CM Codes Research Articles

Higher post procedural bleeding in patients with advanced chronic kidney disease undergoing percutaneous coronary intervention.

Advanced chronic kidney disease (ACKD) is common in patients undergoing percutaneous coronary intervention (PCI). Post-PCI bleeding has been shown to increase mortality and remains an important challenge in these patients. Previous studies have shown increased post-PCI bleeding in CKD patients but often ACKD patients are excluded from these trials. The goal of this study was to evaluate if patients undergoing PCI with advanced renal disease have higher bleeding complications. We analyzed the National Inpatient Sample (NIS) database to compare the post-PCI bleeding rates for ACKD (CKD stage 3 and above) undergoing PCI between 2006 and 2011 to those without ACKD in patients over the age of 40. Specific ICD-9 CM codes were used to identify these patients. A total of 49,192 patients had post-PCI bleeding during the study period of which 3,675 (7.5%) had ACKD. Patients with ACKD were older (68.7±11.7 years). During the study period, there was a decline in post-PCI bleeding rates in both ACKD and control groups. Patients with ACKD have significantly higher post-PCI bleeding rates compared to the control group. For example, in 2006, 133.9 in patients with ACKD had bleeding vs. 104.4 per 100,000 in patients without ACKD (P<0.05). After multivariate adjustment for bassline comorbidities, ACKD remained independently associated with post-PCI bleeding risk (OR: 1.07, CI: 1.03-1.11, P<0.001). Despite the overall decline in post-PCI bleeding in patients undergoing PCI, ACKD remains independently associated with post-procedural bleeding.

Prevalence and Cost of Routine Preoperative Care for Low-Risk Cataract Surgery a Decade after Choosing Wisely

ObjectiveExamine the frequency and cost of procedural clearance tests and exams in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the US. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts post-surgical adverse events. DesignRetrospective health care claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania, USA. ParticipantsMembers aged ≥65 years who were continuously enrolled 6 months before and after having cataract surgery from 2018 through 2021 and had approved surgery claim(s). MethodsPreoperative exams or tests occurring in the 30 days prior to surgery were identified via procedural and diagnosis codes on claims of eligible members (e.g., CPT codes for blood panels and preprocedural ICD-10 CM codes). Prevalence and cost were directly estimated from claims; variables predictive of preoperative care receipt and adverse events were tested using mixed effects modeling. Main Outcome MeasuresTotal costs, prevalence, and strength of association as indicated by odds ratios. ResultsUp to 42% of members having cataract surgery had a physician office visit for surgical clearance, and up to 23% of members had testing performed either in isolation or along with clearance visit(s). The combined costs for the preoperative visits and tests were $4.3M (approximately $107-114 per impacted member). There was little difference in member characteristics between those receiving and not receiving either preoperative testing or exams. Mixed effects models showed that the most impactful determinants of preoperative care were the surgical facility and member’s care teams; for preoperative testing, facilities were a stronger predictor than care teams. Adverse events were rare and unassociated with receipt of preoperative testing, exams, or a combination of the two. ConclusionsRates of routine preoperative testing before cataract surgery have not declined despite intervening guidance from the Choosing Wisely campaign to reduce this utilization. Additionally, preoperative evaluations, many likely unnecessary, were very common. Further attention to and reconsideration of current policies and practice for preoperative care may be warranted, especially at the facility level.

Outcomes Among Hospitalized Patients with Acute Chest Syndrome and Concomitant Clinical Depression: A United States Population-Based Cohort Study

Background Acute chest syndrome is a life-threatening complication of sickle cell disease, seen in both children and adults. Hospitalization and immediate treatment are necessary to prevent morbidity and mortality. Clinical depression is quite prevalent in patients with sickle cell disease, and review of literature reveals association of depression with increased annual emergency department visits, hospitalizations, and blood transfusions in patients with sickle cell disease. Whether this leads to worse outcomes is yet to be ascertained. Methods We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified hospitalized patients with acute chest syndrome and concomitant clinical depression using appropriate ICD-10 CM codes. We stratified patients based on whether they had clinical depression during the hospitalization or not. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (OR) for the primary and secondary outcomes. A p value of &amp;lt;0.05 was considered statistically significant. The aim of this study is to investigate the outcomes among hospitalized patients with acute chest syndrome and comorbid clinical depression looking primarily at the in-hospital mortality and hospital length of stay (LOS). Results We identified a total of 5271 hospitalized patients with acute chest syndrome, of which 10.72% (565/5271) had comorbid clinical depression. The overall in-hospital mortality among those with acute chest syndrome was 3.70% (195/5271). Among those with clinical depression, the overall in-hospital mortality rate was not significantly higher at 5.31% (30/565) (p=0.385). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, clinical depression among hospitalized patients with acute chest syndrome did not significantly increase the risk for in-hospital mortality (adjusted OR 1.39, 95% confidence interval [CI], 0.49-3.91; p=0.533) or prolong hospital LOS (median LOS 6 days versus 7 days, p=0.631) Conclusion Acute chest syndrome continues to be an important cause of hospital admissions in patients with sickle cell disease. Our analysis revealed that clinical depression is commonly encountered in this subset of patients. Clinical depression did not have a statistically significant impact on outcomes including increased in-hospital mortality or prolonged hospital LOS. Prospective studies with large sample sizes are needed to better understand these outcomes.

Outcomes Among Hospitalized Patients with Relapsing Multiple Myeloma Utilizing Palliative Care: A United States Population-Based Cohort Study

Background Multiple myeloma has a limiting effect on quality of life, with pain being a commonly reported symptom secondary to lytic lesions. Palliative care plays an important role in both pain management as well as addressing individualized goals of care. Newer treatment options are often implemented in patients with relapsing multiple myeloma, and have the potential to cause further treatment related adverse effects. The role of palliative care in this subgroup needs further exploration. Methods We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified hospitalized patients who have relapsing multiple myeloma and subsequently had a palliative care encounter using appropriate ICD-10 CM codes. We stratified patients based on whether they had a palliative care encounter during the hospitalization or not. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of &amp;lt;0.05 was considered statistically significant. The aim of this study is to investigate the outcomes among hospitalized patients with relapsing multiple myeloma with an in-patient palliative care encounter looking primarily at the in-hospital mortality, hospital LOS as well as total hospital charges. Results We identified a total of 16,726 hospitalized patients with relapsing multiple myeloma, of which 11.30% (1890/16,726) had an in-patient palliative care encounter. The overall in-hospital mortality among those with multiple myeloma was 9.86% (1040/16,726). Among those who had a palliative care encounter, the overall in-hospital mortality rate was significantly higher at 29.97% (566/1890) (p=&amp;lt;0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, the inpatient palliative care encounter among hospitalized multiple myeloma patients significantly increased the risk for in-hospital mortality (adjusted OR 11.99, 95% confidence interval [CI], 8.03-17.92; p=&amp;lt;0.001), longer hospital LOS (median LOS 7 days versus 5 days, p=&amp;lt;0.001) and higher total hospital charges (median total hospital charge 76131 vs 48855, p=0.002) Conclusion Our analysis revealed a statistically significant increased risk of in-hospital mortality, hospital LOS, and total hospital charges in hospitalized patients with relapsing multiple myeloma who had a palliative care encounter. Caution should be exercised in interpreting these results as they may reflect uncontrolled and more advanced disease in patients utilizing palliative care. Further prospective studies are needed to better understand short and long-term outcomes in this patient population.

Abstract 18539: The Impact of Prophylactic Heparin on Pocket Hematoma Formation After Cardiac Implantable Electronic Device Implantation a Real-World Experience

Introduction: Intravenous heparin is strongly associated with pocket hematoma (PH) formation in patients undergoing cardiac implantable electronic device (CIED) implantation. However, there is no data on subcutaneous prophylactic heparin in this population Hypothesis: We hypothesized that the subcutaneous heparin may increase the odds of PH in patients undergoing CIED implantation using data from a large, nationally representative sample of the US population. Methods: The Premier Healthcare Database was analyzed from 2016-2019 to identify patients &gt;18 years old undergoing CIED implantation. Patients with PH were then identified by using ICD-10 CM codes. A multivariable logistic regression model was used to adjust for confounders Results: A total of 267,650 patients underwent CIED implantation between January 1, 2016, and December 31, 2019, of which 4,496 (1.68%) \developed PH. Single chamber pacemaker in 7.22%, dual-chamber pacemaker was implanted in 58.3% of patients, and CRT-P in 4.59%, ICD in 18.58%, CRT-D in 11.31%. Of the total cohort, 559 Patients received subcutaneous heparin within 3 days of the CIED implant procedure. Of these 559 patients, 91 (16%) patients were on subcutaneous heparin (pre-procedural: 19; post-procedural: 57) and developed PH. Subcutaneous heparin is associated with increased odds (OR :13.8,p&lt;0.01) of PH formation. Conclusions: This study suggests that subcutaneous heparin is a strong risk factor for the development of PH. This may independently drive up the rates of PH in the inpatient population. Further studies on the timing of subcutaneous heparin need to be conducted.

Abstract 16440: Gender Differences of In-Hospital Outcomes in Acute Myocardial Infarction and Cardiogenic Shock Patients Using Impella: From the Nation Inpatient Sample 2016-2019

Background: There is a lack of independent studies on gender differences in hospital outcomes with Impella in patients with acute myocardial infarction (AMI) combined with cardiogenic shock (CS). Our study aims to provide evidence on the impact of gender differences on AMI-CS patients receiving Impella with a nationally representative sample. Methods: Data were obtained from the National Inpatient Sample (NIS) from 2016 to 2019. Patients with AMI and CS were searched in the NIS using ICD-10 CM codes, and those with Impella were screened using ICD-10PCS codes. Patients treated with Impella were then stratified by gender. We used multivariate regression analysis with inverse probability weighting(IPTW) based on propensity scores to compare the risk of in-hospital death after Impella among patients of different genders. Results: From 2016-2019, a total of 2,953 inpatients with AMI combined with CS using Impella were identified. Of these, 28.5% were women. Women treated with Impella were older (mean age 68.42 versus 64.68 years, P&lt;0.0001). Male inpatients on Impella had a higher proportion of NSTEMI, and were more likely to have smoking, congestive heart failure, cardiac arrhythmias, and acute renal failure. Female inpatients were more likely to have STEMI and were more likely to have Chronic pulmonary disease, uncomplicated hypertension, hypothyroidism, and valvular disease. After IPTW-adjusted baseline clinical covariates, women using Impella had a higher risk of in-hospital death than men, while length of stay and total hospital cost did not differ significantly between genders (OR, 1.33 [95%CI, 1.10-1.60]; Beta, -0.05 [95%CI, -0.80-0.71]; and Beta, 8105.24 [95%CI, -25376.84-9166.35]; respectively). Conclusions: Impella use was lower in women. However, in-hospital mortality was significantly higher in women among AMI-CS patients using Impella. Further studies are needed to explore the reasons for higher mortality in female patients using Impella.

Abstract 12298: Outcomes of Catheter Ablation for Atrial Fibrillation in Patients With Rheumatic Mitral Valve Disease

Introduction: There is a lack of data on procedural safety and outcomes in patients with rheumatic mitral valve disease (RMVD) undergoing atrial fibrillation (AF) ablation. Hypothesis: We hypothesized that the presence of RMVD may affect the outcomes of patients undergoing AF ablation and tested this hypothesis using data from a large, nationally representative sample of the US population. Methods: The National Readmissions Database (NRD) was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing AF ablation. Patients with RMVD were then identified by using ICD-10 CM codes. A multivariable logistic regression model was used to adjust for confounders. Results: Our cohort included 50,728 weighted AF ablation procedures, of which 3,500 (6.9%) patients had RMVD. Patients with RMVD were older at the time of catheter ablation, with a significantly higher percentage of females, less likely to have paroxysmal AF, and had a higher burden of comorbidities including congestive heart failure, renal failure, and hypertension. On multivariable analysis, the presence of RMVD was associated with higher odds of cardiovascular complications (adjusted odds ratio [aOR] 1.28; 95% confidence interval [CI]: 1.12-1.47; p&lt;0.01) with no difference in the odds of in-hospital mortality or other periprocedural outcomes. Also, RMVD was associated with longer length of stay (adjusted mean difference: +1.06; 95% CI: +0.67 - +1.45; p&lt;0.01) days and lower odds of routine home discharge (aOR:0.77; 95% CI: 0.69-0.87; p&lt;0.01). There was no difference in the odds of 30-day or 180-day all-cause, AF-related, or atrial flutter-related readmissions in patients with RMVD vs. no RMVD (Figure 1). Conclusion: In conclusion, patients with RMVD undergoing AF ablation have higher odds of periprocedural cardiovascular complications with similar odds of 30-day and 180-day all-cause and AF-related readmissions

Abstract 12413: Arrhythmia Burden, Associated Outcomes, and Cost Implications in Patients Hospitalized With Idiopathic Pulmonary Fibrosis

Introduction: Arrhythmias are a common cardiovascular manifestation of idiopathic pulmonary fibrosis (IPF), however, associated costs and hospital outcomes are unknown. We aim to determine the impact of cardiac arrhythmias on outcomes and costs among hospitalized IPF patients. Methods: A retrospective cohort analysis was conducted using the National Inpatient Sample from 2017-2019. IPF-associated hospitalizations with and without concurrent arrhythmia were compared and identified by appropriate ICD-10 CM codes. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were the duration of hospitalization and associated costs. Results: Among 92,125 IPF patients, 28.5% (n=26,235) were diagnosed with 29,885 arrhythmias. The most frequent (65%) form of arrhythmias was atrial tachyarrhythmias of which atrial fibrillation was the most predominant (88%). The frequency of bradyarrhythmias, ventricular tachyarrhythmias, and unspecified arrhythmias were 10%, 8%, and 17%, respectively. The IPF-arrhythmia group was predominantly male (64% vs 36%, P &lt; 0.001) and significantly older (76 vs 69 years, p&lt;0.001) with a higher number of comorbidities (3 or more Charlson comorbidity index score: 52% vs 40%, p&lt;0.001). All-cause mortality was significantly higher in the IPF-arrhythmia cohort (12.3% vs. 9.5%, p&lt;0.001) and the odds of in-hospital death remained significantly higher among the IPF-arrhythmia cohort after adjusting for sociodemographic and hospital-level factors (AOR 1.30, 95% CI 1.17-1.44, P &lt;0.001). The hospital length of stay was longer (8.4 vs. 6.7 days, p&lt;0.001), and costs were higher ($123,185 vs. $88,073, p&lt;0.001) among the IPF-arrhythmia cohort. Conclusions: Concurrent arrhythmias are associated with worse survival outcomes and costs for patients with IPF. Future studies are needed to confirm the benefits of treatment and elucidate the appropriateness and cost-effectiveness of screening for arrhythmias among IPF patients.

Abstract 13516: Outcomes Among Heart Failure Patients Hospitalized for Infective Endocarditis: A United States National Cohort Study

Introduction: We aim to investigate the impact of heart failure (HF) among hospitalized patients with infective endocarditis (IE) in terms of in-hospital outcomes including the risk for mortality, development of cardiogenic shock (CS) and certain arrythmias, as well as hospital length of stay (LOS). Methods: We queried the 2018-2020 United States National Inpatient Sample (NIS) Database in conducting this retrospective cohort study. We identified hospitalized adult patients greater than 18 years of age with HF and IE using appropriate ICD-10 CM codes. Those with HF were subsequently stratified into systolic and diastolic HF. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the outcomes of interest. Results: A total of 150,059 hospitalized patients with IE were identified in the years 2018-2020, of which 33.58% (50,390/150,059) had HF. The overall in-hospital mortality rate among hospitalized patients with IE is 12.13% (18,185/150,059). Among those with HF, the in-hospital mortality rate was significantly higher at 15.11% (7,614/50,390, p&lt;0.001). Using a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, HF among hospitalized patients with IE increased the risk for adverse in-hospital outcomes. (Table 1) Conclusions: Our study showed that concomitant HF among hospitalized patients with IE increased the risk for in-hospital mortality, longer LOS, development of CS and certain arrythmias including atrial fibrillation, ventricular tachycardia, and ventricular fibrillation. This highlights the significant impact of HF as a potential predictor of worse outcomes among hospitalized IE patients.

Abstract 13389: Outcomes of Transcatheter Aortic Valve Replacement in Patients With Prior Mediastinal Radiation in the United States

Introduction: Although prior mediastinal radiation is associated with significantly worse clinical outcomes after SAVR, it is unknown if the same holds true for patients undergoing transcatheter aortic valve replacement (TAVR). Hypothesis: We hypothesized that the presence of prior mediastinal radiation may affect the outcomes of patients undergoing TAVR and tested this hypothesis using data from a nationally representative sample of the US population. Methods: The National Readmissions Database was analyzed from 2016-2019 to identify patients ≥ 18 years old undergoing TAVR. Patients with prior mediastinal radiation were then identified by using ICD-10 CM codes. Propensity score matching was used to adjust for confounders. Results: Our cohort included 173,743 patients undergoing TAVR, of which 2,780 (1.6%) had prior mediastinal radiation. Patients with prior mediastinal radiation undergoing TAVR were younger, had a higher proportion of females, and had a lower burden of comorbidities including hypertension, diabetes, and renal failure. Crude percentages are reported in Figure 1. On propensity score-matched analysis, the presence of prior mediastinal radiation was associated with similar odds of in-hospital mortality and peri-procedural complications including cardiovascular complications, peripheral vascular complications, pulmonary complications, neurological complications, major bleeding, and new pacemaker implantation along with similar odds of 30-day and 180-day all-cause, stroke-related, bleeding-related, and heart failure-related readmissions compared to those without prior mediastinal radiation. Conclusion: In conclusion, our data suggest that patients with prior mediastinal radiation undergoing TAVR have similar outcomes compared to those who have no history of mediastinal radiation.

Abstract 18513: Causes and Predictors of 30-day Readmissions Following Covid-19 Hospitalizations and Co-Existing Acute Heart Failure: Insights From National Readmission Database 2020

Introduction: COVID-19 infection notably impacts the cardiovascular system, with evidence of higher in-hospital mortality in patients with acute heart failure (AHF) and COVID-19 infection. However, less is known about short-term outcomes following discharge. Therefore, we sought to analyze readmission data in COVID-19 hospitalizations with AHF from the National Readmission Database (NRD). Methods: NRD (2020) was queried to identify all COVID-19 hospitalizations and co-existing AHF using ICD-10 CM codes. The group was then stratified into heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). The outcomes were 30-day readmission rate, length of stay (LOS), total hospital charge (THC), and predictors of readmission. Multivariate/univariate logistic and linear regression analyses were used to analyze the outcomes and adjust for possible confounders. Results: A total of 53,337 COVID-19 admissions with co-existing AHF were identified, of which 38,401 were discharged alive. Within 30 days from discharge, 8,159 (21.26%) were readmitted. Upon stratification, 51% belonged to the HFrEF group and were found to have scarcely higher 30 days readmission rates than encounters with HFpEF (21.46% vs. 21.14%). Readmissions lead to an additional mean THC of $85,687 and a mean LOS of 7.8 days. The top five all-causes of readmissions were COVID-19 infection (24.8%), heart failure (16.2%), sepsis (15.4%), acute kidney injury (2.2%), and pneumonia (1.2%). Figure-1 shows a multivariate analysis of independent factors associated with readmissions. Conclusions: Our analysis showed a 21.26% 30-days readmission rate following acute heart failure during COVID-19 infection. Cirrhosis, anemia, diabetes mellitus, chronic lung diseases, and discharge against medical advice were significant readmission predictors. Optimizing these co-morbidities during index admission may reduce readmissions and overall financial burden.

Abstract 18683: Prevalence of Obesity in Transgender Adults and Its Impact on Major Adverse Cardiac and Cerebrovascular Events and Pulmonary Embolism: A Population-Based Analysis

Introduction: Although obesity and its impact on major adverse cardiac and cerebrovascular events (MACCE) and pulmonary embolism(PE) have been extensively studied, little is known about obesity’s impact on MACCE and PE in the transgender population. Through this study, we sought to establish the prevalence of obesity and its impact on MACCE outcomes and PE in this population subset. Methods: Using the National Inpatient Sample 2020 database, we identified admissions of transgender patients or patients with prior sex reassignment surgery using ICD-10 CM Codes. Later, all these patients were divided into obesity and non-obesity cohorts. Multivariate regression analysis was then performed for in-hospital MACCE and PE to calculate the odds ratio (OR). Predictors for MACCE were also identified in transgender patients with obesity. Results: In 2020, 19,345 transgender patients or patients who had sex reassignment surgery were admitted to the hospital; 16,390 (84.7%) had no obesity, and 2,955 (15.3%) had obesity. In the obesity cohort, 64.5% of patients had a mean age between 18-44 years, 66.5% were white, 47.9% were transgender males, and 52.1% were transgender females. The most common comorbidities include hypertension (43.5%), diabetes (32.5%), and chronic pulmonary disease. (27.7%). Among the transgender patients with obesity, 5.4% had MACCE events, and 1.2% had cardiac arrest. A statistically significant association was observed in MACCE [OR 2.1, 95% confidence interval (CI) 1.24-3.55, p=0.006] and cardiac arrest (OR 3.92, 95% CI 1.11-12.63, p=0.022 among obesity cohort, with age being the important predictor of MACCE. However, no statistically significant association was observed in acute myocardial infarction (OR 1.82, 95% CI 0.8503.93, p=0.125), acute ischemic stroke (1.34, 95% CI 0.39-4.62, p=0.638) and PE (2.18, 95% CI 0.83-5.72, p=0.113). Conclusion: We observed increased odds of MACCE and cardiac arrest in transgender patients with obesity in our large population-based analysis. This observation could be a result of hormonal treatment that transgender adults receive or associated disparities with transgender care. Further large-scale studies are needed to understand the impact of obesity and MACCE events, and PE in this population.

Abstract 18348: Causes and Predictors of 30-Day Readmissions Following Permanent Pacemaker Implantation in Patients With Cardiac Amyloidosis: From National Readmission Database (2016-2020)

Introduction: Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy where local deposition of amyloid fibrils causes heart failure, arrhythmias, and conduction system abnormalities. Involvement of the AV nodal and infra-hisian conduction system increases the need for a permanent pacemaker (PPM). Studies have noted worse outcomes in patients with implantable-cardioverter defibrillator placement in amyloidosis, but a comparison with PPM is lacking. We sought to analyze readmissions in CA patients following PPM placement utilizing National Readmission Database (NRD). Methods: NRD (2016 to 2020) was queried to identify adults with a diagnosis of CA who underwent PPM implantation using ICD-10 CM and PCS codes. The primary outcome was a 30-day readmission rate. Secondary outcomes were in-hospital mortality, length of stay (LOS), total hospital charge (THC), and predictors of readmission. Multivariate/univariate logistic and linear regression analyses were used to analyze the outcomes and adjust for possible confounders. Results: A total of 1,027 encounters of CA who underwent PPM were identified, of which 975 were discharged alive. Within 30 days from discharge, 141 (14.5%) were readmitted. Those readmitted had a longer LOS and higher burden of comorbidities while were similar in age, sex, hospital characteristics, and household income status. Readmissions lead to an additional mean THC of $55,079 and a mean LOS of 6.3 days. The top five causes of readmissions were heart failure (23%), sepsis (6.6%), hypertensive heart disease (4%), bradycardia (3.5%), and acute kidney injury (3.2%). Figure-1 shows the forest plot of a multivariate analysis of independent factors associated with readmissions. Conclusions: Our findings show that up to 15% of patients with CA who undergo PPM implantation get readmitted with heart failure being the most common etiology. Optimizing comorbidities with PPM implantation in CA may provide better outcomes and reduce admissions.

Outcomes Among Hospitalized Patients with Amyloidosis and Atrial Fibrillation: A Nationwide Analysis

Background Amyloidosis can affect virtually any organ system; deposition in the heart usually occurs in primary (AL) and mutated transthyretin (ATTR) subtypes. Clinical presentation ranges from heart failure and infiltrative cardiomyopathy to life threatening ventricular arrythmias. Atrial fibrillation has often been described in literature to manifest in patients with amyloidosis, although its clinical significance needs further exploration. Methods We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified hospitalized patients with amyloidosis and atrial fibrillation using appropriate ICD-10 CM codes. We stratified patients based on whether they had atrial fibrillation during the hospitalization or not. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of &amp;lt;0.05 was considered statistically significant. The aim of this study is to investigate the outcomes among hospitalized patients with amyloidosis and atrial fibrillation looking primarily at the in-hospital mortality, risk for cardiogenic shock, and hospital length of stay (LOS). Results We identified a total of 84604 hospitalized patients with amyloidosis, of which 31.73% (26845/84604) had comorbid atrial fibrillation. The overall in-hospital mortality among those with amyloidosis was 6.42% (5432/84604). Among those who had atrial fibrillation, the overall in-hospital mortality rate was significantly higher at 7.17% (389/5432) (p=0.011). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, atrial fibrillation among hospitalized patients with amyloidosis did not significantly increase the risk for in-hospital mortality (adjusted OR 1.12, 95% confidence interval [CI], 0.96-1.31; p=0.150) or prolong hospital LOS (p=0.199). However, concomitant atrial fibrillation among hospitalized patients with amyloidosis increased the risk for cardiogenic shock (aOR 1.65, 95% confidence interval [CI], 1.31-2.06; p=&amp;lt;0.001) Conclusion Atrial fibrillation continues to be a significant comorbidity in patients with amyloidosis. Our study found a statistically significant increase in the risk for cardiogenic shock, but not for in-patient mortality and hospital LOS. Early identification and prompt management with medical therapy or cardioversion is necessary to prevent disastrous complications. Further prospective cohort studies will help to better assess both short- and long-term outcomes in this patient population.

A Nationwide Analysis of the Outcomes Among Hospitalized Patients with Heparin Induced Thrombocytopenia and Concomitant COVID-19 Infection

Background Heparin induced thrombocytopenia (HIT) and COVID-19 infection are independently associated with thromboembolic complications. Our study aims to assess outcomes among hospitalised patients with concomitant HIT and COVID-19 infection, since data among this subgroup is lacking. Methods We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified patients who have heparin induced thrombocytopenia (HIT) and COVID-19 infection using appropriate ICD-10 CM codes. We stratified patients based on the presence or absence of COVID-19 infection. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of &amp;lt;0.05 was considered statistically significant. The aim of this study was to investigate the impact of COVID-19 infection on in-hospital mortality, hospital LOS, total hospitalization charge and risk for arterial or venous thrombosis among hospitalized patients with HIT. Results We identified a total of 9896 hospitalized patients with heparin-induced thrombocytopenia (HIT), of which 7.68% (760/9896) had concomitant COVID-19 infection. The overall in-hospital mortality among those hospitalized patients with HIT was 17.14% (1695/9896). Among those with concomitant COVID-19 infection, the mortality rate was significantly higher at 50% (380/760, p=0.001). Further, compared to those without COVID-19 infection, those with concomitant COVID-19 infection had a significantly longer median LOS (21 days vs 11 days, p=0.001) and higher total hospitalization charge ($292,325 vs $143,972, p=0.001). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, COVID-19 infection was found to be an independent predictor of increased in-hospital mortality (adjusted OR 5.13; 95% confidence interval [CI], 3.36-7.84; p=0.001), longer LOS (adjusted OR 6.21; 95% confidence interval [CI], 3.56-8.86; p=0.001) and higher total hospitalization charge (p=0.001). However, it was not significantly associated with increased risk for arterial (adjusted OR 0.72; 95% confidence interval [CI], 0.18-2.83; p=0.63) or venous (adjusted OR 0.91; 95% confidence interval [CI], 0.48-1.74; p=0.79) thrombosis. Conclusion Our analysis showed that among hospitalized patients with HIT, concomitant COVID-19 infection increased the risk for in-hospital mortality, longer LOS and higher total hospitalization charge, however, it did not significantly increase the risk for the development of arterial and venous thrombosis. Prospective studies with control of possible confounders are warranted in order to better describe these associations.

Intersection of sepsis, atrial fibrillation, and severe obesity: a population-based analysis in the United States.

Atrial fibrillation (AF) is an indicator of poor prognosis in patients with sepsis and can increase the risk of stroke and mortality. Data on the impact of severe obesity on the outcomes of sepsis complicated by AF remains poorly understood. National Inpatient Sample (2018) and ICD-10 CM codes were used to identify the principal sepsis admissions with AF. We assessed comorbidities and outcomes of sepsis in people without obesity (BMI < 30) vs. non-severe obesity (BMI 30-35) and severe obesity (BMI > 35) cohorts. We also did a subgroup analysis to further stratify obesity based on metabolic health and analyzed the findings. The primary outcomes were the prevalence and adjusted odds of AF, AF-associated stroke, and all-cause mortality in sepsis by obesity status. Multivariable regression analyses were adjusted for patient- and hospital-level characteristics and comorbidities. Our main analysis showed that of the 1,345,595 sepsis admissions, the severe obesity cohort was the youngest (median age 59 vs. non-severe 64 and people without obesity 68 years). Patients with obesity, who were often female, were more likely to have hypertension, diabetes, congestive heart failure, chronic pulmonary disease, and chronic kidney disease. The crude prevalence of AF was highest in non-severe obesity (19.9%). The adjusted odds of AF in non-severe obesity (OR 1.21; 95% CI:1.16-1.27) and severe obesity patients with sepsis (OR 1.49; 95% CI:1.43-1.55) were significantly higher than in people without obesity (p < 0.001). Paradoxically, the rates of AF-associated stroke (1%, 1.5%, and 1.7%) and in-hospital mortality (3.3%, 4.9%, and 7.1%) were lowest in the severe obesity cohort vs. the non-severe and people without obesity cohorts, respectively. On multivariable regression analyses, the all-cause mortality revealed lower odds in sepsis-AF patients with severe obesity (OR 0.78; 95% CI:0.67-0.91) or non-severe obesity (OR 0.63; 95% CI:0.54-0.74) vs. people without obesity. There was no significant difference in stroke risk. A higher prevalence of cardiovascular comorbidities can be linked to a higher risk of AF in people with obesity and sepsis. Paradoxically, lower rates of stroke and all-cause mortality secondary to AF in people with obesity and sepsis warrant further investigation.

Association of Discharge Location Following Pediatric Tracheostomy with Social Determinants of Health: A National Analysis.

To evaluate the breakdown of discharge locations among pediatric tracheostomy patients and determine the impact of demographic variables and social determinants of health. Retrospective review of the 2016 and 2019 Healthcare Cost and Utilization Project Kids' Inpatient Database (HCUP KID). A total of 4000 United States community hospitals, defined as short-term, non-Federal, general, and specialty hospitals. ICD-10-PCS, ICD-10 CM codes, and HCUP data elements were selected for patients and variables of interest. Bivariate comparisons were performed using Rao-Scott Chi-square tests; significance levels in post hoc pairwise testing were adjusted using Bonferroni adjustment. Multinomial generalized logistic regression models were used to determine the average annual odds ratio (OR) of 3 dispositions at discharge relative to discharge home for self-care. Patients aged 11-17, patients from large metropolitan areas, and patients of "Other" race have an increased odds of discharge to a short- or long-term care facility (all P < .001). Weekend admissions, nonelective admissions, patients in Northeast hospitals, and patients at urban nonteaching hospitals are also more likely to be discharged to a short- or long-term care facility (all P < .001). Mean and median total costs of admission were $424,387 and $243,479, respectively, with a median total charge of $854,499. Among pediatric tracheostomy patients, demographic factors that affect discharge disposition include age, community type, and race, and significant hospital factors include day and type of admission, geographic region, and hospital type. Hospitalizations are associated with high overall costs and charges to the patient, which are increasing over time.

Healthcare and economic burden of heart failure with amyloidosis: An insight from National Readmission Database

IntroductionWe analyzed trends, causes and predictors of 30-days readmission in cardiac amyloidosis and inspected the impact of these readmissions on mortality, morbidity, and utilization of healthcare resources. MethodsHeart Failure with cardiac amyloidosis patients were selected from National readmission Database (NRD) using ICD-10 CM codes. Patients younger than 18 years, elective readmissions, readmissions due to trauma, patients with missing data and December 2018 admissions were excluded. Primary outcome was all-cause 30-day readmissions rate, secondary outcomes were factors associated with 30-days readmissions and their effect on morbidity, mortality, and healthcare resource utilization. ResultsOut of 4123 total heart failure with cardiac amyloidosis index admissions in 2018, 3374 patients were included in final analysis. 19.6% were readmitted within 30 days. Readmitted patients were younger, sicker, admitted to small or large hospital. Hypertensive heart and Chronic Kidney Disease (CKD Stage I-IV) with Congestive Heart Failure (CHF), hypertensive heart and CKD (Stage V) or End Stage Renal Disease (ESRD) with CHF, hypertensive heart disease with CHF, acute kidney failure, and sepsis were the most common causes of readmissions. Young age, admission to small and large size hospitals were independent predictors of 30-day readmissions. Readmissions had higher mortality, costed 6.6 extra in hospital days to patients and $16380 per admission to healthcare system. ConclusionsCardiac amyloidosis readmissions were associated with increased morbidity and mortality of patients and extra burden on the healthcare system. There is a need to identify patients at risk for readmissions to improve patient outcomes and decrease healthcare cost.

Outcomes among patients with pancreatic malignancy on long-term anticoagulation hospitalized for acute pulmonary embolism: A nationwide analysis.

e16266 Background: Pancreatic cancer is known to have an increased risk of thromboembolic events. Acute pulmonary embolism further complicates the clinical picture and confers a poor prognosis in this population. Data regarding prophylactic anticoagulation in patients with pancreatic malignancy is lacking, although there is evidence that prophylaxis does reduce incidence of venous thromboembolism in pancreatic malignancy. Whether this benefit equates to improved clinical outcomes needs further clarification. Methods: We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified patients who have pancreatic malignancy and acute pulmonary embolism using appropriate ICD-10 CM codes. We stratified patients based on the presence or absence of long-term anticoagulation. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of &lt;0.05 was considered statistically significant. The aim of this study is to investigate the outcomes among patients with pancreatic malignancy hospitalized for acute pulmonary embolism looking primarily at the in-hospital mortality, hospital length of stay (LOS) as well as total hospital charges. Results: We identified a total of 160,000 hospitalized patients with acute pulmonary embolism, of which 0.6% (1,120/160,000) had malignant neoplasm of the pancreas and 20.09% (225/1120) are on long-term anticoagulation. The overall in-hospital mortality among those with pancreatic malignancy hospitalized for acute PE was 5.91% (66/1,120). Among those who are on long-term anticoagulation, the overall in-hospital mortality rate was lower at 4.44% (10/225), however, it was not significantly different from those who are not on anticoagulation 6.29% (14/225) (p value=0.64). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, the use of long-term anticoagulation among hospitalized acute PE patients with history of pancreatic malignancy did not significantly decrease risk for in-hospital mortality (adjusted OR 0.37; 95% confidence interval [CI], 0.09-1.57; p=0.18), hospital LOS (adjusted OR 0.80; 95% confidence interval [CI], 0.63-10.26; p=0.86) or total hospital charges (p=0.32). Conclusions: Our analysis showed that among patients with pancreatic malignancy hospitalized for acute pulmonary embolism, the use of prior long-term anticoagulation did not significantly decrease the risk for in-hospital mortality, hospital LOS as well as total hospital charges. Prospective studies with control of possible confounders are warranted to further clarify the use of prophylactic anticoagulation in pancreatic malignancy and its impact on outcomes.

A retrospective analysis of the outcomes among hospitalized patients with myeloid leukemia undergoing leukapheresis: Insight from the National Inpatient Sample.

e19021 Background: Hyperleukocytosis often complicates the clinical picture in hematological malignancies. Historically, leukapheresis has been used to reduce the quantity of circulating white cells to reduce leukostasis, which can predispose to hypercoagulability and thromboembolism. Literature shows that leukapheresis does not offer any long-term survival benefits to patients, with some evidence of even worse outcomes at 6 months. Methods: We utilized the 2018-2020 National Inpatient Sample (NIS) Database in conducting a retrospective cohort study. We identified hospitalized patients who have myeloid leukemia undergoing leukapheresis using appropriate ICD-10 CM codes. We stratified patients based on whether they underwent leukapheresis or not. A survey multivariable logistic and linear regression analysis was used to calculate adjusted odds ratios (ORs) for the primary and secondary outcomes. A p value of &lt; 0.05 was considered statistically significant. The aim of this study is to investigate the outcomes among hospitalized patients with myeloid leukemia undergoing leukapheresis looking primarily at the in-hospital mortality, hospital length of stay (LOS) as well as total hospital charges. Results: We identified a total of 27,000 hospitalized patients with acute and chronic myeloid leukemia, of which 0.5% (135/27,000) underwent leukapheresis. The overall in-hospital mortality among those with myeloid leukemia was 9.86% (2662/27,000). Among those who underwent leukapheresis, the overall in-hospital mortality rate was significantly higher at 22.22% (30/135) (p = 0.05). Utilizing a stepwise survey multivariable logistic regression model that adjusted for patient and hospital level confounders, the use of leukapheresis among hospitalized myeloid leukemia patients did not significantly decrease the risk for in-hospital mortality (adjusted OR 2.54 95% confidence interval [CI], 0.84-7.73; p = 0.10), hospital LOS (adjusted OR 2.76; 95% confidence interval [CI], -2.11-7.62; p = 0.27) or total hospital charges (p = 0.19). Conclusions: Our analysis showed that among hospitalized patients with myeloid leukemia, leukapheresis did not significantly decrease the risk for in-hospital mortality, hospital LOS as well as total hospital charges. Caution should be exercised in interpreting the higher rate of in-hospital mortality among those who underwent leukapheresis as the higher mortality rate can be due to small sample size, or the fact that patients who require leukapheresis have uncontrolled and more advanced disease. Hyperleukocytosis in these patients may indicate a worse prognosis. A prospective study with a larger sample size to test for possible confounders is warranted in order to further delineate these associations.