All-cause Emergency Department Visits Research Articles

Timing of follow-up visits after hospital discharge for COPD: Application of a new method.

A common strategy to reduce COPD readmissions is to encourage patient follow-up with a physician within 1 to 2 weeks of discharge, yet evidence confirming its benefit is lacking. We used a new study design called target randomized trial emulation to determine the impact of follow-up visit timing on patient outcomes. All Ontario residents aged 35 or older discharged from a COPD hospitalization were identified using health administrative data and randomly assigned to those who received and did not receive physician visit follow-up by within seven days. They were followed to all-cause emergency department visits, readmissions or death. Targeted randomized trial emulation was used to adjust for differences between the groups. COPD emergency department visits, readmissions or death was also considered. There were 94,034 patients hospitalized with COPD, of whom 73.5% had a physician visit within 30 days of discharge. Adjusted hazard ratio for all-cause readmission, emergency department visits or death for people with a visit within seven days post discharge was 1.03 (95% Confidence Interval [CI]: 1.01-1.05) and remained around 1 for subsequent days; adjusted hazard ratio for the composite COPD events was 0.97 (95% CI 0.95-1.00) and remained significantly lower than 1 for subsequent days. While a physician visit after discharge was found to reduce COPD events, a specific time period when a physician visit was most beneficial was not found. This suggests that follow-up visits should not occur at a predetermined time but be based on factors such as anticipated medical need.

Impact of a tubeless, disposable insulin pump on emergency department visits and inpatient admissions among a Medicare population.

A tubeless, disposable insulin pump (Omnipod DASH Insulin Management System, Insulet Corporation) has demonstrated improved glycemic outcomes for people with diabetes who require insulin. The impact of the system on downstream health care events has not been studied. To assess health care resource utilization for a Medicare population before and after starting tubeless, disposable insulin pump therapy. This retrospective, observational analysis used data from the Centers for Medicare & Medicaid Services 100% Research Identifiable Files. Study outcomes included change in event rates for diabetes-related emergency department (DRED) visits, all-cause emergency department (ACED) visits, diabetes-related inpatient (DRIP) admissions, and all-cause inpatient (ACIP) admissions among Medicare beneficiaries who started the tubeless, disposable insulin pump in 2020 (postpump observation period) as compared with the same duration and calendar period in 2019 (prepump observation period) with no pump use. Subgroup analyses were performed based on Medicare entitlement reason, diabetes type, and diagnosis status for depressive disorder. A total of 811 users met the criteria for analysis: 46.2% had type 2 diabetes, a majority (59.2%) were aged 65 years or older, and 37.0% had a diagnosis for depressive disorder. Significant reductions were observed for DRED of -46.9% (95% CI = -63% to -23%); ACED of -29.0% (95% CI = -37% to -20%); ACIP of -19.9% (95% CI = -32% to -6%). DRIP rates declined notably (-36.6%; 95% CI = -61% to 4%). Event rates observed across subgroups demonstrated consistent downward trends; however, not all were statistically significant. These findings demonstrate that use of the tubeless, disposable insulin pump was associated with reductions in DRED, ACED, and ACIP. Our results provide real-world evidence to support the use of the tubeless, disposable insulin pump among Medicare beneficiaries who require insulin, regardless of diabetes type or Medicare entitlement reason. Additional studies are recommended to further evaluate the effect of insulin pumps on health care utilization among the Medicare population and other insurance populations.

Trends of Peanut-Induced Anaphylaxis Rates Before and After the 2017 Early Peanut Introduction Guidelines in Montreal, Canada

Food allergies, particularly peanut, represent the predominant cause of anaphylaxis. While early allergen introduction has emerged as a potential preventive strategy, the precise impact of recent guidelines on peanut-induced anaphylaxis rates in Canada remains unclear. To assess the impact of the 2017 Addendum Guidelines for the Prevention of Peanut Allergy on peanut-induced anaphylaxis rates in Canada. Using a comprehensive longitudinal registry capturing pediatric anaphylaxis presentations to the Montreal's Children's Hospital, we compared children with and without known peanut allergy who presented with peanut-induced anaphylaxis between 2011 and 2019 inclusive, excluding data beyond 2019 due to the COVID-19 pandemic. We calculated rates of peanut-induced anaphylaxis presentations per 100,000 age-adjusted all-cause Emergency Department visits using 4-month intervals. Interrupted time series analysis was used to compare anaphylaxis rate trends before and after 2017 for children ages 0-2 and 3-17 years. We examined n = 2011 cases of pediatric anaphylaxis, including 429 (21%) triggered by peanuts. Compared to pre-guideline estimates, the yearly rate of change of peanut anaphylaxis rates decreased by 7.96 (95% CI -14.57 to -1.36, p = 0.018) after 2017 amongst patients with new onset anaphylaxis in children 2 years of age or younger (n = 109). No significant changes were identified for older patients ages 3-17, or in patients with known peanut allergy. Early introduction guidelines in Canada are associated with a reduced risk of new-onset peanut-induced anaphylaxis in young children within a single centre in Montreal. Further research is required to assess the impact on a wider population and other food allergens.

Impact of breakthrough SARS-CoV-2 infections on vaccinated patients with colorectal cancer: A retrospective cohort study.

e15656 Background: Cancer patients are vulnerable to severe SARS-COVID outcomes due to the immunosuppressive effect by both the inherent nature of cancer and its diverse therapeutic interventions. Although COVID-19 vaccines have shown efficacy, their effectiveness appears to decrease among cancer patients. We hypothesize that colorectal cancer (CRC) patients are at a higher risk of breakthrough COVID-19 infection and severe outcomes. Methods: We conducted a retrospective cohort study using TriNetX, a population-based database that sources data from electronic medical records (EHRs) of 61 health care organizations in the US. Using ICD-10 codes, we created two cohorts of patients with COVID-19: with CRC and without CRC. The primary aim was a composite outcome of hospitalization, emergency department (ED) visits, and mortality. Secondary aims of our study included risk of hospitalization, ED visits, critical care admission, intubation, and mortality, individually. We performed propensity score matching (PSM) of 44 variables to control for confounding. Odds ratio (OR) and 95% confidence interval (CI) were used to report associations for the propensity-matched cohorts. Results: In CRC patients, the composite outcome (ED visits, hospitalization, death) was 51.6% with breakthrough infections, higher than 44.3% in matched patients without CRC (aOR = 1.39; [95%CI: 1.17 - 1.53]). CRC patients had a significantly elevated cumulative event probability within 180 days (log-rank test, p < 0.0001). Though mortality and critical care stay were similar, CRC patients had a higher risk of hospitalization (aOR = 1.3; [95%CI: 1.12 – 1.50]) and intubation (aOR = 1.79; [95%CI: 1.06 – 3.03]). In subgroup analysis, CRC patients had a higher composite outcome after 2 doses (aOR = 1.39; [95%CI: 1.17 - 1.53]) and 3 doses (aOR = 1.56; [95%CI: 1.26 - 1.95]). Those with 3 doses faced a higher risk of critical stay (aOR = 1.74; [95%CI: 1.06 – 2.86]). Younger CRC patients (16-64 years) with breakthrough infections were at higher risk of all-cause ED visits (aOR = 2.61; [95%CI: 1.73 - 3.94]). No significant differences were observed based on sex. Conclusions: Our retrospective study provides real-world evidence that CRC patients are at a higher risk of more severe outcomes after breakthrough COVID-19 infections. This may warrant a reevaluation of current preventive measures and the possible need for frequent booster vaccine doses for this patient population. [Table: see text]

#2011 Reduced hospitalisation or emergency department visits with long- versus short-term SZC in patients with history of hyperkalaemia: GALVANIZE Outcomes

Abstract Background and Aims Hyperkalaemia is associated with increased healthcare resource use and often requires long-term management. The GALVANIZE Outcomes study is a comparison of hyperkalaemia-related and all-cause hospitalisations or emergency department visits between matched patients treated with long- or short-term sodium zirconium cyclosilicate (SZC), using real-world data. This analysis evaluated outcomes in patients with a history of hyperkalaemia. Method A large US insurance claims database (from HealthVerity) was used to identify adults who initiated SZC (index date) in the outpatient setting between 1 January 2019 and 30 June 2022, with a diagnosis of hyperkalaemia within 6 months prior to the index date. Exclusion criteria included patients without either 6 months of continuous insurance coverage prior to index, or 30 days of continuous insurance coverage post-index. Patients were followed to the earliest of 6 months post-index, loss of coverage, end of the study period or (re) initiation of a potassium binder. Patients with short-term SZC use (≤30 days) were exact and propensity score–matched to patients with long-term SZC use (>90 days). Hyperkalaemia-related hospitalisations and emergency department visits were identified by the International Classification of Diseases (tenth revision) diagnosis code for hyperkalaemia. Rates of the composite outcomes of the number of hyperkalaemia-related hospitalisations or emergency department visits (primary endpoint) and all-cause hospitalisations or emergency department visits (exploratory endpoint) per person-year (PPY) were compared during follow-up using generalised estimating equations. Results Among 2088 eligible matched pairs with a history of hyperkalaemia, the mean age was 63.8 years and 41.4% of the population was female. Most patients (94.9%) had a diagnosis of chronic kidney disease, which mostly included stage 3 (27.3%), stage 4 (25.4%) and stage 5/end-stage (38.7%) kidney disease, while one-third (34.4%) had a diagnosis of heart failure irrespective of ejection fraction. The median (interquartile range) duration of follow-up was 183 (183, 183) days for long-term SZC and 169 (82, 183) days for short-term SZC. During follow-up, in patients with a history of hyperkalaemia, those with long-term SZC use had a 43% lower rate of hyperkalaemia-related hospitalisations or emergency department visits than matched patients with short-term SZC use (rate [95% confidence interval] PPY: 0.89 [0.79–0.98] vs 1.56 [1.35–1.76]; P<0.001) (Fig. 1). Similarly, patients with long-term SZC use had a 35% lower rate of all-cause hospitalisations or emergency department visits than those with short-term SZC use (2.63 [2.44–2.82] vs 4.05 [3.71–4.40]; P<0.001]) (Fig. 2). Conclusion In this real-world study of patients with hyperkalaemia, individuals treated with long-term SZC experienced significantly lower rates of hyperkalaemia-related and all-cause hospitalisations or emergency department visits compared with matched patients with short-term SZC use.

Bleeds and resource use in hemophilia B: retrospective observational study.

To describe people with hemophilia B (PWHB) in the US who experience bleeds despite factor replacement therapy and to quantify the associated burden from the third-party payer perspective. Observational study of adult male PWHB treated with factor IX replacement therapy identified from the PharMetrics Plus claims data from 2010 to 2019. Patients with medically recorded bleeds (MRBs) were identified using diagnostic codes. Rates and rate ratios of inpatient admissions, emergency department (ED) visits, and outpatient visits among PWHB with and without MRBs were estimated. The presence of comorbidities was identified using diagnostic codes, and the analysis was stratified by age group. There were 345 PWHB with MRBs and 252without MRBs. More than half of PWHB with MRBs (56.8%) had 1 or more comorbidity vs 39.3% of PWHB without MRBs. The prevalence of anxiety and depression was high in PWHB, regardless of bleed status and age group, whereas the prevalence of other comorbidities increased with age group. The rate of all-cause inpatient admissions for PWHB with MRBs was 14.8 per 100 person-years (95%CI, 12.8-17.1), 2.5 times higher than for PWHB without MRBs. The rate of all-cause ED visits for PWHB with MRBs was 67.6per 100 person-years (95% CI, 63.2-72.3), 2.7 times higher than for those without MRBs. This study reports significant resource use and clinical burden among PWHB who seek medical care. PWHB with MRBs had considerable all-cause resource use compared with PWHB without MRBs. The prevalence of mental illness was consistently high across all age groups.

The Impact of Primary Care Clinic and Family Physician Continuity on Patient Health Outcomes: A Retrospective Analysis From Alberta, Canada.

Continuity of care is broadly associated with better patient health outcomes. The relative contributions of continuity with an individual physician and with a practice, however, have not generally been distinguished. This retrospective observational study examined the impact of continuity of care for patients seen at their main clinic but by different family physicians. We analyzed linked health administrative data from 2015-2018 from Alberta, Canada to explore the association of physician and clinic continuity with rates of emergency department (ED) visits and hospitalizations across varying levels of patient complexity. Physician continuity was calculated using the known provider of care index and clinic continuity with an analogous measure. We developed zero-inflated negative binomial models to assess the association of each with all-cause ED visits and hospitalizations. High physician continuity was associated with lower ED use across all levels of patient complexity and with fewer hospitalizations for highly complex patients. Broadly, no (0%) clinic continuity was associated with increased use and complete (100%) clinic continuity with decreased use, with the largest effect seen for the most complex patients. Levels of clinic continuity between 1% and 50% were generally associated with slightly higher use, and levels of 51% to 99% with slightly lower use. The best health care outcomes (measured by ED visits and hospitalizations) are associated with consistently seeing one's own primary family physician or seeing a clinic partner when that physician is unavailable. The effect of partial clinic continuity appears complex and requires additional research. These results provide some reassurance for part-time and shared practices, and guidance for primary care workforce policy makers.

Increased Risk of Breakthrough SARS-CoV-2 Infections in Patients with Colorectal Cancer: A Population-Based Propensity-Matched Analysis.

Background/Objectives: This study aimed to investigate the association between colorectal cancer (CRC) and the risk of breakthrough respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in vaccinated patients with CRC. Methods: This retrospective cohort study used the TriNetX research network to identify vaccinated patients with CRC. Patients were matched using propensity score matching (PSM) and divided into patients with CRC and control (without history of CRC) groups. The primary outcome was the risk of breakthrough SARS-CoV-2 in vaccinated patients. The secondary outcome was a composite of all-cause emergency department (ED) visits, hospitalization, and death during the follow-up period after the diagnosis of COVID-19. Results: A total of 15,416 vaccinated patients with CRC were identified and propensity matched with 15,416 vaccinated patients without CRC. Patients with CRC had a significantly increased risk for breakthrough infections compared to patients without CRC (aOR = 1.78; [95% CI: 1.47-2.15]). Patients with CRC were at increased risk of breakthrough SARS-CoV-2 infections after two doses (aOR = 1.71; [95% CI: 1.42-2.06]) and three doses (aOR = 1.36; [95% CI: 1.09-1.69]) of SARS-CoV-2 vaccine. Vaccinated patients with CRC were at a lower risk of COVID-19 infection than unvaccinated CRC patients (aOR = 0.342; [95% CI: 0.289-0.404]). The overall composite outcome (all-cause ED visits, all-cause hospitalization, and all-cause death) was 51.6% for breakthrough infections, which was greater than 44.3% for propensity score-matched patients without CRC (aOR = 1.79; [95% CI: 1.29-2.47]). Conclusions: This cohort study showed significantly increased risks for breakthrough SARS-CoV-2 infection in vaccinated patients with CRC. Breakthrough SARS-CoV-2 infections in patients with CRC were associated with significant and substantial risks for hospitalizations.

Ambient heat exposure patterns and emergency department visits and hospitalizations among medicare beneficiaries 2008–2019

ObjectiveTo assess the association between ambient heat and all-cause and cause-specific emergency department (ED) visits and acute hospitalizations among Medicare beneficiaries in the conterminous United States. DesignRetrospective cohort study. SettingConterminous US from 2008 and 2019. Participants2% random sample of all Medicare fee-for-service beneficiaries eligible for Parts A, B, and D. Main outcome measuresAll-cause and cause-specific (cardiovascular, renal, and heat-related) ED visits and unplanned hospitalizations were identified using primary ICD-9 or ICD-10 diagnosis codes. We measured the association between ambient temperature – defined as daily mean temperature percentile of summer (June through September) – and the outcomes. Hazard ratios and their associated 95% confidence intervals were estimated using multivariable Cox proportional hazards regression, adjusting for individual level demographics, comorbidities, healthcare utilization factors and zip-code level social factors. ResultsAmong 809,636 Medicare beneficiaries (58% female, 81% non-Hispanic White, 24% <65), older beneficiaries (aged ≥65) exposed to >95th percentile temperature had a 64% elevated adjusted risk of heat-related ED visits (HR [95% CI], 1.64 [1.46,1.85]) and a 4% higher risk of all-cause acute hospitalization (1.04 [1.01,1.06]) relative to <25th temperature percentile. Younger beneficiaries (aged <65) showed increased risk of heat-related ED visits (2.69 [2.23,3.23]) and all-cause ED visits (1.03 [1.01,1.05]). The associations with heat related events were stronger in males and individuals dually eligible for Medicare and Medicaid. No significant differences were observed by climatic region. We observed no significant relationship between temperature percentile and risk of CV-related ED visits or renal-related ED visits. ConclusionsAmong Medicare beneficiaries from 2008 to 2019, exposure to daily mean temperature ≥ 95th percentile was associated with increased risk of heat-related ED visits, with stronger associations seen among beneficiaries <65, males, and patients with low socioeconomic position. Further longitudinal studies are needed to understand the impact of heat duration, intensity, and frequency on cause-specific hospitalization outcomes.

Can Timely Outpatient Visits Reduce Readmissions and Mortality Among Heart Failure Patients?

Outpatient follow-up after a hospital discharge may reduce the risk of readmissions, but existing evidence has methodological limitations. To assess effect of outpatient follow-up within 7, 14, 21 and 30days of a hospital discharge on 30-day unplanned readmissions or mortality among heart failure (HF) patients; and whether this varies for patients with different clinical complexities. We analyzed medical records between January 2016 and December 2021 from a prospective cohort study. Using time varying mixed effects parametric survival models, we examined the association between not having an outpatient follow-up and risk of adverse events. We used interaction models to assess if the effect of outpatient follow-up visit on outcomes varies with patients' clinical complexity (comorbidities, grip strength, cognitive impairment and length of inpatient stay). Two hundred and forty-one patients with advanced HF. 30-day all-cause (or cardiac) adverse event defined as all cause (or cardiac) unplanned readmissions or death within 30days of an unplanned all-cause (or cardiac) admission or emergency department visit. We analyzed 1595 all-cause admissions, inclusive of 1266 cardiac admissions. Not having an outpatient follow-up (vs having an outpatient follow-up) significantly increased the risk of 30-day all-cause adverse event. (risk [95% CI] - 14days: 35.1 [84.5,-1.1]; 21days: 43.9 [48.2,6.7]; 30days: 31.1 [48.5, 7.9]) The risk (at 21days) was higher for those with one co-morbidity (0.25 [0.11,0.58]), mild (0.67 [0.45, 1.00]) and moderate cognitive impairment (0.38 [0.17, 0.84]), normal grip strength (0.57 [0.34, 0.96]) and length of inpatient stay 7-13days (0.45 [0.23, 0.89]). Outpatient follow-up within 30days after a hospital discharge reduced risk of 30-day adverse events among HF patients, the benefit varying according to clinical complexity. Results suggest the need to prioritize patients who benefit from outpatient follow-up for these visits.

Comparative safety of tramadol and other opioids following total hip and knee arthroplasty

BackgroundTramadol is increasingly used to treat acute postoperative pain among older adults following total hip and knee arthroplasty (THA/TKA). However, tramadol has a complex pharmacology and may be no safer than full opioid agonists. We compared the safety of tramadol, oxycodone, and hydrocodone among opioid-naïve older adults following elective THA/TKA.MethodsThis retrospective cohort included Medicare Fee-for-Service beneficiaries ≥ 65 years with elective THA/TKA between January 1, 2010 and September 30, 2015, 12 months of continuous Parts A and B enrollment, 6 months of continuous Part D enrollment, and no opioid use in the 6 months prior to THA/TKA. Participants initiated single-opioid therapy with tramadol, oxycodone, or hydrocodone within 7 days of discharge from THA/TKA hospitalization, regardless of concurrently administered nonopioid analgesics. Outcomes of interest included all-cause hospitalizations or emergency department visits (serious adverse events (SAEs)) and a composite of 10 surgical- and opioid-related SAEs within 90-days of THA/TKA. The intention-to-treat (ITT) and per-protocol (PP) hazard ratios (HRs) for tramadol versus other opioids were estimated using inverse-probability-of-treatment-weighted pooled logistic regression models.ResultsThe study population included 2,697 tramadol, 11,407 oxycodone, and 14,665 hydrocodone initiators. Compared to oxycodone, tramadol increased the rate of all-cause SAEs in ITT analyses only (ITT HR 1.19, 95%CLs, 1.02, 1.41; PP HR 1.05, 95%CLs, 0.86, 1.29). Rates of composite SAEs were not significant across comparisons. Compared to hydrocodone, tramadol increased the rate of all-cause SAEs in the ITT and PP analyses (ITT HR 1.40, 95%CLs, 1.10, 1.76; PP HR 1.34, 95%CLs, 1.03, 1.75), but rates of composite SAEs were not significant across comparisons.ConclusionsPostoperative tramadol was associated with increased rates of all-cause SAEs, but not composite SAEs, compared to oxycodone and hydrocodone. Tramadol does not appear to have a superior safety profile and should not be preferentially prescribed to opioid-naïve older adults following THA/TKA.

Association of buprenorphine retention and subsequent adverse outcomes following non-fatal overdose: An analysis using statewide linked Maryland databases

IntroductionPatients receiving buprenorphine after a non-fatal overdose have lower risk of future nonfatal or fatal overdose, but less is known about the relationship between buprenorphine retention and the risk of adverse outcomes in the post-overdose year. ObjectiveTo examine the relationship between the total number of months with an active buprenorphine prescription (retention) and the odds of an adverse outcome within the 12 months following an index non-fatal overdose. Materials and methodsWe studied a cohort of people with an index non-fatal opioid overdose in Maryland between July 2016 and December 2020 and at least one filled buprenorphine prescription in the 12-month post-overdose observation period. We used individually linked Maryland prescription drug and hospital admissions data. Multivariable logistic regression models were used to examine buprenorphine retention and associated odds of experiencing a second non-fatal overdose, all-cause emergency department visits, and all-cause hospitalizations. ResultsOf 5439 people, 25% (n=1360) experienced a second non-fatal overdose, 78% had an (n=4225) emergency department visit, and 37% (n=2032) were hospitalized. With each additional month of buprenorphine, the odds of experiencing another non-fatal overdose decreased by 4.7%, all-cause emergency department visits by 5.3%, and all-cause hospitalization decreased by 3.9% (p<.0001, respectively). Buprenorphine retention for at least nine months was a critical threshold for reducing overdose risk versus shorter buprenorphine retention. ConclusionsBuprenorphine retention following an index non-fatal overdose event significantly decreases the risk of future overdose, emergency department use, and hospitalization even among people already on buprenorphine.

Association of factors with childhood asthma and allergic diseases using latent class analysis

We hypothesize that children characterized by deprived factors have poorer health outcomes. We aim to identify clustering of determinants and estimate risk of early childhood diseases. This 1993–2019 longitudinal cohort study combines three Canadian pediatric cohorts and their families. Mothers and children are clustered using latent class analysis (LCA) by 16 indicators in three domains (maternal and newborn; socioeconomic status [SES] and neighbourhood; environmental exposures). Hazard ratios (HR) of childhood asthma, allergic rhinitis (AR), and eczema are quantified with Cox proportional hazard (PH) regression. Rate ratios (RR) of children’s health services use (HSU) are estimated with Poisson regression. Here we report the inclusion of 15,724 mother–child pairs; our LCA identifies four mother-clusters. Classes 1 and 2 mothers are older (30–40 s), non-immigrants with university education, living in high SES neighbourhoods; Class 2 mothers have poorer air quality and less greenspace. Classes 3 and 4 mothers are younger (20–30 s), likely an immigrant/refugee, with high school-to-college education, living in lower SES neighborhoods with poorer air quality and less greenspace. Children’s outcomes differ by Class, in comparison to Class 1. Classes 3 and 4 children have higher risks of asthma (HR 1.24, 95% CI 1.11–1.37 and HR 1.39, 95% CI 1.22–1.59, respectively), and similar higher risks of AR and eczema. Children with AR in Class 3 have 20% higher all-cause physician visits (RR = 1.20, 95% CI 1.10–1.30) and those with eczema have 18% higher all-cause emergency department visits (RR = 1.18, 95% CI 1.09–1.28) and 14% higher all-cause physician visits (RR = 1.14, 95% CI 1.09–1.19). Multifactorial-LCA mother-clusters may characterize associations of children’s health outcomes and care, adjusting for interrelationships.

The effectiveness of oral anti-SARS-CoV-2 agents in non-hospitalized COVID-19 patients with nonalcoholic fatty liver disease: a retrospective study.

Background: The effectiveness of the novel oral antiviral agents, nirmatrelvir plus ritonavir and molnupiravir, in treating COVID-19 in patients with nonalcoholic fatty liver disease is unclear. Objective: To assess the effectiveness of novel oral antiviral agents against COVID-19 among patients with nonalcoholic fatty liver diseases. Methods: This retrospective cohort study used the TriNetX Research Network to identify non-hospitalized patients with COVID-19 and nonalcoholic fatty liver disease between 1 January 2022, and 30 June 2023. Propensity score matching was used to form two matched cohorts treated with or without nirmatrelvir-ritonavir or molnupiravir. Results: In the two matched cohorts of 6,358 patients each, the use of novel oral antiviral agents was associated with a significantly lower risk of all-cause emergency department visits, hospitalization, or mortality (6.59% versus 8.24%; hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.70-0.91). The novel antiviral group had a significantly lower risk of all-cause emergency department visits (HR, 0.85; 95% CI, 0.74-0.99). Additionally, the incidence of hospitalization was significantly lower in the oral antiviral group than in the control group (HR, 0.71; 95% CI, 0.55-0.90). There were no deaths in the oral antiviral group but 12 deaths in the control group. Conclusion: Novel oral antiviral agents are beneficial for treating COVID-19 in patients with nonalcoholic fatty liver disease.

Warm season ambient ozone and children's health in the USA.

Over 120 million people in the USA live in areas with unsafe ozone (O3) levels. Studies among adults have linked exposure to worse lung function and higher risk of asthma and chronic obstructive pulmonary disease (COPD). However, few studies have examined the effects of O3 in children, and existing studies are limited in terms of their geographic scope or outcomes considered. We leveraged a dataset of encounters at 42 US children's hospitals from 2004-2015. We used a one-stage case-crossover design to quantify the association between daily maximum 8-hour O3 in the county in which the hospital is located and risk of emergency department (ED) visits for any cause and for respiratory disorders, asthma, respiratory infections, allergies and ear disorders. Approximately 28 million visits were available during this period. Per 10 ppb increase, warm-season (May through September) O3 levels over the past three days were associated with higher risk of ED visits for all causes (risk ratio [RR]: 0.3% [95% confidence interval (CI): 0.2%, 0.4%]), allergies (4.1% [2.5%, 5.7%]), ear disorders (0.8% [0.3%, 1.3%]) and asthma (1.3% [0.8%, 1.9%]). When restricting to levels below the current regulatory standard (70 ppb), O3 was still associated with risk of ED visits for all-cause, allergies, ear disorders and asthma. Stratified analyses suggest that the risk of O3-related all-cause ED visits may be higher in older children. Results from this national study extend prior research on the impacts of daily O3 on children's health and reinforce the presence of important adverse health impacts even at levels below the current regulatory standard in the USA.

Impact of a pharmacist-managed remote heart failure program in patients with a multisensor-capable implanted device.

Added layers of remote management in heart failure (HF) have become available for patients with an implantable cardioverter defibrillator (ICD). The aim of this study was to investigate the impact of pharmacist-managed HF monitoring in patients with a multisensor-capable ICD. This was a retrospective, data-only, single-arm study that compared primary outcome events individually in the preactivation and postactivation periods at a single center. The primary outcomes were the total number of all-cause and HF-related hospitalizations and all-cause emergency department (ED) visits and the median length of stay for all-cause and HF-related hospitalizations. The secondary outcome quantified medication utilization. In total, 132 patients completed the 1-year follow-up period. Overall, there was a 49% reduction in the number of patients with an all-cause hospitalization, a 77% reduction in the number of patients with an HF-related hospitalization, and a 36% reduction in the number of patients with an ED visit. More patients were hospitalized, visited the ED (P < 0.005), and had a longer median length of stay for all-cause hospitalizations in the preactivation period (P < 0.05). Overall medication utilization increased in the postactivation period. A pharmacist-led remote monitoring program, utilizing a multisensor diagnostic, was effective at significantly reducing hospitalizations, ED visits, and length of stay.

Impacts of regular physical activity on hospitalisation in chronic obstructive pulmonary disease: a nationwide population-based study

IntroductionStudies that comprehensively evaluate the association between physical activity (PA) levels, particularly by quantifying PA intensity, and healthcare use requiring emergency department (ED) visit or hospitalisation in patients with chronic...

Effect of a transitional care model following hospitalization for heart failure: 3-year outcomes of the Patient-Centered Care Transitions in Heart Failure (PACT-HF) randomized controlled trial.

Patients are at high risk of death or readmission following hospitalization for heart failure (HF). We tested the effect of a transitional care model that included month-long nurse-led home visits and long-term heart function clinic visits - with services titrated to estimated risk of clinical events - on 3-year outcomes following hospitalization. In a pragmatic, stepped-wedge cluster randomized trial, 10 hospitals were randomized to the intervention versus usual care. The primary outcome was a composite of all-cause death, readmission, or emergency department (ED) visit. Secondary outcomes included components of the primary composite outcomes, HF readmissions and healthcare resource utilization. There were 2494 patients (50.4% female) with mean age of 77.7 years. The primary outcome was reached in 1040 (94.2%) patients in the intervention and 1314 (94.5%) in the usual care group at 3 years. The intervention did not reduce the risk of the primary composite outcome (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.81-1.05) nor the component outcomes overall, although numerically reduced the risk of ED visits in women but not men (HR 0.79, 95% CI 0.63-1.00 vs. HR 0.98, 95% CI 0.80-1.19; sex-treatment interaction p = 0.23). The uptake of guideline-directed medical therapy was no different with the intervention than with usual care, with the exception of sacubitril/valsartan, which increased with the intervention (3.3% vs 1.5%; relative risk 6.2, 95% CI 1.92-20.06). More than 9 of 10 patients hospitalized for HF experienced all-cause death, readmission, or ED visit at 3 years. A transitional care model with services titrated to risk did not improve the composite of these endpoints, likely because there were no major differences in uptake of medical therapies between the groups. ClinicalTrials.gov Identifier NCT02112227.

Evaluation of pharmacist-led transition of care program in patients with acute coronary syndrome

BackgroundGuideline-directed medical therapies (GDMTs), initiated in-hospital and continued during the transition to outpatient care, are paramount to successful outcomes for patients with acute coronary syndrome (ACS). Incomplete discharge medication prescribing and delayed follow-up lead to worse cardiovascular outcomes. ObjectivesWe investigated a system of care using inpatient and outpatient clinical pharmacists to close GDMT gaps, ensure seamless transition to outpatient care, improve patient education, and optimize therapies. MethodsWe conducted a pre-post cohort analysis of patients with ACS pre- versus post-intervention to compare process metrics and key outcomes using electronic health record data. ResultsThere were 181 and 135 patients in the pre- and post-intervention cohorts, respectively. Patients post-intervention were significantly more likely to have appropriately-timed follow-up visits scheduled with cardiology (79% vs. 51%, P < 0.0001) and primary care (57% vs. 43%, P = 0.01), to be discharged with prescriptions for P2Y12 inhibitors (87% vs. 64%, P < 0.0001), high dose statins (86% vs. 70%, P = 0.001), and beta blockers (87% vs. 76%, P = 0.01), and significantly less likely to have 30-day all-cause hospital readmissions (4% vs. 12%, P = 0.02) and emergency department (ED) visits (10% vs. 18%, P = 0.04). ConclusionsThe integration of advanced practicing pharmacists into a cardiology team at transition and post-hospitalization resulted in improved rates of posthospital follow-up visits, optimization of GDMT medications, and significantly lower 30-day hospital readmission and ED utilization.

Disparities in the impact of heat wave definitions on emergency department visits during the first year of life among preterm and full-term infants in California

IntroductionHeat waves will be aggravated due to climate change, making this a critical public health threat. However, heat wave definitions to activate alert systems can be ambiguous, highlighting the need to assess a range of definitions to identify those that contribute to the most adverse health outcomes. Additionally, children are highly susceptible to the impacts of heat waves, especially infants, despite the lack of focus on this subpopulation. We aimed to assess the relationship between 30 heat wave definitions and the first all-cause emergency department (ED) visits for California infants. We also examined modification of this relationship by preterm birth status and demographic characteristics to identify possible health disparities. MethodsLive-born, singleton deliveries from the Study of Outcomes in Mothers and Infants born in 2014–2018 were included. Thirty heat wave definitions were assessed based on temperature metrics (minimum/maximum temperatures), thresholds (90th; 92.5th; 95th; 97.5th; 99th percentiles), and duration (1-; 2-; 3-days). A time-stratified case-crossover design assessed heat wave impacts on ED visits using infants with a warm season ED visit (May–October) within the first year of life (n = 228,250). Effect modification by preterm birth status, age, sex, race/ethnicity, education, and delivery payment type was also investigated. ResultsInfants demonstrated increased risk of an ED visit with exposure to all heat definitions. The 3-day minimum temperature 99th percentile definition had the highest adjusted odds ratio (AOR: 1.14; 95% CI: 1.05–1.23) for the total population. Term infants were more affected by some heat waves than preterm infants. Effect modification was additionally identified, such as by maternal education. DiscussionThis study provides insight on the heat wave definitions that lead to adverse health outcomes and the identification of the most susceptible infants to these impacts, which has implications on heat-related interventions.