1.23, 1.02-1.49, P = 0.035), malignancy (1.87, 1.40-2.49, P < 0.001), weekend admission compared to weekday admission (1.23, 1.02-1.47, P = 0.029), and length of stay (LOS) ≥5 days (1.39, 1.16-1.65, P < 0.001). Note that 50% of readmissions happened within 30 days of discharge. CONCLUSION Cardiac etiologies remain the most common reason for the readmission after AFL ablation. Identifying high risk patients, careful discharge planning, and close follow-up postdischarge can potentially reduce readmission rates in AFL ablation patients.
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ATRIAL FIBRILLATION IN PATIENTS WITH NON-STEMI: INSIGHTS FROM A NATIONAL DATABASE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33730-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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IMPACT OF CARDIAC DEVICES ON READMISSION AND SHORT TERM MORTALITY IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION: A NATIONWIDE STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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CHADS2 AND CHA2DS2VASC SCORES AS PREDICTORS OF LENGTH OF STAY AND COST OF CARE IN HOSPITALISED ATRIAL FIBRILLATION PATIENTS: INSIGHTS FROM A NATIONAL DATABASE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33703-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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INSIGHTS INTO OUTCOMES WITH INTRACARDIAC ECHOCARDIOGRAM USE IN STRUCTURAL INTERVENTIONS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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A Review of Hypertension Management in Atrial Fibrillation. Curr Hypertens Rev 2016; 12:196-202. [PMID: 27964699 DOI: 10.2174/1573402112666161213111527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 11/27/2016] [Accepted: 11/28/2016] [Indexed: 11/22/2022]
Abstract
Atrial fibrillation (AF) is one of the commonest arrhythmias in clinical practice and has major healthcare and economic implications. It is a growing epidemic with prevalence all set to double to 12 million by 2050. After adjusting for other associated conditions, hypertension confers a 1.5- and 1.4-fold risk of developing AF, for men and women respectively. Furthermore, in patients with AF, the presence of hypertension has a cumulative effect on the risk of stroke. Growing evidence suggests reversal or attenuation of various structural and functional changes predisposing to AF with the use of antihypertensive medications. Randomized trials have shown major reduction in the risk of stroke and heart failure with blood pressure reduction. However, such trials are lacking in AF patients specifically. The Joint National Committee-8 guidelines have not addressed the threshold or goal BP for patients with known AF. Furthermore, "J-shaped" or "U-shaped" curves have been noted during hypertension management in patients with AF with published data demonstrating worse outcomes in patients with strict BP control to <110/60 mmhg similar to coronary artery disease. In this review, we outline the available literature on management of hypertension in patients with AF as well as the role of individual anti-hypertensive medications in reducing the incidence of AF Fig. 1.
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TCT-673 Etiolgies for readmission and complications following Transcatheter Aortic Valve Replacement (TAVR): A Nationwide Perspective. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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TCT-802 Utilization of Angioplasty and Stenting in Infrainguinal Peripheral Arterial Disease outcomes – 180 days follow-up. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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TCT-782 Peripheral arterial disease: Hospitalization Trends in USA (2003-2013). J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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TCT-702 Transcatheter Aortic Valve Replacement: Predictors of 30-day readmission and in-hospital mortality during primary and readmission. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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TCT-773 Thrombolysis(Catheter Directed/Systemic) in Pulmonary Embolism: Predictors and Etiologies of Readmissions. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Impact of Glycoprotein IIb/IIIa Inhibitors Use on Outcomes After Lower Extremity Endovascular Interventions From Nationwide Inpatient Sample (2006-2011). Catheter Cardiovasc Interv 2016; 88:605-616. [PMID: 26914274 DOI: 10.1002/ccd.26452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 10/18/2015] [Accepted: 01/18/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of our study was to study the impact of glycoprotein IIb/IIIa inhibitors (GPI) on in-hospital outcomes. BACKGROUND There is paucity of data regarding the impact of GPI on the outcomes following peripheral endovascular interventions. METHODS The study cohort was derived from Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database between the years 2006 and 2011. Peripheral endovascular interventions and GPI utilization were identified using appropriate ICD-9 Diagnostic and procedural codes. Two-level hierarchical multivariate mixed models were created. The study outcomes were: primary (in-hospital mortality and amputation studied separately) and secondary (composite of in-hospital mortality and postprocedural complications). Hospitalization costs were also assessed. RESULTS GPI utilization (OR, 95% CI, P-value) was independently predictive of lower amputation rates (0.36, 0.27-0.49, <0.001). There was no significant difference in terms of in-hospital mortality (0.59, 0.31-1.14, P 0.117), although GPI use predicted worse secondary outcomes (1.23, 1.03-1.47, 0.023). Following propensity matching, the amputation rate was lower (3.2% vs. 8%, P < 0.001), while hospitalization costs were higher in the cohort that received GPI ($21,091 ± 404 vs. 19,407 ± 133, P < 0.001). CONCLUSIONS Multivariate analysis revealed GPI use in peripheral endovascular interventions to be suggestive of an increase in composite end-point of in-hospital mortality and postprocedural complications, no impact on in-hospital mortality alone, significantly lower rate of amputation, and increase in hospitalization costs. © 2016 Wiley Periodicals, Inc.
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LENGTH OF STAY AND HOSPITALIZATION COSTS OF MULTIVESSEL PERCUTANEOUS CORONARY INTERVENTION IN HEMODYNAMICALLY STABLE PATIENTS PRESENTING WITH ST ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30092-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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UTILIZATION OF MULTIVESSEL PERCUTANEOUS CORONARY INTERVENTION IN HEMODYNAMICALLY STABLE PATIENTS PRESENTING WITH ST ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30616-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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IN-HOSPITAL OUTCOMES OF MULTIVESSEL PERCUTANEOUS CORONARY INTERVENTION IN HEMODYNAMICALLY STABLE PATIENTS PRESENTING WITH ST ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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In-Hospital Outcomes of Atherectomy During Endovascular Lower Extremity Revascularization. Am J Cardiol 2016; 117:676-684. [PMID: 26732418 DOI: 10.1016/j.amjcard.2015.11.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 10/22/2022]
Abstract
Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012. Peripheral endovascular interventions including atherectomy were identified using appropriate International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The subjects were divided and compared in 2 groups: atherectomy versus no atherectomy. Two-level hierarchical multivariate mixed models were created. The coprimary outcomes were in-hospital mortality and amputation; secondary outcome was a composite of in-hospital mortality and periprocedural complications. Hospitalization costs were also assessed. Atherectomy utilization (odds ratio, 95% CI, p value) was independently predictive of lower in-hospital mortality (0.46, 0.28 to 0.75, 0.002) and lower amputation rates (0.83, 0.71 to 0.97, 0.020). Atherectomy use was also predictive of significantly lower secondary composite outcome of in-hospital mortality and complications (0.79, 0.69 to 0.90, 0.001). In the propensity-matched cohort, atherectomy utilization was again associated with a lower rate of amputation (11.18% vs 12.92%, p = 0.029), in-hospital mortality (0.71% vs 1.53%, p 0.001), and any complication (13.24% vs 16.09%, p 0.001). However, atherectomy use was also associated with higher costs ($24,790 ± 397 vs $22635 ± 251, p <0.001). Atherectomy use in conjunction with angioplasty (with or without stenting) was associated with improved in-hospital outcomes in terms of lower amputation rates, mortality, and postprocedural complications.
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Asthma: Hospitalization Trends and Predictors of In-Hospital Mortality and Hospitalization Costs in the USA (2001-2010). Int Arch Allergy Immunol 2015; 168:71-8. [PMID: 26595589 DOI: 10.1159/000441687] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the last decade, the proportion of people with asthma in the USA grew by nearly 15%, with 479,300 hospitalizations and 1.9 million emergency department visits in 2009 alone. The primary objective of our study was to evaluate in-hospital outcomes in patients admitted with asthma exacerbation in terms of mortality, length of stay (LOS) and hospitalization costs. METHODS We queried the HCUP's Nationwide Inpatient Sample (NIS) between 2001 and 2010 using the ICD9-CM diagnosis code 493 for asthma (n = 760,418 patients). The NIS represents 20% of all hospitals in the USA. Multivariate logistic regression analysis was used to evaluate predictors of in-hospital mortality. LOS and hospitalization costs were also analyzed. RESULTS The overall LOS was 3.9 days and as high as 8.3 days in patients requiring mechanical ventilation. LOS has decreased in recent years, though it continues to be higher than in 2001. The hospitalization cost increased steadily over the study period. The overall in-hospital mortality was 1% and as high as 9.8% in patients requiring mechanical ventilation. Multivariate predictors of longer LOS, higher hospitalization costs and in-hospital mortality included increasing age and hospitalizations during the winter months. Private insurance was predictive of lower hospitalization costs and LOS as well as lower in-hospital mortality. CONCLUSION Asthma continues to account for significant in-hospital mortality and resource utilization, especially in mechanically ventilated patients. Age, admissions during winter months and the type of insurance are independent predictors of in-hospital outcomes.
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TCT-805 Intravascular Ultrasound Utilization And In-hospital Outcomes In Peripheral Vascular Interventions: Insights From Nationwide Inpatient Sample. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.1115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Impact of Hospital Volume on Outcomes of Lower Extremity Endovascular Interventions (Insights from the Nationwide Inpatient Sample [2006 to 2011]). Am J Cardiol 2015; 116:791-800. [PMID: 26100585 DOI: 10.1016/j.amjcard.2015.05.050] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 05/23/2015] [Accepted: 05/23/2015] [Indexed: 10/23/2022]
Abstract
Our primary objective was to study postprocedural outcomes and hospitalization costs after peripheral endovascular interventions and the multivariate predictors affecting the outcomes with emphasis on hospital volume. The study cohort was derived from Healthcare Cost and Utilization Project Nationwide Inpatient Sample database (2006 to 2011). Peripheral endovascular interventions were identified using appropriate International Classification of Diseases, Ninth Revision diagnostic and procedural codes. Annual institutional volumes were calculated using unique identification numbers and then divided into quartiles. Two-level hierarchical multivariate mixed models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and postprocedural complications. Amputation rates and hospitalization costs were also assessed. Multivariate analysis (odds ratio, 95% confidence interval, p value) revealed age (1.46, 1.37 to 1.55, p <0.001), female gender (1.28, 1.12 to 1.46, p <0.001), baseline co-morbidity status as depicted by a greater Charlson co-morbidity index score (≥2: 4.32, 3.45 to 5.40, p <0.001), emergent or urgent admissions(2.48, 2.14 to 2.88, p <0.001), and weekend admissions (1.53, 1.26 to 1.86, p <0.001) to be significant predictors of primary outcome. An increasing hospital volume quartile was independently predictive of improved primary (0.65, 0.52 to 0.82, p <0.001 for the fourth quartile) and secondary (0.85, 0.73 to 0.97, 0.02 for the fourth quartile) outcomes and lower amputation rates (0.52, 0.45 to 0.61, p <0.001). A significant reduction hospitalization costs ($-3,889, -5,318 to -2,459, p <0.001) was also seen in high volume centers. In conclusion, a greater hospital procedural volume is associated with superior outcomes after peripheral endovascular interventions in terms of inhospital mortality, complications, and hospitalization costs.
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Abstract
Background: Multivessel coronary artery disease carries significant mortality risk. Comprehensive data on inhospital outcomes following multivessel percutaneous coronary intervention (MVPCI) are sparse. Methods: We queried the Healthcare Cost and Utilization Project’s nationwide inpatient sample (NIS) between 2006 and 2011 using different International Classification of Diseases, 9th Revision, Clinical Modification procedure codes. The primary outcome was inhospital all-cause mortality, and the secondary outcome was a composite of inhospital mortality and periprocedural complications. Results: The overall mortality was low at 0.73% following MVPCI. Multivariate analysis revealed that (odds ratio, 95% confidence interval, P value) age (1.63, 1.48-1.79; <.001), female sex (1.19, 1.00-1.42; P = .05), acute myocardial infarction (AMI; 2.97, 2.35-3.74; <.001), shock (17.24, 13.61-21.85; <.001), a higher burden of comorbidities (2.09, 1.32-3.29; .002), and emergent/urgent procedure status (1.67, 1.30-2.16; <.001) are important predictors of primary and secondary outcomes. MVPCI was associated with higher mortality, length of stay (LOS), and cost of care as compared to single vessel single stent PCI. Conclusion: MVPCI is associated with higher inhospital mortality, LOS, and hospitalization costs compared to single vessel, single stent PCI. Higher volume hospitals had lower overall postprocedural mortality rate along with shorter LOS and lower hospitalization costs following MVPCI.
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Trends of Hospitalizations in the United States from 2000 to 2012 of Patients >60 Years With Aortic Valve Disease. Am J Cardiol 2015; 116:132-41. [PMID: 25983278 DOI: 10.1016/j.amjcard.2015.03.053] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 03/26/2015] [Accepted: 03/26/2015] [Indexed: 11/27/2022]
Abstract
In recent years, there has been an increased emphasis on the diagnosis and treatment of valvular heart disease and, in particular, aortic stenosis. This has been driven in part by the development of innovative therapeutic options and by an aging patient population. We hypothesized an increase in the number of hospitalizations and the economic burden associated with aortic valve disease (AVD). Using Nationwide Inpatient Sample from 2000 to 2012, AVD-related hospitalizations were identified using International Classification of Diseases, Ninth Revision, Clinical Modification, code 424.1, as the principal discharge diagnosis. Overall AVD hospitalizations increased by 59% from 2000 to 2012. This increase was most significant in patients >80 years and those with higher burden of co-morbidities. The most frequent coexisting conditions were hypertension, heart failure, renal failure, anemia, and diabetes. Overall inhospital mortality of patients hospitalized for AVD was 3.8%, which significantly decreased from 4.5% in 2000 to 3.5% in 2012 (p <0.001). The largest decrease in mortality was seen in the subgroup of patients who had heart failure (62% reduction), higher burden of co-morbidities (58% reduction), and who were >80 years (53% reduction). There was a substantial increase in the cost of hospitalization in the last decade from $31,909 to $38,172 (p <0.001). The total annual cost for AVD hospitalization in the United States increased from $1.3 billion in 2001 to $2.1 billion in 2011 and is expected to increase to nearly 3 billion by 2020. The last decade has witnessed a significant increase in hospitalizations for AVD in the United States. The associated decrease in inhospital mortality and increase in the cost of hospitalization have considerably increased the economic burden on the public health system.
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Variability in utilization of drug eluting stents in United States: Insights from nationwide inpatient sample. Catheter Cardiovasc Interv 2015; 87:23-33. [DOI: 10.1002/ccd.25977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/25/2015] [Accepted: 04/04/2015] [Indexed: 11/10/2022]
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HOSPITAL VOLUME AND OUTCOMES IN PERIPHERAL VASCULAR INTERVENTIONS IN THE UNITED STATES. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)62066-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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IMPACT OF HOSPITAL VOLUME ON IN-HOSPITAL MORTALITY AND PERI-PROCEDURAL COMPLICATIONS IN PERIPHERAL VASCULAR INTERVENTIONS OF LOWER LIMBS IN THE UNITED STATES. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)62063-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Palliative care in the cardiac intensive care unit. Am J Cardiol 2015; 115:687-90. [PMID: 25727085 DOI: 10.1016/j.amjcard.2014.12.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/11/2014] [Accepted: 12/11/2014] [Indexed: 11/24/2022]
Abstract
Patients admitted to today's cardiac intensive care units (CICUs) have increasingly complex medical conditions; consequently, palliative care is becoming an integral component of their care. Although there is a robust body of literature emanating from other intensive care unit settings, there has been less discussion about the role of palliative care in the CICU. This study examined all admissions to the Mount Sinai Hospital CICU from January 1 through December 31, 2012. Of the 1,368 patients admitted, there were 117 CICU patient deaths. End-of-life discussions were carried out in 85 patients (72.6%) who died during that hospital admission; the primary CICU team led these discussions and helped with decision making in >1/2 of them. For the 85 patients who had goals of care (GOC) discussions, there was a higher rate of redirected GOC toward comfort care or no escalation of care (38.8% vs 3.1%, p <0.001) and withdrawal of life-sustaining treatments, such as mechanical ventilation and vasopressors (23.5% vs 6.3%, p = 0.02) compared with patients for whom no GOC discussions were held. Among patients who had GOC discussions, there was no statistically significant difference for patients who had their mechanical circulatory support, defibrillator, or pacing therapies turned off compared with patients who were not involved in GOC discussions. With the exception of discontinuation of mechanical circulatory support which took place for 6 of the 7 patients in the CICU, end-of-life interventions were split evenly between the palliative care unit and the CICU. There was no difference in CICU length of stay or days to mortality from the time of CICU admission between the 2 groups. In conclusion, our study demonstrates the effect of palliative care and end-of-life decision making in the CICU. As such, we advocate for increased palliative care education and training among clinicians who are involved in cardiac critical care.
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Abstract W P310: Contemporary Trends In The Ischemic Stroke “Weekend Effect” On IV Thrombolytic Use, In-hospital Mortality, Discharge Disposition, Hospital Charges, And Length Of Stay - A National Perspective. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wp310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
We sought to check current stutus of weekend effect (differences in acute ischemic stroke (AIS) outcomes between patients admitted at the weekend versus weekday) which is the basis of many change in health policy to deal with disparities.
Objective:
To evaluate the influence of admission on a perticular day of the week (DOW) on outcomes in AIS pts.
Methods:
We reviewed the HCUP's Nationwide Inpatient Sample (NIS) database from 2008 - 11 for all emergency room (ER) admissions for AIS using ICD 9-CM code. NIS represents 20% of all US hospital. Pts aged < 18 years were excluded. After adjusting for age, gender, median income level, primary payer, hospital region, teaching status, and bed size, a Survey Logistic and Linear regression models were used to compare weekend versus weekday stroke admissions in terms of: incidence of IV thrombolytic (IVT) use, in-hospital mortality and discharge disposition. Length of stay (LOS) was calculated only in pts who survived. Cost to charge ratio files were merged with NIS to calculate cost of care. The cost of care was adjusted for inflation with reference to 2011. Chi-square was utilized for univariate analysis for categorical variable.
Results:
A total 390,401 (weighted: 1,933,243) ER admissions were studied, of which 99,968 (weighted: 494,863) were admitted on weekends. The average age of the cohort was 71 years, 53.4 % females, and 60.8% were whites. In univariate analysis, admission on weekend was associated with higher mortality (7.28% vs. 7.13%, p<0.001), higher utilization of IVT (4.10% vs. 3.72%, p<0.001) and higher discharge to long term facility (44.7% vs. 42.9%, p<0.001). After adjusting for confounders, weekend admission was associated with higher utilization of IVT (OR/days/cost, 95% CI, P-value) (OR 1.10, 1.06 - 1.14; p<0.001); increased discharge to long term facility (OR 1.08, 1.06 - 1.10; p<0.001) and have statistically shorter LOS (-0.08 days, -0.14 - -0.02; p = 0.007). There was no difference in in-hospital mortality (OR: 1.02, 0.99 - 1.05; p = 0.17) or cost of care (142$, - 5 - 288; p=0.06) for weekend admission.
Conclusion:
Admission on a weekend is a predictor of higher utilization of IVT and discharge to a long-term facility , but there was no difference in in-hospital mortality or cost of care.
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Abstract W MP118: Influence of Do-Not-Resuscitate Orders on Length of Stay and Cost of care after Intracerebral Hemorrhage after Charlson's Comorbidity Index adjustment in United States. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.wmp118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The trends in utilization of Do-Not-Resuscitate Orders (DNR) and its effect upon outcomes among patients with intracerebral hemorrhage (ICH) is not studied within a national representative population.
Objective:
To identify the contemporary rate of utilization impact of DNR status on length of stay (LOS) and cost of care among patients (pts) admitted with ICH.
Methods:
We reviewed the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) database from 2011 for ICH using ICD 9-CM code (431) as a primary diagnosis. We defined patients’ DNR status with ICD CM code - V49.86 as a secondary diagnosis. Comorbid conditions were defined by Charlson's Comorbidity Index (CCI). Cost to charge ratio files were merged with NIS to calculate cost of care. LOS was calculated only in pts who were alive. T test was utilized for univariate analysis for continuous variable. Hierarchical multilevel regression models were generated to determine independent predictors of LOS and cost of care.
Results:
Total of 13440 pts (weighted: 64617) with ICH were analyzed, out of which 2029 pts (weighted: 9713) had DNR orders. Average LOS and cost of care for all ICH pts were 8.76 ± 0.12 days and $ 19386 ± 261, respectively. In univariate analysis, LOS and cost of care were lower in DNR pts (LOS: 5.76 ± 0.34 vs. 9.04± 0.13, p <0.001; Cost: $11020 ± 400 vs. $20916 ± 298, P <0.001). In multivariate analysis, the results were (days/cost, 95% CI, P-value) (LOS: -1.30 days, -2.26 - -0.35, p<0.001; cost: $ -5509, -6851 - -4168, p<0.001). Elective admission was associated with decrease in cost (Cost: $ -2439, -4506 - -372, p=0.02). Pts with private insurance were more likely to have decrease LOS and cost of care (LOS: -1.62, -2.35 - -0.90, p<0.001; Cost: -1439, -2745 - -132, p=0.03) as compared with Medicare/Medicaid. Hospital teaching status was associated increase in cost of care while self pay/others was associated with decrease in cost of care. CCI >= 3 was associated with increase in both cost of care and LOS as compared to CCI= 1.
Conclusions:
DNR status in patient with ICH is a predictor of a significantly lower LOS and cost of care. Appropriate use of DNR status may reduce LOS and cost of care in ICH patients and decrease inappropriate resource utilization.
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