In-hospital Outcomes In Patients Research Articles

The effect of HIV seropositivity on inpatient outcomes in atrial tachyarrhythmias: a US population analysis

Abstract Background With the advent of antiretroviral therapy, the life expectancy of persons living with HIV(PLHIV) has been significantly prolonged and we are now seeing this group increasingly affected by chronic conditions. Atrial fibrillation is the most common sustained tachyarrhythmias in adults and commonly coexists with atrial flutter. HIV-1 especially has been shown to possess a specific cardiac tropism in which chronic immune activation and inflammation may lead to cytotoxicity and death of cardiac myocytes. It has also been associated with left atrial enlargement, which may increase arrhythmia generation and propagation. The effect of HIV on outcomes in atrial tachyarrhythmias have been poorly studied, so we therefore wanted to explore this influence on in-patient outcomes. Purpose To assess the effect of HIV seropositivity on inhospital outcomes of patients admitted with atrial fibrillation/flutter (AF) Method The study uses data from the HCUP-NIS database, which includes billing information from hospitals across the US. The study population included patients admitted with a principal diagnosis of atrial fibrillation or atrial flutter in 2020. Patients with HIV positivity were identified using ICD-10 codes. Multivariate regression was used to analyze outcomes while adjusting for confounders. They were classified into two groups: AF-only (AF-O) and AF with HIV (AF-H). Results A total of 400,715 patients were admitted with a primary diagnosis of atrial fibrillation/flutter in 2020, 1175 were PLHIV. Patients in the AF-H group were more likely to be younger, non-Caucasian, tobacco smokers, have lower median income, be uninsured, have HFrEF and CKD. They however had lower rates of HFpEF than persons in the AF-O group. After adjusting for hospital level confounders, the in-hospital mortality rate was similar between the two groups (aOR 0.46 95% CI 0.05-3.98, p=0.48). The rates of ischemic stroke/systemic embolization, major bleeding, in hospital respiratory failure, length of stay and total hospital charges were also not significantly different Conclusion The study suggests that AF patients with HIV have similar in-hospital mortality rates as patients without. There are significant differences in the economic and ethnic makeup of the two groups but these did not significantly influence the outcomes of interest. Larger cohorts will be needed to confirm these findings definitively, especially as more persons with HIV continue surviving past the sixth decade of life.

Demographic, clinical characteristics, managements strategies and in-hospital outcomes of patients enrolled in prospective nationwide SCAD registry

Abstract Spontaneous coronary artery dissection (SCAD) is an uncommon yet increasingly recognized cause of acute coronary syndrome (ACS), particularly in young to middle-aged women. This multicentric, prospective nation-wide registry aimed to elucidate the demographic characteristics, clinical presentation, management strategies, and outcomes of patients with SCAD. A total of 95 patients with SCAD were enrolled in 10 centers, with females constituting 81% of the cohort, and with an average age of 49.7±11.9 years. Among the traditional risk factors, prior hypertension was observed in 49%, followed by hyperlipidemia in 43%, diabetes mellitus in 9% and prior or current smoking in 47% of patients. The presentation of SCAD as ST-elevation myocardial infarction (STEMI) was predominant, occurring in 61% of cases, with the left anterior descending artery (LAD) being the most involved vessel (68%). Regarding the classification of SCAD, type 2 SCAD was the most frequent (53%), followed by type 1 (24%) and type 4 (16%). Notably, involvement of the distal segment of the culprit artery was observed in 68% of cases, while baseline TIMI 3 flow was noted in 52% of patients. Percutaneous coronary intervention (PCI) was performed in 52% of cases, with pre-interventional TIMI 0-2 flow (62% Vs. 28%; p<0.05) and proximal artery involvement (41% Vs. 13%; p<0.05) being more prevalent compared to conservatively managed patients. Final stent implantation was performed in 67% of PCI cases, with TIMI 3 flow restoration in 76% of patients undergoing PCI. The average left ventricular ejection fraction prior to discharge was 51±9.9%. In-hospital mortality was reported in three female patients, undergoing attempted PCI with left main and LAD involvement. The use of antiplatelet therapy was widespread, with aspirin administered to 98% and P2Y12 inhibitors to 75% of patients at discharge. Data from this prospective nationwide multicentric SCAD registry show that SCAD occurs predominantly in relatively young female patients, with moderately prevalent traditional cardiovascular risk factors, usually presents as STEMI, with good overall survival rates despite half of the patients managed conservatively. PCI was often attempted in SCAD lesion with compromised arterial flow and located proximally, with lower rates of stent implantation and procedure success compared to traditionally observed rates in primary PCI. This underscores the importance of heightened awareness and tailored management approaches for this unique subset of ACS patients in order to refine risk stratification, optimize treatment strategies, and improve outcomes in this population.

Twenty Years of Sustained Improvement in Quality of Care and Outcomes for Patients Hospitalized With Stroke or Transient Ischemic Attack: Data From The Get With The Guidelines-Stroke Program.

The Get With The Guidelines-Stroke program is a quality improvement initiative designed to enhance adherence to evidence-based stroke care. Since its inception in 2003, over 2800 hospitals in the United States have participated in the program. We examined patient characteristics, adherence to performance measures, and in-hospital outcomes in patients hospitalized for acute ischemic stroke, subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack in The Get With The Guidelines-Stroke hospitals from 2003 through 2022. We quantified temporal changes in performance measure adherence and clinical outcomes over time. Performance measure denominators consisted of patients who were eligible, excluding those with contraindications. Over the 20 years of the program, a total of 7837 849 stroke cases (median age 71 years, 51.0% female; 69.2% ischemic strokes, 3.9% SAHs, 11.5% ICHs, and 15.3% TIAs) were entered into the registry. Except for antithrombotics at discharge, in which the baseline performance was >92%, there was sustained improvement in all performance metrics regardless of type of cerebrovascular event (P<0.01 for all). In patients with acute ischemic stroke, large improvements were observed for anticoagulation for atrial fibrillation (55.7% in 2003 to 97.2% in 2022), smoking cessation counseling (44.7%-97.8%), dysphagia screening (53.8%-83.5%), thrombolytic treatment for patients arriving by 3.5 hours, treat by 4.5 hours (15.2%-92.9%), door-to-needle time within 60 minutes (19.0%-75.3%), and endovascular door-to-puncture time within 90 minutes (54.7%-62.8%). Similar improvements were also observed for measures relevant to patients with subarachnoid hemorrhage, intracerebral hemorrhage, and transient ischemic attack. Multivariable analysis showed that there was a sustained increase in odds of receiving each performance measure over time, independent of patient and hospital characteristics for each type of cerebrovascular event. After risk adjustment, there were temporal trends that patients were less likely to be discharged to a skilled nursing facility, and, for ischemic stroke only, more likely to be discharged directly home. During the first 20 years, Get With The Guidelines-Stroke participation was associated with sustained improvement in evidence-based care and outcomes for patients with stroke and transient ischemic attack in the United States.

Sex-related differences in clinical characteristics and in-hospital outcomes of patients in acute type A aortic dissection

ObjectiveThe aim of this study was to investigate sex-related differences in the clinical characteristics and hospital outcomes of patients undergoing surgery for acute type A aortic dissection (AAAD).MethodsThis study was a retrospective study. Patients who underwent surgery for AAAD at the Department of Cardiac Surgery, Fujian Medical University Union Hospital, from January 2014 to March 2023 were consecutively included. Data was extracted from electronic medical records. The primary outcome measure was in-hospital mortality, and secondary outcome measures included new-onset postoperative arrhythmia (POA), acute kidney injury (AKI), hepatic dysfunction, neurological complications, gastrointestinal hemorrhage, ICU length of stay, and hospital length of stay. Patients were divided into two groups based on sex, and data analysis was performed using SPSS 25.0 software.ResultsA total of 1137 subjects were included, with 863 males (75.9%) and 274 females (24.1%). There were statistically significant differences in age and BMI between the two groups (P < 0.05). There was no statistically significant difference in the incidence of pain at the onset between the two groups, but chest tightness in females was higher than in males (22.6% vs. 13.8%). Regarding primary outcomes, the in-hospital mortality rate was 11.1% for males and 10.6% for females (P = 0.803). There were no statistically significant differences between the groups in ICU days, length of hospitalization, neurological complications, or liver dysfunction (P > 0.05). The rate of POA in females was 4.7%, higher than in males (2.2%), but AKI and gastrointestinal hemorrhage were both higher in males than in females (P < 0.05). Multivariate analysis showed that age, white blood cell (WBC) counts, lactic acid, operation duration and prolonged mechanical ventilation (PMV) increased the risk of in-hospital mortality in male patients. Hypertension, WBC counts, lactic acid, and PMV increased the risk of in-hospital mortality in female patients.ConclusionDespite significant baseline characteristic differences between male and female AAAD patients, there were no significant differences in onset symptoms. The in-hospital mortality rates were similar between male and female patients, but the risk factors for in-hospital mortality differed.

Characteristics and In-Hospital Outcomes of Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries - Insights From the Real-World JAMIR Database.

Few studies have investigated the clinical characteristics and in-hospital outcomes of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) using real-world databases in the coronary intervention era. We conducted a retrospective analysis of 22,236 patients (mean [±SD] age 68±13 years, 23.4% female) enrolled in the Japan Acute Myocardial Infarction Registry (JAMIR) between 2011 and 2016. Based on urgent coronary angiography findings, 286 (1.3%) patients were diagnosed as MINOCA, and the remaining 21,950 (98.7%) as MI with obstructive coronary artery disease (MI-CAD). MINOCA patients were characterized by younger age, fewer coronary risk factors, lower rate of ST-elevation myocardial infarction, lower Killip classification, and lower peak creatinine phosphokinase levels than MI-CAD patients. In-hospital all-cause mortality did not differ between the MINOCA and MI-CAD groups (5.2% vs. 5.7%, respectively; P=0.82). Comparing cause-specific mortality, non-cardiac mortality was higher in the MINOCA than MI-CAD group (4.2% vs. 1.6%; P<0.01). Importantly, non-cardiac death was more prevalent among elderly (≥65 years) than younger (<65 years) patients in the MI-CAD group, whereas this trend was not observed in the MINOCA group. Analysis of the real-world JAMIR database revealed a relatively high prevalence of non-cardiac death among MINOCA patients, underscoring the need for comprehensive management to improve disease prognosis, particularly in younger patients.

7679 The Role of Thyrotoxicosis in Determining Clinical Outcomes for Hospitalized Patients with Dilated Cardiomyopathy: A Propensity Match National Cohort

Abstract Disclosure: R. Mukhtar: None. H. Younas: None. A. Taha: None. D. Virlan: None. A. Ceban: None. A. Racovita: None. J. Patel: None. Background: Thyrotoxicosis, a condition associated with high morbidity and mortality, has been notably linked to adverse clinical outcomes in patients with cardiovascular diseases. This study aims to comprehensively analyze the clinical impact of thyrotoxicosis on in-hospital outcomes in patients hospitalized with DCM. Methods: Based on 2020 National In-patient Sample Database, DCM patients were categorized into two groups depending on whether thyrotoxicosis was present or absent at the time of admission. To evaluate the impact of thyrotoxicosis on clinical outcomes, comparative analyses were conducted using propensity score matching and multivariable regression analysis. All statistical analyses were performed using STAT v 17. Results: Among 545,390 hospitalizations for DCM, 2,900 (0.5%) patients were presented with thyrotoxicosis. Propensity score matching revealed that DCM patients with thyrotoxicosis had higher heart failure rates (7.87% vs. 5.62%, aOR: 1.39, 95% CI: 1.04-1.86, p-value: 0.03). There was no statistically significant difference in in-patient mortality (2.60% vs. 3.65%, aOR: 0.81, 95% CI 0.58-1.13, p-value: 0.21), conduction disorders (3.26% vs. 2.70%, aOR: 1.38, 95% CI: 0.89-2.13, p-value: 0.15), acute coronary artery syndrome (0.62% vs. 0.86%, aOR: 0.94, 95% CI: 0.54-1.64, p-value: 0.82), acute kidney injury (18.57% vs. 18.59%, aOR 0.99, 95% CI: 0.77-1.17, p-value: 0.62), and acute stroke (0.29% vs. 0.30%, aOR: 0.60, 95% CI: 0.15-2.44, p-value: 0.48) between DCM patients with and without thyrotoxicosis. Thyrotoxicosis was associated with increased length of stay [5 days (IQR: 6) vs. 4 days (IQR: 7)] and total charge [$54,256 (IQR: 82,126) vs. $47,942 (IQR: 75,003)] in patients admitted with DCM. Conclusion: This research indicates that DCM patients co-presenting with thyrotoxicosis have an increased risk of heart failure and resource utilization during hospitalization. There were no significant effects observed in conduction disorders, in-patient mortality, acute coronary, kidney, or stroke outcomes among DCM patients hospitalized with or without thyrotoxicosis. Future prospective studies are warranted to enhance our understanding of clinical outcomes associated with thyrotoxicosis in patients hospitalized with DCM. Presentation: 6/3/2024

Differences on In-hospital Outcomes in Patients with Cardiogenic Shock due to STEMI vs NSTEMI Using A Nationwide Database

ABSTRACT Background Our study aims to compare in-hospital management and outcomes in patients with cardiogenic shock due to ST-segment elevation myocardial infarction (STEMI) vs. non-ST-segment elevation myocardial infarction (NSTEMI). Methods We conducted a retrospective cohort study using the National Inpatient Sample database between 2016-2019, including patients with STEMI/NSTEMI complicated by cardiogenic shock. An inverse probability treatment weighting (IPTW) analysis was performed to compare in-hospital management and outcomes between patients with STEMI and NSTEMI. Adjusted relative risks (aRR) with their 95% confidence intervals (CI) were estimated. Results A total of 150,395 patients with cardiogenic shock due to acute myocardial infarction were included, of whom 52.8% had STEMI. The median age was 68 years (60 - 77) and 35% were female. Percutaneous coronary intervention (PCI), intra-aortic balloon counterpulsation, percutaneous ventricular assist device, extracorporeal membrane oxygenation and mechanical ventilation use were significantly higher in the STEMI group compared to NSTEMI. Coronary artery bypass grafting (CABG), renal replacement therapy, length of hospital stay, and total costs were lower in the STEMI group. Pulmonary arterial catheterization and cardiac transplantation were similar between both groups. IPTW analysis showed that in-hospital mortality was significantly higher in the STEMI group compared to NSTEMI (34.2% vs. 28.8%, aRR 1.19, 95% CI 1.14 - 1.23) and also major bleeding. Conclusion In conclusion, patients with cardiogenic shock due to STEMI had worse prognosis, higher use of PCI/mechanical circulatory support and major bleeding than the NSTEMI group. In contrast, patients with NSTEMI had greater use of CABG and hospital resources.

Coronavirus Disease-19-associated Mucormycosis: A Single-center Observational Study of 69 Patients.

We studied the clinical presentation, risk factors, complications, and in-hospital outcomes of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM). A retrospective study was done on 69 COVID-19 patients with microbiologically proven mucormycosis admitted over a period of seven months from March 2021 to September 2021. All 69 mucormycosis patients (46 males, 23 females) had reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed COVID-19 infection. Their mean age was 52.8 years, with mucormycosis developing in 51 patients (73.9%) within 30 days of COVID-19 infection; 7 (10.1%) were positive on admission. Rhino-orbital-cerebral mucormycosis (ROCM) was the most common (40.3%), followed by rhino-orbital (37.3%) and sinonasal (22.4%). Diabetes mellitus was present in 98.6% of patients. Common symptoms of mucormycosis were facial pain, headache, facial swelling, and vision loss. During COVID-19, 88.4 and 52.5% received immunosuppressive treatment and zinc sulfate, respectively; 34.7% needed intensive care unit (ICU) admission. The mortality rate was 26.1%. On multivariate logistic regression analysis, the presence of chronic kidney disease, leukocytosis, ophthalmoplegia, oral/palate ulceration, current need for invasive ventilation, and past duration of oxygen therapy and zinc supplementation were significantly associated with mortality. Patients with current COVID-19 infection had severe disease with increased need for intensive care (57.1 vs 14.5%) and higher mortality (57.1 vs 22.6%) compared to mucormycosis patients with previous COVID-19 infection. Rhino-orbital-cerebral, rhino-orbital, and sinonasal were the most common presentations in cases of mucormycosis, with a mortality rate of 26.1%. COVID-19 coinfection predisposes patients with mucormycosis to severe disease with higher mortality.

Impact of body mass index on in-hospital outcomes in patients receiving leadless pacemakers: A five-category analysis

BackgroundThe adoption of leadless pacemakers (LPMs) is increasing, yet the impact of body mass index (BMI) on procedural outcomes remains underexplored. ObjectiveThe purpose of this study was to explore the impact of BMI on in-hospital outcomes for patients receiving LPM implantation. MethodsData from the National Inpatient Sample from 2018–2021 were analyzed for patients older than 18 years who underwent LPM implantation, with specific inclusion and exclusion criteria applied. Patients were identified using International Classification of Diseases 10th Revision codes and categorized into BMI groups: underweight, normal, overweight, obese, and morbidly obese. The primary outcome assessed was in-hospital mortality. Secondary outcomes included blood transfusion, pericardial complications, infection/inflammation, removal/revision, and other complications. ResultsThe study included 3832 patients who underwent LPM implantation between 2018 and 2021, weighted to represent 19,610 patients, with 3540 having an appropriate BMI designation. Mortality was lower in the obese group (2.3%) compared to the nonobese group (2.7%) (adjusted odds ratio [aOR] 0.462, 95% confidence interval [CI] 0.259–0.623, P = .009). Compared to the normal weight group, those categorized as overweight, obese, and morbidly obese demonstrated a lower risk of in-hospital mortality (aOR 0.432, 95% CI 0.299–0.734, P = .009; aOR 0.465, 95% CI 0.238–0.721, P <.001; aOR 0.299, 95% CI 0.153–0.586, P <.001, respectively). ConclusionThese findings support the existence of the obesity paradox in patients with LPM implantation, where higher BMI categories are associated with improved mortality outcomes, meeting our prespecified primary endpoint. Further studies are needed to clarify the mechanisms behind these observations.

TCT-669 Impact of Epilepsy on In-Hospital Outcomes in Patients With Takotsubo Cardiomyopathy: A National Inpatient Sample Analysis

TCT-669 Impact of Epilepsy on In-Hospital Outcomes in Patients With Takotsubo Cardiomyopathy: A National Inpatient Sample Analysis

TCT-583 Influence of Heparin-Induced Thrombocytopenia on In-Hospital Outcomes in Patients With Left Ventricular Assist Devices (LVAD): A Decade-Long Study

TCT-583 Influence of Heparin-Induced Thrombocytopenia on In-Hospital Outcomes in Patients With Left Ventricular Assist Devices (LVAD): A Decade-Long Study

In-Hospital Outcomes of Patients with Non-ST Elevation Myocardial Infarction Undergoing Early Invasive Percutaneous Coronary Intervention

Methodology: A cross-sectional study was conducted in the Adult Cardiology Department at the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan, from August 2019 to February 2020. The study included 165 patients, both male and female, aged 40 to 75 years, who presented with NSTEMI and underwent early invasive PCI. All patients were either admitted through the emergency department or referred from outpatient services at NICVD. Comprehensive medical assessments were performed, and relevant medical history and clinical details were documented. PCI procedures were conducted under the supervision of experienced consultant cardiologists with over five years of procedural expertise. The primary outcomes evaluated were the incidence of cardiogenic shock, heart failure, and in-hospital mortality. Results: Of the 165 patients included in the study, 125 (75.8%) were male, with a mean age of 56.6±7.72 years and a mean BMI of 26.5±3.8 kg/m². Hypertension was prevalent in 100 (60.6%) patients, while 78 (47.3%) had diabetes mellitus. A history of smoking was reported in 70 (42.4%) patients. Heart failure emerged as the most common in-hospital adverse outcome, occurring in 25 (15.2%) patients, followed by cardiogenic shock in 9 (5.5%) patients, and in-hospital mortality in 20 (12.1%) patients. Conclusion: Among patients undergoing early invasive PCI following NSTEMI, heart failure was the most frequent adverse in-hospital outcome, followed by mortality and cardiogenic shock. These findings underscore the importance of vigilant monitoring and management of high-risk NSTEMI patients during the early stages of PCI intervention.

Prevalence, Characteristics, and Treatment Strategy of Different Types of Heart Failure in Patients With Nonvalvular Atrial Fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia in patients with heart failure (HF). Epidemiological data regarding HF in patients with AF are lacking. We describe the epidemiology, clinical features, treatment strategies, and in-hospital outcomes in patients with AF and HF. Patients with HF and nonvalvular AF in the Improving Care for Cardiovascular Disease in China-AF cohort from February 2015 to December 2019 were included. Patients were stratified by left ventricular ejection fraction into HF with reduced EF, HF with mildly reduced EF, and HF with preserved EF groups. The primary outcome was the occurrence of hospitalization for major adverse cardiovascular events, including death, cardiogenic shock, cardiac arrest, and stroke. Overall, 16 562 patients with AF and HF were included (mean age: 72.35±11.07 years; 46.1% female). HF with preserved EF (63.1%) accounted for the largest proportion, followed by HF with mildly reduced EF (19.0%) and HF with reduced EF (17.9%). Different HF subtypes in patients with AF had unique baseline demographic and clinical characteristics after multinomial logistic regression analysis. Compared with the HF with preserved EF group, hospitalization for major adverse cardiovascular events was increased in the HF with mildly reduced EF group (odds ratio=1.55 [95% CI, 1.18-2.03]) and HF with reduced EF group (odds ratio 1.60 [95% CI, 1.21-2.13]) after adjusting for confounders. In this large Chinese AF registry, the distribution of HF differed from the non-AF population. Patients with AF with different types of HF have unique demographic and clinical characteristics. Occurrence rates of in-hospital outcomes were higher in patients with HF with mildly reduced EF and patients with HF with reduced EF compared with the HF with preserved EF group. URL: http://www.clinicaltrials.gov; Unique identifier: NCT02309398.

Impact of Non-Alcoholic Fatty Liver Disease on Sepsis Inpatient Outcomes: A Nationwide Sample Analysis (2000-2019).

Background/Objectives: Patients with Non-Alcoholic Fatty Liver Disease (NAFLD) are reported to have an increased risk of developing severe infections, leading to hospitalizations with sepsis. However, data regarding the impact of comorbid NAFLD on in-hospital outcomes of patients with sepsis is scarce. Methods: This nationwide retrospective observational study using discharge data from the National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), and Agency for Healthcare Research and Quality included 21,057,911 adult patients who were admitted to hospitals in the United States between 2000 and 2019 with a primary discharge diagnosis of sepsis. These patients were categorized according to the presence or absence of comorbid NAFLD. The twenty-year trend of nationwide NAFLD prevalence among sepsis inpatients was elucidated. Multivariable logistic regression analysis was used to analyze NAFLD's impact on sepsis outcomes. Results: In the twenty-year study period, the prevalence of NALFD among sepsis inpatients trended up from 1.2% in 2000 to 4.2% in 2019. Similar trends were observed in regional analysis. While overall sepsis mortality decreased, comorbid NAFLD in sepsis patients was consistently associated with a higher adjusted in-hospital all-cause mortality rate (adjusted odds ratio (OR), 1.19; 95% confidence interval (CI), 1.07-1.32), higher odds of developing septic shock, and higher likelihood of development of multi-organ dysfunction. Conclusions: Comorbid NAFLD in the stage of NASH or cirrhosis is associated with higher in-hospital all-cause mortality and worse clinical outcomes in sepsis inpatients. Addressing this rising epidemic will be of paramount importance to improve sepsis in-hospital outcomes.

Obesity hypoventilation syndrome is associated with worse in-hospital outcomes in patients with acute myocardial infarction: A nationwide study

BackgroundObesity hypoventilation syndrome (OHS) is a condition characterized by obesity, daytime hypercapnia, and sleep-disordered breathing. The impact of OHS on outcomes in patients with acute myocardial infarction (AMI) remains poorly understood. MethodsWe conducted a retrospective analysis using data from the National Inpatient Sample (2016–2020) to evaluate the outcomes of patients with OHS admitted for ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). ResultsAmong STEMI and NSTEMI patients, 0.15 % and 0.37 % had OHS, respectively. After adjusting for confounders, OHS was associated with higher odds of in-hospital mortality, cardiac arrest, acute kidney injury, renal replacement therapy, and respiratory failure requiring intubation in NSTEMI patients. In STEMI patients, OHS was associated with higher odds of cardiac arrest, acute kidney injury, and respiratory failure. ConclusionOHS is associated with worse clinical outcomes in patients admitted with AMI, particularly in those with NSTEMI.

Demographics, Clinical Characteristics and In-Hospital Outcome of Coronavirus Disease 2019 (COVID-19) Patients With or Without Diabetes Mellitus

Introduction Diabetes Mellitus (DM) is one of the important co-morbidity that may negatively influence the clinical outcome of the coronavirus disease 2019 (COVID-19) if it co-exists. There is a paucity of data regarding the characteristics and outcomes of COVID-19 diabetic patients in comparison to non-diabetic patients. Thus, we aimed to compare demographics and clinical characteristics, and in-hospital outcome in COVID-19 positive patients with or without DM. Method This prospective observational study included all consecutive confirmed symptomatic and asymptomatic COVID-19 positive patients from March 8th 2020 to July 7th 2023at the National Heart Foundation Hospital &amp; Research Institute of Bangladesh. Patients were divided into two groups based on whether they had diabetes: Group I- patients with DM and group II- patients without DM. Baseline and clinical characteristics &amp; in-hospital outcome of patients in both groups were assessed for comparison. Result This study included a total of 2506 confirmed COVID-19 positive patients. Of them 1003 (40%) patients had DM (Group-I) &amp; 1503 (60%) were without DM (Group-II). Diabetic COVID-19 positive patients were older (56.87 ±11.84 years vs 45.92 ± 16.91 years; p=0.001) and had more co-morbidities (p= 0.001) than patients without DM. Only 4.2% healthcare personnel had DM. Diabetic patients (G-I) had more risk factors and comorbidities than non-diabetic patients (G-II): cardiovascular disease (90.4% vs 65.7%; p=0.001); hypertension (84.3% vs 41.4%; p=0.001); chronic kidney disease (47.7% vs 29.8%;p=0.001); smoking (37.8% vs 25.9%; p=0.001); dyslipidemia (37.2% vs 17.4%;p=0.001); and chronic obstructive pulmonary disease/bronchial asthma (7.5% vs 4.3%; p=0.001). Most of the patients with DM (G-I) were symptomatic (77.5% vs 66.7%; p=0.001). Shortness of breath was significantly higher in diabetic patients (44.8% vs 30.6%; p=0.001). Sore throat (12.0% vs 2.9%; p=0.001), diarrhea (5.4% vs 1.2%; 0.001), anosmia (10.6% vs 3.8%; p=0.001), and headache (16.5% vs 8.8%; p=0.001) were significantly higher in Group-II patients. Diabetic patients had more severe form of COVID-19 disease {(moderate: 3.5% vs 1.4%; p=0.001), (severe: 9.5% vs 4.1%; p=0.001), and (critical ill: 1.3% vs 0.4%; p=0.01)}.Most of the diabetic patients were hospitalized (52.0% vs 29.6%; p=0.001) and most of the non-diabetic patients were treated either in home isolation or in institutional isolation (70.4% vs 48.0%; p=0.001). COVID-19 patients with DM had worse outcome than patients without DM (mortality rate- 6.1% vs 2.6%; p=0.001). Conclusion COVID-19 diabetic patients were usually older, have more comorbidities, a higher probability of hospitalization, increased risk of severe/critical COVID-19 and associated with higher mortality rate as compared with patients without DM. Bangladesh Heart Journal 2024; 39(2): 108-116

In-Hospital Outcomes of Patients With Acute Respiratory Distress Syndrome Treated With Extracorporeal Membrane Oxygenation.

Treatment of acute respiratory distress syndrome (ARDS) with extracorporeal membrane oxygenation (ECMO) remains controversial. This study aims to examine outcomes in ARDS patients treated with or without ECMO. Using the National Inpatient Sample (NIS) database, all ARDS patients including those who were treated with ECMO were included in the analysis. Univariable and multivariable logistic regressions were used to estimate the odds of in-hospital outcomes between groups. A total of 2,540,350 patients were identified (2,538,849 with ARDS; 1,501 with ARDS on ECMO). The patients who underwent ECMO included younger patients and more men. Using ECMO in ARDS patients was associated with higher in-hospital mortality, cardiopulmonary arrest, major bleeding, sepsis, acute kidney injury, and longer hospital stays (31.7 vs. 8.3 days; p < 0.001 for all). A subgroup analysis based on age and sex had similar outcomes. Using ECMO in patients with ARDS was associated with worse in-hospital outcomes, including mortality and length of stay.

Outcome of Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) in a Tertiary Care Hospital

Background: Patients with chronic obstructive pulmonary disease (COPD) may suffer from recurrent exacerbations, with a worsening of symptoms and reduction in lung function that may not be recovered in a small proportion of patients. Exacerbations of COPD are associated with increased morbidity and mortality. Objectives: The objectives of the study were to find out the in-hospital outcome of patients admitted with COPD exacerbation Methods: This prospective observational study was conducted in the Department of Medicine, Shere Bangla Medical College Hospital, Barisal during the period of January 2022 to December 2022. 42 known patients with COPD exacerbation admitted in medicine unit during the study period were enrolled in the study by convenient sampling. COPD with bronchogenic carcinoma, with bronchiectasis and with ischaemic heart disease were excluded from the study. All patients were examined regularly for cough, sputum, grading of dyspnoea, tracheal tug, prominence of accessory muscles, sleep disturbance, frequency of inhaled β-2 agonist therapy per day for 7 days. After 7 days follow up, patients were categorized into-improved, when it fulfills the following GOLD criteria or not improved. After processing all available information Statistical analysis was done using SPSS for windows version 22. Results: The mean±SD age of the patients was 66.3±10.0 years with a range of 46-85 years.There were 37(88.1%) male patients and 5(11.9%) female patients. The mean±SD duration of illness of the patients was 9.24±4.05 years with a range of 2-15 years. The median duration was 10 years. Tracheal tag, prominence of accessory muscles of respiration, sleep disturbance, cyanosis, and loss of consciousness was present in 95.2%, 95.2%, 71.4%, 28.60% and 9.5% patients respectively. X-ray chest P-A view showed that 88.1% patients had the diagnosis of only COPD, 2.4% had COPD with cardiomegaly and 2.4% had COPD with cor-pulmonale and 7.1% normal X-ray finding. ECG finding showed that 9.5% patients had Cor pulmonale with COPD, 11.9% had sinus tachycardia, 4.8% had. RVH, 2.4% had p pulmonale with sinus tachycardia. The mean±SD oxygen saturation of the patients was 92.10±5.27% with a range of 72-95%. The median saturation was 94%. The mean±SD length of hospital stay was 5.21±1.18 days with a range of 3-7 days. The median length of hospital stay was 5 days. 39(92.9%) patients were improved and discharged from the hospital and 3(7.1%) patients died. Conclusion: The mean length of hospital stay was about 5 days. 92.9% of the cases, the symptoms of exacerbations of COPD subside within 10 days with standard regimen of treatment and in-hospital mortality was 7.1%

The Influence of SARS-CoV-2 Vaccination on the Mortality and Outcomes of Patients with Both Myocardial Infarction and COVID-19.

Background: This multi-site retrospective analysis with a control group was devised to evaluate the impact of prophylactic SARS-CoV-2 vaccination the on outcomes of myocardial infarction (MI) patients with confirmed COVID-19. Methods: An overall of 129 subjects who had been diagnosed with COVID-19 and MI were included in the analysis and were divided into the study group (44 vaccinated patients) and the control group (85 non-vaccinated comparable patients). The primary outcome measure was defined as the time until in-hospital death, while the secondary outcome measure was defined as the time until death outside the hospital setting. Results: According to in-hospital mortality analysis, 1 (2.27%) subject died in the study group, whereas a total of 19 (22.4%) subjects died among the controls (OR = 0.08; CI: 0.001-0.553; p = 0.023). The impact of vaccination on the in-hospital outcomes of patients treated for COVID-19 and MI was further confirmed using Cox regression analysis (HR: 0.1 CI: 0.01-0.77; p = 0.026). The observed difference was the absence of respiratory failure requiring mechanical ventilation in the study group, whereas it was observed in 14 (16.47%) patients in the control group. During out-of-hospital observation, there were no observed differences in mortality (OR: 1.56; 95% CI: 0.21-11.52; p = 0.66). Conclusions: The complete prophylactic SARS-CoV-2 vaccination course demonstrates a protective role in patients undergoing treatment for MI with confirmed COVID-19 during in-hospital observation.

Outcomes among patients with non-ST-elevation myocardial infarction on chronic anticoagulation: Insights from the National Inpatient Sample.

Chronic systemic anticoagulation use is prevalent for various thromboembolic conditions. Anticoagulation (usually through heparin products) is also recommended for the initial management of non-ST-elevation myocardial infarction (NSTEMI). To evaluate the in-hospital outcomes of patients with NSTEMI who have been on chronic anticoagulation. Using the National Inpatient Sample (NIS) years 2016-2020, NSTEMI patients and patients with chronic anticoagulation were identified using the appropriate International Classification of Diseases, 10th version (ICD-10) appropriate codes. The primary outcome was all-cause in-hospital mortality while the secondary outcomes included major bleeding, ischemic cerebrovascular accident (CVA), early percutaneous coronary intervention (PCI) (i.e., within 24 h of admission), coronary artery bypass graft (CABG) during hospitalization, length of stay (LOS), and total charges. Multivariate logistic or linear regression analyses were performed after adjusting for patient-level and hospital-level factors. Among 2,251,914 adult patients with NSTEMI, 190,540 (8.5%) were on chronic anticoagulation. Chronic anticoagulation use was associated with a lower incidence of in-hospital mortality (adjusted odds ratio [aOR]: 0.69, 95% confidence interval [CI]: 0.65-0.73, p < 0.001). There was no significant difference in major bleeding (aOR: 0.95, 95% CI: 0.88-1.0, p = 0.15) or ischemic CVA (aOR: 0.23, 95% CI: 0.03-1.69, p = 0.15). Chronic anticoagulation use was associated with a lower incidence of early PCI (aOR: 0.78, 95% CI: 0.76-0.80, p < 0.001) and CABG (aOR: 0.43, 95% CI: 0.41-0.45, p < 0.001). Chronic anticoagulation was also associated with decreased LOS and total charges (adjusted mean difference [aMD]: -0.8 days, 95% CI: -0.86 to -0.75, p < 0.001) and (aMD:$-19,340, 95% CI: -20,692 to -17,988, p < 0.001). Among patients admitted with NSTEMI, chronic anticoagulation use was associated with lower in-hospital mortality, LOS, and total charges, with no difference in the incidence of major bleeding.