All-cause Hospitalization Rates Research Articles

Health Care Utilization of Children Born to Women With and Without Inflammatory Bowel Disease in the First 5 Years of Life: A Population-Cohort Study.

Children born to women with inflammatory bowel disease (IBD) may have increased health care utilization in early life due to genetic susceptibilities and exposure to inflammation in utero, although this has not been robustly evaluated. We aimed to characterize health care use between these groups. We accessed province-wide health administrative databases to identify children born to women with and without IBD between 2002 and 2019. Differences in hospitalizations, emergency department visits, ambulatory visits, and endoscopy visits in the first 5 years of life were characterized. We further assessed differences in mental health-related health care utilization between groups. Multivariable negative binomial regression was performed to calculate adjusted incidence rate ratios (IRRs) with 95% confidence intervals (CIs). We included 17,447 and 1,832,334 children born to women with and without IBD, respectively. Compared with those born to women without IBD, children born to women with IBD appeared to have an increased rate of all-cause hospitalizations (IRR 1.06, 95% CI 1.03-1.10), all-cause emergency department visits (IRR 1.08, 95% CI 1.05-1.10), ambulatory visits (IRR 1.06, 95% CI 1.05-1.07), and endoscopic visits (IRR 2.14, 95% CI 1.70-2.69). Children born to women with IBD also seemed to have increased mental health-related ambulatory visits (IRR 1.93, 95% CI 1.01-3.76), with the most common reasons coded for these visits being neurodevelopmental/behavioral and developmental delay concerns. Children born to women with IBD may have increased health care utilization compared with those born to women without IBD.

Real-World Treatment Patterns After Discontinuation of Venetoclax or BTKis in the Frontline Setting Among Older Adults With Chronic Lymphocytic Leukemia.

Venetoclax and Bruton's tyrosine kinase inhibitors (BTKis) are key treatment options for patients with chronic lymphocytic leukemia (CLL) in the frontline setting. This study characterized postdiscontinuation treatment patterns and hospitalization of frontline venetoclax and BTKis in a national sample of older adults with CLL. We identified 1,770 Medicare beneficiaries 66 years and older with CLL initiating venetoclax with obinutuzumab (VEN-O, n = 193) or BTKi treatment (n = 1,577) in the frontline setting between June 01, 2019, and June 30, 2020. Discontinuation was defined as a consecutive 90-day gap in treatment at any point over an 18-month follow-up. BTKi patients were expected to receive treatment continuously; VEN-O patients were expected to complete 11 months of treatment (12 cycles × 28 days = 336 days). The rates of subsequent CLL treatment and all-cause/CLL-related hospitalization were assessed. Over an 18-month follow-up, 102 (52.8%) VEN-O patients discontinued after completing the fixed-duration period; 597 (37.9%) BTKi and 57 (29.5%) VEN-O patients discontinued treatment prematurely. The median time to discontinuation was 11.9 months (VEN-O) and 4.0 months (BTKi patients), respectively. Few patients (n < 11) who discontinued VEN-O initiated another CLL treatment over a median postdiscontinuation follow-up period of 6.1 months. By contrast, 39.0% of discontinuers in the BTKi group had evidence of subsequent CLL treatment over a median 13.8-month postdiscontinuation follow-up period. Post-BTKi regimens included BCL-2 (35.6%), subsequent BTKi (31.8%), chemotherapy (14.6%), anti-CD20 monotherapy (9.9%), and other (8.2%). The rate of postdiscontinuation all-cause and CLL-related hospitalization per 100 patient-months was 2.0 and 1.5 for the VEN-O group and 3.3 and 2.9 for the BTKi group, respectively. In this real-world study, early discontinuation was more common in patients initiating a BTKi in contrast to VEN-O. Patients who initiated a BTKi also had high rates of subsequent treatment and hospitalization.

Real-world perioperative treatment patterns and economic burden of recurrence in early-stage HER2-negative breast cancer: a SEER-Medicare study

ABSTRACT Aim This study aimed to describe treatment patterns and quantify the economic impact of recurrence in early-stage human epidermal growth factor receptor 2 (HER2)-negative breast cancer (BC). Materials & Methods Medicare beneficiaries with stages I–III HER2-negative BC and lumpectomy or partial/total mastectomy were identified from SEER-Medicare data (2010–2019). Perioperative therapies were reported in the neoadjuvant and adjuvant setting. Locoregional recurrence and distant metastasis were identified using a claims-based algorithm developed with clinical input and consisting of diagnosis-based and treatment-based indicators. All-cause and BC-related healthcare resource utilization (HRU) per-patient-month and monthly healthcare costs were estimated from the recurrence date for patients with recurrence and from an imputed index date for patients without recurrence using frequency matching. HRU and costs were compared between groups stratified by hormone receptor-positive (HR+) or triple negative BC (TNBC) using multivariable regression models. Results Of 28,655 patients, 8.5% experienced recurrence, 90.4% had HR + disease, and 5.6% received neoadjuvant therapy. Relative to patients without recurrence, patients with recurrence had more advanced disease (stage II/III: 73.7% vs. 34.0%) and higher-grade tumors (Grade 3/4: 40.6% vs. 18.0%) at diagnosis. Recurrence in HR+/HER2-negative BC and TNBC was associated with higher rates of all-cause hospitalizations (incidence rate ratio [IRR]: 2.84 and 3.65), emergency department (ED) visits (IRR: 1.75 and 2.00), and outpatient visits (IRR: 1.46 and 1.55; all p < 0.001). Similarly, recurrence was associated with higher rates of BC-related HRU, particularly for ED visits in HR+/HER2-negative BC (IRR: 4.24; p < 0.001) and hospitalizations in TNBC (IRR: 11.71; p < 0.001). Patients with HR+/HER2-negative BC and TNBC recurrence incurred higher monthly all-cause (cost difference [CD]: $3,988 and $4,651) and BC-related healthcare costs (CD: $3,743 and $5,819). Conclusions Our findings highlight the considerable economic burden of recurrence in early-stage HER2-negative BC and underscore the unmet need for optimization of therapies that reduce recurrence in this population.

Implementing INTERACT in Veterans Health Administration Community Living Centers: A pragmatic randomized trial.

Hospital transfers from VA Community Living Centers (CLCs) are common. The objective of this study was to evaluate the effect of introducing the Intervention to Reduce Acute Care Transfers (INTERACT) program into VA CLCs. Cluster randomized trial involving 16 pair-matched VA CLCs. Intervention CLC nursing staff were trained in the use of INTERACT tools designed to identify early signs of a clinical change in condition and improve communication and documentation. One tool was embedded into the VA Electronic Medical Record. Intervention staff were supported by bi-weekly calls over 18 months to reinforce INTERACT tool use. The primary outcome for intent-to-treat analyses was the rate of all-cause hospitalizations per 1000 person days. Secondary outcomes, assessed through structured record reviews and algorithms, were intervention CLCs change in 1) potentially inappropriate transfer decisions and 2) potentially preventable transfers. CLC staff implementation and engagement in INTERACT were documented. Only five of the eight intervention CLCs substantially engaged in the intervention. Using a negative-binomial regression with random effects, adjusting for month, intervention, and the interaction of time and the intervention, we observed no statistically significant difference between intervention and control facilities in all-cause hospitalizations. This was confirmed with matched resident-level, as-treated, analyses among residents in the five engaged CLCs and their matched controls. Structured implicit review of intervention CLC's medical records revealed low rates of inappropriate transfer decisions both before and after the intervention. Introducing INTERACT into volunteer VA CLCs did not reduce the rates of all-cause hospitalizations. In both the pre- and post-intervention periods, all-cause hospitalization rates were relatively higher, and inappropriate transfers lower in VA CLCs than commonly observed in community NHs. Low rates of potentially inappropriate transfers and higher nurse and physician staffing in CLCs may explain why INTERACT was not implemented as fully as planned.

Assessing the impact of acute severe hypertension in the emergency department: A prospective cohort study in Karachi, Pakistan.

Acute Severe Hypertension (ASH), presenting as a Hypertensive Emergency (HE) or Hypertensive Urgency (HU), is a frequent reason for emergency department (ED) admissions. This study sought to assess the prevalence of ASH among adult ED patients in Pakistan and investigate all-cause mortality and hospitalization rates over six months. We conducted a prospective single-center cohort study in Karachi, Pakistan, from June 3, 2019, to September 22, 2020. We enrolled all adult male and non-pregnant female patients presenting to the emergency department with a systolic blood pressure of ≥180 mm Hg or diastolic blood pressure of ≥120 mm Hg. Telephonic follow-ups were conducted at one, three-, and six months post-discharge from the hospital. The Cox Regression Model was used to identify the risk factors for mortality. Of 49,431 ED visits during the study period, 1,525 (3.1%) met the inclusion criteria, and 1,161 (76.2%) were enrolled. A total of 356 patients (30.6%) were diagnosed with HE, and 805 (69.2%) with HU. Among follow-up patients, 14.6% with HE and 4.7% with HU experienced mortality within six months. Notably, the risk of mortality was higher in patients aged >65 years (aRR = 1.90, 95% CI = 1.20 to 3.02) and those suffering from stroke (aRR = 2.09, 95% CI = 1.21 to 3.61) or acute kidney injury (aRR = 1.82, 95% CI = 1.09 to 3.04). Conversely, regular blood pressure monitoring (aRR = 0.08, 95% CI = 0.03-0.19) and adherence to antihypertensive medications (aRR = 0.23, 95% CI = 0.09-0.56) significantly lowered the risk HE resulted in heightened mortality at six months, while HU, traditionally deemed benign, also led to substantial morbidity and mortality. This underscores the ED visit for ASH as a crucial opportunity for preventing short-term and longer-term health complications.

Evaluating the burden of illness of metabolic dysfunction-associated steatohepatitis in a large managed care population: The ETHEREAL Study.

Metabolic dysfunction-associated steatohepatitis (MASH; formerly nonalcoholic steatohepatitis) is the inflammatory form of metabolic dysfunction-associated steatotic liver disease (formerly nonalcoholic fatty liver disease). MASH is a progressive disease associated with increased risk for many hepatic and extra-hepatic complications such as cirrhosis, hepatocellular carcinoma, the requirement for liver transplantation, and cardiovascular (CV)-related and kidney-related complications. It is important to understand the clinical and economic burden of MASH. To assess and compare the clinical and economic burdens of MASH in adults with the non-MASH population in a real-world setting. This observational, retrospective study used the Healthcare Integrated Research Database (HIRD), which contains health care claims data for commercially insured and Medicare Advantage health plan members across the United States. All-cause, CV-related, and liver-related medical costs and health care resource utilization were evaluated in patients with at least 2 diagnoses of MASH during the patient identification period (October 1, 2016, to April 30, 2022) and compared with a non-MASH cohort 1:1 matched on age, Quan Charlson Comorbidity Index, region of residence, and health plan type and length of enrollment. Generalized linear regression with negative binomial and γ distribution models were used to compare health care resource utilization and medical costs, respectively, while controlling for confounders. Covariate-adjusted all-cause, CV-related, and liver-related hospitalization rate ratios and medical cost ratios were assessed and compared for the MASH and matched non-MASH cohorts. A total of 18,549 patients with MASH were compared with 18,549 matched patients in the non-MASH cohort. After adjusting for covariates, MASH was associated with significantly higher rates of hospitalization and higher medical costs compared with the non-MASH cohort. When compared with the non-MASH cohort, patients with MASH had 1.22 (95% CI = 1.15-1.30; P < 0.0001) times higher rates of all-cause hospitalization, 1.13 (95% CI = 1.03-1.24; P = 0.008) times higher rates of CV-related hospitalization, and 7.22 (95% CI = 4.91-10.61; P < 0.0001) times higher rates of liver-related hospitalization. Similarly, all-cause medical costs were 1.26 (95% CI = 1.22-1.30; P < 0.0001) times higher, CV-related medical costs were 1.66 (95% CI = 1.59-1.73; P < 0.0001) times higher, and liver-related medical costs were 7.79 (95% CI = 7.42-8.17; P < 0.0001) times higher among patients with MASH. Compared with those of the non-MASH cohort with similar age, Quan Charlson Comorbidity Index, health plan, region of residence, and duration of enrollment, patients with MASH had significantly higher all-cause, CV-related, and liver-related hospitalizations and medical costs.

Treatment persistence, adherence and healthcare resource utilisation for iGlarLixi versus basal-bolus insulin or premixed insulin in older adult ethnic minorities with type 2 diabetes: SoliEthnicity study.

Most type 2 diabetes (T2D) studies have predominantly enrolled White people aged <65 years. This retrospective study evaluated outcomes for iGlarLixi (fixed-ratio combination [FRC] of insulin glargine 100 U/mL and lixisenatide) versus basal-bolus or premixed insulin in African American, Asian and Hispanic adults with T2D aged ≥65 years. Medicare claims data were assessed from beneficiaries receiving basal insulin who newly initiated iGlarLixi, basal-bolus insulin, or premixed insulin between 7/1/2019 and 12/30/2021. Groups were propensity score matched at baseline and followed for up to 12 months. Endpoints (primary: treatment persistence; secondary: treatment adherence, hypoglycaemia event rates, healthcare resource utilisation) were assessed using multivariable regression. Treatment persistence was higher for iGlarLixi versus basal-bolus or premixed insulin in the overall population (26.9%, 7.6%, 18.9%; adjusted p < 0.0001) and numerically higher in all ethnic subgroups. Treatment adherence was numerically higher for iGlarLixi versus basal-bolus or premixed insulin in the overall population (28.0%, 8.0%, 19.0%) and in all subgroups. Hypoglycaemia event rates were numerically lower for iGlarLixi versus basal-bolus insulin or premixed insulin in the overall population (2.5, 3.8, 7.5/100 person-years' follow-up) and in all subgroups except Asians receiving basal-bolus insulin. All-cause and diabetes-related hospitalisation and emergency department visit event rates were lower with iGlarLixi versus basal-bolus insulin or premixed insulin in the overall population, and in all subgroups except for hospitalisations in Hispanics. FRC therapies such as iGlarLixi represent an appropriate treatment option when intensifying basal insulin therapy in ethnic minority older adults with T2D.

Impact of a Universal Monitoring system (“Third party”) on Outcomes among ICD patients: A Nationwide Study

BackgroundAdherence to recommended follow-up schedules for remote monitoring (RM) of patients with ICDs is inconsistent, which may influence clinical outcomes. Systematic organization through a « third-party » universal monitoring system (UMS) may be beneficial. ObjectivesEvaluate clinical impact of RM and any incremental benefit of UMS vs. conventional RM. MethodsIn the comprehensive French nationwide health database (SNDS) we identified 69,394 ICD patients (67.9±13.4 years, male 77.5%, 34.9% CRT-D) with clinical data. Hospitalizations and survival were assessed for 1 year (2019).Patients were classified by RM status (No-RM and RM), then RM separated further by follow-up method (Conventional manufacturer-specific RM or UMS). Adjusted annual mortality rates and hospitalizations (all-cause, heart failure, number and duration) were compared in No-RM vs. RM, then Conventional RM vs UMS. ResultsMortality rate was reduced in RM vs No-RM (HR 0.96, 95% CI 0.95-0.97, P<0.001). In RM, all-cause hospitalizations increased in number but their cumulative duration diminished (HR 0.98, 95% CI 0.98-0.99, P<0.001). Compared to Conventional RM, UMS was associated with reduced rates of mortality (HR 0.74, 95% CI 0.73-0.77, P<0.001), all-cause and heart failure hospitalizations (HR 0.96, 95% CI 0.95-0.97, P< 0.001), and hospital stay duration (HR 0.96, 95% CI 0.95-0.97, P <0.001). ConclusionRM was associated with improved survival in ICD recipients. Importantly, we found that use of UMS was associated with additional improvement in clinical outcomes including survival and hospitalizations. These observations point to organizational challenges in conventionally managed RM that can be mitigated by a universal monitoring platform.

Real-World Healthcare Resource Utilization, Healthcare Costs, and Injurious Falls Among Elderly Patients with Geographic Atrophy.

This study assessed the clinical and economic burden of geographic atrophy (GA) using real-world data from elderly patients with Medicare Advantage plans in the United States. A retrospective cohort design of patients with GA only, GA + visual impairment (GA + VI), GA + blindness (GA + B), and patients without GA were identified using administrative healthcare claims data from Optum Clinformatics Data Mart. Inverse probability of treatment weighting controlled for confounding when comparing patients with GA only vs without GA, GA + VI vs GA only, and GA + B vs GA only. Endpoints included all-cause and ophthalmic condition-related healthcare resource utilization (HRU), injurious falls, and healthcare costs. HRU and injurious falls were assessed per-person-per-year and per 100 person-years, respectively. Cohorts were compared using rate ratios, 95% confidence intervals (CIs), and p-values from weighted Poisson regression models. Healthcare costs were evaluated per-person-per-year using mean cost differences, 95% CIs, and p-values from weighted linear regression. The study included 18,119 patients with GA only, 2,285 with GA + VI, 1,716 with GA + B, and 72,476 patients without GA. Higher rates of all-cause hospitalizations (RR [95% CI]: 1.08 [1.03, 1.12]), outpatient visits (1.08 [1.05, 1.10]), other visits (1.14 [1.08, 1.21]), and falls with head injuries (1.24 [1.05, 1.45]) were observed in patients with GA vs without GA (P<0.05). GA was associated with higher annual all-cause total healthcare costs, spending an average of $1,171 more after adjustment (P<0.05). Progression to GA + VI and GA + B was associated with a more pronounced burden. The clinical and economic burden of GA is substantial and escalates as the disease advances. These findings suggest early intervention aimed at slowing GA progression may help to mitigate the healthcare burden associated with advancement of GA to visual impairment and blindness.

Primary thromboprophylaxis in ambulatory symptomatic patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials

BackgroundThe global impact of the COVID-19 pandemic has prompted the search for strategies to improve outcomes in affected individuals, including those initially managed in outpatient settings. Thromboembolic events have been reported as a concerning complication. ObjectivesThe aim of this study was to evaluate efficacy and safety of primary thromboprophylaxis in outpatients with COVID-19. The study protocol was registered in PROSPERO (CRD42022362776). MethodsThe study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and conducted a comprehensive search of PubMed/MEDLINE, ClinicalTrials.gov, and OVID/Embase and CENTRAL from Cochrane for studies up to December 11, 2023, without language restrictions. Randomized controlled trials comparing prophylactic-dose anticoagulation with placebo or standard of care in symptomatic outpatients with COVID-19 were included in this analysis. The primary outcome was the composite of all-cause hospitalization and death within 30 days. Secondary outcomes included venous thromboembolism, the composite of venous thromboembolism and major arterial cardiovascular events, and the individual components of the primary outcome. ResultsSeven randomized controlled trials and 3758 COVID-19 outpatients were included. When compared with placebo or standard of care, thromboprophylaxis was associated with similar rates of all-cause hospitalization or mortality (relative risk, 1.00; 95% CI, 0.77-1.31) and lower rates of venous thromboembolism (relative risk, 0.28; 95% CI, 0.08-0.94), corresponding to a 0.6% absolute risk reduction and number needed to treat of 174. ConclusionThromboprophylaxis in symptomatic COVID-19 outpatients led to reduction in venous thromboembolism risk, with no impact on hospitalization or death. However, the overall low absolute risk reduction may not support its routine use.

Effects of body mass index on worsening of heart failure and all-cause death in patients with heart failure and reduced left ventricular ejection fraction: a 10-year follow-up study

Abstract Background/Introduction Obesity in patients with heart failure (HF) with reduced ejection fraction (HFrEF) is common, and with the emergence of effective anti-obesity drugs, a better understanding of the relation between BMI and clinical outcome in HFrEF is needed. Purpose This study aimed to analyse whether a body mass index (BMI) above 27 kg/m2 (cut-off used in trials) is associated with a greater rate of all-cause death and HF hospitalization in patients with HFrEF. Methods We included 1,017 medically optimized according to existing HF guidelines at the time and clinically stable HF patients with a left ventricular ejection fraction of &amp;lt;45% from the NorthStar study. Patients were included between 2005 and 2009 and followed for 10 years using Danish nationwide registries. The outcomes of interest were all-cause death and hospital discharge for HF (overnight stay). Descriptive statistics were grouped according to tertiles of BMI. The association between BMI as a continuous variable and the outcomes of interest was analysed using restricted cubic splines in Cox proportional-hazards models. Reported were hazard ratios (HR) with 95% confidence intervals (CI) adjusted for relevant prognostic covariates (reference: BMI = 27 kg/m2). Results At enrolment, the median age was 69 years, 75% were men, and the median BMI was 26.3 kg/m2 (Table 1). Patients in the upper 3rd BMI tertile were younger (median age 67), had a lower level of NT-proBNP level (median 737.5 pg/ml) and a higher proportion of diabetes (29.9%). During 10 years of follow-up, HF hospitalization occurred in 683 patients (61.7%), and 623 patients died (56.3%). A BMI above 27 kg/m2 was associated with a higher rate of HF hospitalization (significantly from BMI 35.2 kg/m2: HR 1.30 [CI 1.00-1.68]; Figure 1). Similar findings were observed for all-cause mortality (significantly from BMI 35.7 kg/m2: HR 1.27 [CI 1.00-1.62]) Conclusion In patients with HFrEF, a BMI above 27 kg/m2 was associated with a higher rate of HF hospitalization and all-cause death. Efforts to find effective and safe approaches to reducing weight in obese patients with HFrEF are warranted.Figure 1

Mortality, Clinical Complications, and Healthcare Resource Utilization Associated with Managing Transfusion-Dependent β-Thalassemia and Sickle Cell Disease with Recurrent Vaso-occlusive Crises in Italy.

To examine the clinical burden and healthcare resource utilization (HCRU) among patients with transfusion-dependent β-thalassemia (TDT) and patients with sickle cell disease (SCD) with recurrent vaso-occlusive crises (VOCs) in Italy. Eligible patients were identified from an administrative claims database from 1 January 2010 and 1 February 2019. Patients with TDT had ≥ 1 iron chelation treatment, ≥ 8 red blood cell transfusions (RBCTs) during any 12-month period, and ≥ 12 months of available data pre- and post-index (i.e., first RBCT claim). Patients with SCD with recurrent VOCs had ≥ 2 VOCs/year in ≥ 2 consecutive years and ≥ 12 months of available data pre- and post-index (second VOC claim in the second of 2 consecutive years). Patients were propensity score matched to five controls by age, sex, geographic area, and index year. Clinical and HCRU outcomes were evaluated post-index. In total, 214 patients with TDT and 111 patients with SCD with recurrent VOCs were matched to 1070 and 555 controls, respectively. Both patient groups had substantially higher mortality rates than controls (TDT: 4.8 versus 0.8 deaths per 100 person-years; SCD: 1.6 versus 0.4 deaths per 100 person-years). Clinical complications were prevalent in both patient groups. Compared with controls, both patient groups had significantly higher mean rates of all-cause hospitalizations (TDT: 1.4 versus 0.1; SCD: 2.0 versus 0.1) and outpatient services (TDT: 21.9 versus 1.6; SCD: 6.2 versus 1.0) per patient per year (all: p < 0.05). Management of TDT and SCD in Italy is associated with significant clinical and health system burden, highlighting the need for new treatments that eliminate RBCTs and VOCs.

Combined Impact of Residual Mitral Regurgitation and Gradient After Mitral Valve Transcatheter Edge-to-Edge Repair

BackgroundReducing mitral regurgitation (MR) during mitral transcatheter edge-to-edge repair (M-TEER) may come at the cost of increased mitral valve gradient (MVG). The combined impact of residual MR and MVG on clinical outcomes after M-TEER is unknown. ObjectivesThis study sought to evaluate the impact of postprocedure MR and MVG on clinical outcomes after M-TEER. MethodsEXPANDed is a pooled, patient-level cohort of the EXPAND (A Contemporary, Prospective Study Evaluating Real-world Experience of Performance and Safety for the Next Generation of MitraClip Devices) and EXPAND G4 studies, which were designed to evaluate real-world safety and effectiveness of the third- and fourth-generation MitraClip TEER Systems. Subjects were categorized by echocardiographic core laboratory (ECL) assessments into 4 groups according to 30-day MR grade and mean MVG: 1) MR ≤1+/MVG <5 mm Hg; 2) MR ≤1+/MVG ≥5 mm Hg; 3) MR ≥2+/MVG <5 mm Hg; and 4) MR ≥2+/MVG ≥5 mm Hg. ResultsA total of 1,723 subjects had evaluable echocardiograms at 30 days: 72% had MR ≤1+/MVG <5 mm Hg, 18% had MR ≤1+/MVG ≥5 mm Hg, 7% had MR ≥2+/MVG <5 mm Hg, and 3% had MR ≥2+/MVG ≥5 mm Hg. MR≤1+ was sustained through 1 year in 93% of patients who achieved 30-day MR≤1+. MVG decreased from 30 days to 1 year in subjects with MVG ≥5 mm Hg (6.7 ± 4.0 to 5.5 ± 2.5 mm Hg MR ≤1+/MVG ≥5 mm Hg and 6.5 ± 1.5 to 5.5 ± 1.7 mm Hg MR ≥2+/MVG ≥5 mm Hg). One-year rates of all-cause mortality and heart failure hospitalization were lower for subjects who achieved MR ≤1+ at 30 days, regardless of MVG. ConclusionsReduction of MR to mild or less after M-TEER with the latest-generation MitraClip systems was associated with clinical benefit regardless of MVG.

Enhanced Primary Care for Severe Mental Illness Reduces Inpatient Admission and Emergency Room Utilization Rates.

Cardiovascular disease (CVD) is a leading cause of premature mortality among patients with severe mental illness (SMI). Effective care delivery models are needed to address this mortality gap. This study examines the impact of an enhanced primary care (PC) program that specializes in the treatment of patients with SMI, called Medicine in Psychiatry Service-Primary Care (MIPS-PC). Using multipayer claims data in Western New York from January 1, 2016 to December 31, 2021, patients with SMI and CVD were identified using International Classification of Diseases, Tenth Revision codes. National Provider Identification numbers of MIPS-PC providers were then used to identify those patients who were treated by MIPS-PC during the period. These MIPS-PC-treated patients were compared against a cohort of one-to-one propensity score matched contemporaneous comparison group (ie, patients receiving PC from providers unaffiliated with MIPS-PC). A difference-in-difference approach was used to identify the treatment effects of MIPS-PC on all-cause emergency department (ED) visits and hospitalization rates. The MIPS-PC group was associated with a downtrend in the acute care utilization rates over a 3-year period following the index date (ie, date of first MIPS-PC or other PC provider encounter), specifically a lower hospitalization rate in the first year since the index date (25%; P < 0.001). ED visit rate reduction was significant in the third-year period (18%; P = 0.021). In summary, MIPS-PC treatment is associated with a decreasing trend in acute care utilization. Prospective studies are needed to validate this effect of enhanced PC in patients with SMI and CVD.

Impact of continuous glucose monitoring on emergency department visits and all-cause hospitalization rates among Medicaid beneficiaries with type 2 diabetes treated with multiple daily insulin or basal insulin therapy.

The increasing prevalence of diabetes in the United States continues to drive a steady rise in health care resource utilization, especially emergency department visits and all-cause hospitalizations, and the associated costs. To investigate the impact of continuous glucose monitoring (CGM) on emergency department visits and all-cause hospitalizations among Medicaid beneficiaries with type 2 diabetes (T2D) treated with multiple daily insulin injections (MDIs) or basal insulin therapy (BIT) in a real-world setting. In this retrospective, 12-month analysis, we used the Inovalon Insights claims dataset to evaluate the effects of CGM acquisition on emergency department visits and all-cause hospitalizations in the Managed Medicaid population. The analysis included 44,941 beneficiaries with T2D who were treated with MDIs (n = 35,367) or BIT (n = 9,574). Primary outcomes were changes in the number of emergency department visits and all-cause hospitalizations following 6 months after acquisition of CGM (post-index period) compared with 6 month prior to CGM acquisition (pre-index period). The first claim for CGM was the index date. Inclusion criteria were as follows: aged younger than 65 years, diagnosis of T2D, claims for short- or rapid-acting insulin (MDI group) or basal insulin (not rapid-acting) (BIT group), acquisition of a CGM device between January 1, 2017, and September 30, 2022, and continuous enrollment in their health plan throughout the pre-index and post-index periods. In the MDI group, all-cause inpatient hospitalization rates decreased from 3.25 to 2.29 events/patient-year (hazard ratio = 0.12; 95% CI = 0.11-0.13; P < 0.001) and emergency department visit rates decreased from 2.15 to 1.86 events/patient-year (hazard ratio = 0.52; 95% CI = 0.50-0.53; P < 0.001). In the BIT group, all-cause inpatient hospitalization rates decreased from 1.63 to 1.39 events/patient-year (hazard ratio = 0.11; 95% CI = 0.09-0.12; P < 0.001) and emergency department visit rates decreased from 1.60 to 1.43 events/patient-year (hazard ratio = 0.47; 95% CI = 0.44-0.50; P < 0.001). Acquisition of CGM is associated with significant reductions in emergency department visits and all-cause hospitalizations among people with T2D treated with MDIs or BIT.

1-Year Outcomes of Fourth-Generation Mitral Transcatheter Edge-to-Edge Repair in Japan From the EXPAND G4 Study

BackgroundThe MitraClip (Abbott), a percutaneous edge-to-edge mitral valve (MV) repair device, is the only approved device in Japan for mitral transcatheter edge-to-edge repair (M-TEER) therapy to treat primary and secondary mitral regurgitation (MR). Outcomes of the fourth-generation M-TEER system, featuring independent grasping, improved clip deployment, and 4 clip sizes with wider and longer clip arms, have not been reported in Japan. ObjectivesThis study evaluates the 1-year safety and effectiveness of the fourth-generation M-TEER system in Japan to treat MR in a contemporary, real-world setting. MethodsEXPAND G4 is a prospective, single-arm, international, postmarket study. One-year outcomes from subjects treated in Japan include MR severity (assessed by an echocardiography core laboratory), all-cause mortality, heart failure hospitalization, NYHA functional class, and quality of life. ResultsA total of 95 subjects were treated with the fourth-generation M-TEER system at 7 centers in Japan. Subjects in Japan had a higher surgical risk with smaller cardiac dimensions and MV areas. A 100% implant rate was achieved with a large proportion of standard clips (NT/XT). At 1 year, there was significant and sustained MR reduction (99%, 77/78 MR ≤1+), with low MV mean gradients (2.9 ± 1.8 mm Hg) and improved functional capacity (96.2%, 75/78 NYHA functional class I/II). The 1-year rates of all-cause mortality and heart failure hospitalizations were 9.5% and 18.9%, respectively, with low major and device-related adverse event rates. ConclusionsThis first report of echocardiography core laboratory–assessed outcomes with the fourth-generation M-TEER system in Japan shows that excellent and durable technical and clinical outcomes can be achieved with M-TEER in Japan. (MitraClip EXPAND G4 Study; NCT04177394)

Temporal Trend in Hospitalization Among Patients With Congenital Heart Disease: ADanish Nationwide Study.

The congenital heart disease (CHD) population is growing and aging. We aim to examine the impact by describing the temporal trend and causes of lifetime hospitalization burden among the CHD population. From the Danish National Patient Registry, 23 141 patients with CHD and their hospitalizations from 1977 to 2018 were identified, excluding patients with extracardiac malformation. Patients with CHD were categorized into major CHD and minor CHD, and each patient was matched with 10 controls by sex and year of birth. The rate of all-cause hospitalization increased over time from 28.3 to 36.4 hospitalizations per 100 person-years (PY) with rate difference (RD) per decade of 2.5 (95% CI, 2.0-3.1) hospitalizations per 100 PY for the patients with CHD, compared with the increase from 10.8 to 17.0 per 100 PY (RD per decade, 2.0 [95% CI, 1.8-2.2] per 100 PY) for the control group (RD for CHD versus control, P=0.08). The all-cause hospitalization rate remained constant for the major CHDs (RD per decade, -0.2 [95% CI, -1.2 to 0.9] per 100 PY) but increased for the minor CHDs (RD per decade, 5.2 [95% CI, 4.3-6.0] per 100 PY). For all patients with CHD, the cardiovascular hospitalization rate remained constant over time (RD per decade, 0.2 [95% CI, -0.3 to 0.6] per 100 PY) whereas the noncardiovascular hospitalization rate increased (RD per decade, 2.1 [95% CI, 1.6-2.7] per 100 PY). The length of all-cause hospital stays for all patients with CHD decreased from 2.7 (95% CI, 2.6-2.8) days per PY in 1977 to 1987 to 1.6 (95% CI, 1.6-1.7) days per PY in 2008 to 2018. Compared with previous decades, patients with CHD have an increasing hospitalization rate, similar to the general population, but a decreasing length of hospital stay. The increase in hospitalization rate was driven by noncardiovascular hospitalizations, with the patients with minor CHD being the key contributor to the increasing rate.

Association Between Exercise Program Participation and Hospitalization of Older Adults

Government and insurance sponsored exercise programs have demonstrated decreased hospitalizations, but it is unclear if this is the case for self-referred programs. In this retrospective cohort study from 2013 to 2020, older adults who participated for at least three months at a community-based exercise center (participants) were compared with those who did not (non-participants). Each completed a baseline physical assessment and periodic reassessments thereafter. These data were paired with regional hospital data and a national mortality database. Statistical analysis and modeling were performed from 2020 to 2023. Survival to all-cause hospitalization was assessed with a priori subgroup comparison by gender and cox proportional hazard modeling by age, gender, and comorbidities. The cohort included 718 adults, mean age 69.5 years (SD 8.4), with 411 (57.2%) participants and 307 non-participants. Mean follow-up was 26.7 months. Participants had similar baseline measures of fitness (p>0.05) but were more likely to be retired and less likely to have diabetes or prior stroke than non-participants. Sustained participation was associated with a reduced rate of all-cause hospitalization (9.0% vs 12.7%, p = 0.02), even when adjusted (HR 0.54; 95% CI 0.34, 0.87, p = 0.01). This decrease was noted only in women (p = 0.03) but not in men (p = 0.49), gender was non-significant after adjustment for comorbidities (p = 0.15). Exercise program participation was independently associated with decreased risk of all-cause hospitalization, with possible differential effects by gender. Further randomized trials of the benefits of personalized exercise programs are warranted to assess sex- and gender- specific effects.

Clinical effectiveness of oral antiviral agents for treating non-hospitalized COVID-19 patients with chronic kidney disease

ABSTRACT Objectives This study examined the effectiveness of nirmatrelvir plus ritonavir (NMV-r) and molnupiravir (MOV) in treating COVID-19 among chronic kidney disease (CKD) patients. Methods This retrospective cohort study, using the TriNetX research network, identified stage 3–5 CKD and end-stage kidney disease (ESKD) patients with non-hospitalized COVID-19 between 1 January 2022, and 31 May 2023. Propensity score matching (PSM) was used to compare patients on NMV-r or MOV (antiviral group) against those not receiving these treatments (control group). The primary composite outcome was the cumulative hazard ratio (HR) for all-cause hospitalization or death within the 30-day follow-up. Results After PSM, two balanced cohorts of 6,275 patients each were established. The antiviral group exhibited a lower incidence of all-cause hospitalization or mortality (5.93% vs. 9.53%; HR: 0.626; 95% CI: 0.550–0.713) than controls. Additionally, antiviral recipients were associated with a lower risk of all-cause hospitalization (HR: 0.679; 95% CI: 0.594–0.777) and mortality (HR: 0.338; 95% CI: 0.227–0.504). The beneficial effects of antiviral agents were consistent across sex, age, vaccination status, antiviral type, and CKD stage. Conclusion Oral antiviral agents could be associated with lower rates of all-cause hospitalization or death among non-hospitalized COVID-19 patients with CKD.

Outcomes After Pediatric Pulmonary Valve Replacement in Patients With Tetralogy of Fallot

BackgroundPeople with tetralogy of Fallot might require a transannular patch during primary repair, which leads to pulmonary valve regurgitation. Pulmonary valve replacement (PVR) is performed to prevent complications of chronic pulmonary regurgitation, but the optimal timing of PVR remains a matter of debate. In this study we aimed to assess the association of PVR performed in children younger than 18 years of age with the rate of hospitalizations, interventions, and mortality. MethodsThis was a retrospective observational cohort of people with tetralogy of Fallot born in Québec between 1982 and 2015, using a combination of clinical and administrative data. Marginal means and rates models and survival curves were used to compare outcomes of patients with pediatric PVR (younger than 18 years) and those without. Outcomes of interest were rates of cardiac hospitalizations, all-cause hospitalizations, cardiac interventions, and mortality. Groups were balanced using models weighed on the inverse probability of receiving pediatric PVR. ResultsOf the 316 eligible patients, 58 (18.4%) received a pediatric PVR. Compared with patients who did not receive pediatric PVR, they were at increased risk of cardiac hospitalizations, although the rates of cardiac hospitalization were low: 0.50 vs 0.09 hospitalizations per 20 years (hazard ratio [HR] = 4.71 [95% confidence interval (CI), 2.22-9.96]). Patients who received a pediatric PVR had a comparable risk of all-cause hospitalizations (HR = 0.95 [95% CI, 0.71-1.26]) and of cardiac interventions (HR = 1.13 [95% CI, 0.72-1.77]). ConclusionsPatients who underwent pediatric PVR had higher rates of cardiac hospitalizations, but similar rates of all-cause hospitalizations, cardiac procedures, and mortality. In this observational cohort, pediatric PVR was not associated with an improved outcome.