Burden Of Comorbidities In Patients Research Articles

Contemporary Trends and Outcomes of Intravascular Lithotripsy in Percutaneous Coronary Intervention: Insights From BMC2

BackgroundWith an aging population and an increase in the comorbidity burden of patients undergoing percutaneous coronary intervention (PCI), the management of coronary calcification for optimal PCI is critical in contemporary practice. ObjectivesThis study sought to examine the trends and outcomes of coronary intravascular lithotripsy (IVL), rotational/orbital atherectomy, or both among patients who underwent PCI in Michigan. MethodsWe included all PCIs between January 1, 2021, and June 30, 2022, performed at 48 Michigan hospitals. Outcomes included in-hospital major adverse cardiac events (MACEs) and procedural success. ResultsIVL was used in 1,090 patients (2.57%), atherectomy was used in 1,743 (4.10%) patients, and both were used in 240 patients (0.57% of all PCIs). IVL use increased from 0.04% of PCI cases in January 2021 to 4.28% of cases in June 2022, ultimately exceeding the rate of atherectomy use. The rate of MACEs (4.3% vs 5.4%; P = 0.23) and procedural success (89.4% vs 89.1%; P = 0.88) were similar among patients treated with IVL compared with atherectomy, respectively. Only 15.6% of patients treated with IVL in contemporary practice were similar to the population enrolled in the pivotal IVL trials. Among such patients (n = 169), the rate of MACEs (0.0%) and procedural success (94.7%) were similar to the outcomes reported in the pivotal IVL trials. ConclusionsSince its introduction in February 2021, coronary IVL use has steadily increased, exceeding atherectomy use in Michigan by February 2022. Contemporary use of IVL and atherectomy is generally associated with high rates of procedural success and low rates of complications.

Cardiometabolic Co-morbidity Burden and Circulating Biomarkers in Patients With Chronic Coronary Disease in the ISCHEMIA Trials

Cardiometabolic co-morbidities, diabetes (DM), hypertension (HTN), and obesity contribute to cardiovascular disease. Circulating biomarkers facilitate prognostication for patients with cardiovascular disease. We explored the relation between cardiometabolic co-morbidity burden in patients with chronic coronary disease and biomarkers of myocardial stretch, injury, inflammation, and platelet activity. We analyzed participants from the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trials biorepository with plasma biomarkers (N-terminal probrain natriuretic peptide, high-sensitivity cardiac troponin T, high-sensitivity C-reactive protein, interleukin-6, soluble CD40 ligand, and growth differentiation factor-15) and clinical risk factors (hemoglobin A1c [HbA1c], systolic blood pressure [SBP], and body mass index [BMI]) at baseline. We defined cardiometabolic co-morbidities as DM, HTN, and obesity at baseline. Co-morbidity burden is characterized by the number and severity of co-morbidities. Controlled co-morbidities were defined as HbA1c <7% for those with DM, SBP <130 mm Hg for those with HTN, and BMI <30 kg/m2. Severely uncontrolled was defined as HbA1c ≥8%, SBP ≥160 mm Hg, and BMI ≥35 kg/m2. We performed linear regression analyses to examine the association between co-morbidity burden and log-transformed biomarker levels, adjusting for age, gender, estimated glomerular filtration rate controlled for hemodialysis, and left ventricular ejection fraction. A total of 752 participants (mean age 66 years, 19% women, 84% White) were included in this analysis. Self-reported Black race, current smokers, history of myocardial infarction, and heart failure had a greater cardiometabolic co-morbidity burden. The presence of ≥1 severely uncontrolled co-morbidity was associated with significantly higher baseline levels of high-sensitivity cardiac troponin T, high-sensitivity C-reactive protein, interleukin-6, and growth differentiation factor-15 than participants with no co-morbidities. In conclusion, increasing cardiometabolic co-morbidity burden in patients with chronic coronary disease is associated with higher levels of circulating biomarkers of myocardial injury and inflammation.

Comorbidity burden and outcomes after mechanical thrombectomy for large vessel occlusion: A retrospective analysis

ObjectivesPatients with acute ischemic stroke (AIS) often have an accumulation of pre-existing comorbidities, but its clinical impact on outcomes after mechanical thrombectomy (MT) remains unknown. Therefore, we examined whether comorbidity burden before AIS onset could predict clinical outcomes after MT. MethodsIn this retrospective cohort, we enrolled consecutive patients with community-onset AIS who underwent MT between April 2016 and December 2021. To evaluate each patient's comorbidity burden, we calculated Charlson comorbidity index (CCI), then classified the patients into the High CCI (≥ 3) and the Low CCI (< 3) groups. The primary outcome was a good neurological outcome at 90 days, defined as a modified Rankin scale 0-2 or no worse than the previous daily conditions. All-cause mortality at 90 days and hemorrhagic complications after MT were also compared between the two groups. We estimated the odds ratios and their confidence intervals using a multivariable logistic regression model. ResultsA total of 388 patients were enrolled, of whom 86 (22.2%) were classified into the High CCI group. Patients in the High CCI group were less likely to achieve a good neurological outcome (adjusted odds ratio of 0.26 [95% confidence interval, 0.12–0.58]). Moreover, symptomatic intracranial hemorrhage was more common in the High CCI (14.0% vs. 4.6%; adjusted odds ratio, 4.10 [95% confidence interval, 1.62–10.3]). ConclusionsComorbidity burden assessed by CCI was associated with clinical outcomes after MT. CCI has the potential to become a simple and valuable tool for predicting neurological prognosis among patients with AIS and MT.

Racial Disparities in Outcomes Following Surgical Fixation of Traumatic Thoracolumbar Fractures: A National Database Analysis

This study aims to assess race as an independent risk factor for postoperative complications after surgical fixation of traumatic thoracolumbar fractures for African American and Asian American patients compared with White patients. The 2011-2021 American College of Surgeons - National Surgical Quality Improvement Program (ACS-NSQIP) dataset was used to identify patients undergoing fusion surgeries for thoracolumbar spine fractures. Patient comorbidity burden was assessed using a modified 5-item frailty index score (mFI-5). Chi-squared and ANOVA tests were used to compare baseline clinical characteristics between groups. Multivariate analysis was performed to compare African American and Asian American patients with White patients controlling for age, BMI, and American Society of Anesthesiologists (ASA) score. African American patients experienced longer operative times compared to Asian American and White patients (3.74±1.87hours vs. 3.04±1.71hours and 3.48±1.81hours, P < 0.001). African American and Asian American patients demonstrated higher comorbidity burden with mFI-5>2 compared to White patients (30.7% and 25.6% vs. 19.9%, P < 0.001). African American and Asian American patients had a higher risk of postoperative complications than White patients (22.4% and 20% vs. 19.7%, P < 0.001). African American race was an independent risk factor of postoperative 30-day morbidity (OR 1.19, CI 1.11-1.28, P < 0.001). African American and Asian American patients undergoing thoracolumbar fusion surgeries exhibit disproportionate comorbidity burden, longer LOS, and greater postoperative complications compared with White patients. Furthermore, the African American race was associated with an increased rate of 30-day postoperative complications.

Regional variation from 2013 to 2021 in primary total shoulder arthroplasty utilization, reimbursement, and patient populations

BackgroundTotal shoulder arthroplasty (TSA), encompassing both anatomical and reverse total shoulder arthroplasty, has increased in popularity worldwide. The purpose of this study was to assess how TSA utilization, reimbursement, surgeon practices, and patient populations have evolved within the Medicare population from 2013 to 2021 at a national and regional level. MethodsThe Medicare Physician and Other Practitioners dataset was queried for all episodes of primary TSA (CPT-23472), both anatomic and reverse, between years 2013 and 2021. TSA utilization was assessed as volume per 10,000 Medicare beneficiaries. Average inflation-adjusted reimbursement, physician practice styles, and patient demographics of each TSA surgeon were extracted each year. Data was stratified geographically based on US census classifications and rural-urban commuting codes. Kruskal-Wallis and multivariate regressions were utilized to determine differences between regions. ResultsBetween 2013 and 2021, TSA utilization increased by 121.8% nationally. The increase was greatest in the Northeast (+147.2%) and least in the Midwest (+115.5%). Average TSA reimbursement declined by 8.8% nationally, with the least decline in the Northeast (6.4%) and the greatest decline in the Midwest (-11.9%). In 2021, the Midwest had the highest TSA utilization (18.1/10,000), while having the lowest average reimbursement ($1,108.59; p<0.001). The Northeast had the lowest utilization (11.5/10,000) and highest reimbursement ($1,223.44; p<0.001) in 2021. Nationally, the number of Medicare beneficiaries per surgeon performing shoulder arthroplasty declined by 5.9%, while the average number of TSAs per surgeon (+8.5%) and average number of billable services per beneficiary (+16.6%) both increased. Surgeons in the South performed the most services per beneficiary in 2021 (9.0; p<0.001). The average comorbidity burden of patients decreased by 4.8% between 2013 and 2021, with the West having the healthiest patients in 2021. Higher patient comorbidities were associated with lower physician reimbursement nationally (p<0.001). ConclusionThis study demonstrates that TSA utilization in the Medicare population has more than doubled between 2013 and 2021, while average inflation-adjusted reimbursement has declined by nearly 10%. The Midwest has the highest per-capita TSA utilization, while simultaneously having the lowest average reimbursement per TSA. Over time, TSA surgeons are seeing fewer and healthier beneficiaries but performing more services per beneficiary. Additionally, increased patient complexity may be associated with lower reimbursement. Together, these findings are concerning for long-term equitable access to care within shoulder surgery.

Trends in the Adoption of Outpatient Joint Arthroplasties and Patient Risk: A Retrospective Analysis of 2019 to 2021 Medicare Claims Data.

Total joint arthroplasties (TJAs) have recently been shifting toward outpatient arthroplasty. This study aims to explore recent trends in outpatient total joint arthroplasty (TJA) procedures and examine whether patients with a higher comorbidity burden are undergoing outpatient arthroplasty. Medicare fee-for-service claims were screened for patients who underwent total hip, knee, or shoulder arthroplasty procedures between January 2019 and December 2022. The procedure was considered to be outpatient if the patient was discharged on the same date of the procedure. The Hierarchical Condition Category Score (HCC) and the Charlson Comorbidity Index (CCI) scores were used to assess patient comorbidity burden. Patient adverse outcomes included all-cause hospital readmission, mortality, and postoperative complications. Logistic regression analyses were used to evaluate if higher HCC/CCI scores were associated with adverse patient outcomes. A total of 69,520, 116,411, and 41,922 respective total knee, hip, and shoulder arthroplasties were identified, respectively. Despite earlier removal from the inpatient-only list, outpatient knee and hip surgical volume did not markedly increase until the pandemic started. By 2022Q4, 16%, 23%, and 36% of hip, knee, and shoulder arthroplasties were discharged on the same day of surgery, respectively. Both HCC and CCI risk scores in outpatients increased over time ( P < 0.001). TJA procedures are shifting toward outpatient surgery over time, largely driven by the COVID-19 pandemic. TJA outpatients' HCC and CCI risk scores increased over this same period, and additional research to determine the effects of this should be pursued. Level III, therapeutic retrospective cohort study.

Sleep, Anxiety, Somatization, Quality of Life, and Resilience in Pediatric Patients With Eosinophilic Esophagitis.

Emerging evidence suggests a high burden of psychosocial comorbidities in patients with eosinophilic esophagitis (EoE), although factors associated with this burden have not been explored. We aimed to increase understanding of the psychosocial burden of EoE and assess factors that are associated with disease burden. We conducted a cross-sectional study of patients with EoE (n = 87) recruited from a single-center, multidisciplinary pediatric eosinophilic gastrointestinal disorders clinic (2019-2021). Participants (aged 8-18 years) completed validated assessments during routine clinic visit to assess EoE symptoms (Pediatric Eosinophilic Esophagitis Symptom Score version 2.0), quality of life (Pediatric Quality of LIfe- Eosinophilic Esophagitis), anxiety state and trait (State-Trait Anxiety Score for Children), somatization (Child Somatic Symptoms Inventory 24), sleep disordered breathing (Pediatric Sleep Questionnaire) and, in a subset (n = 35), resilience (Connor Davidson Resilience Scale). Clinical and demographic data were collected. Participants were at a mean (SD) age of 12.8 (3.1) years, and 26% (n = 23) were female. Shorter disease duration (6-12 months) was associated with higher symptom burden ( P = 0.03), somatization ( P < 0.01), and anxiety (State-Trait Anxiety Score for Children Trait P < 0.01) scores. Participants with neurodevelopmental comorbidities had higher anxiety trait, somatization, sleep disordered breathing, and lower quality of life ( P < 0.01 for all). Symptom burden was significantly associated with increased somatic symptoms (adjusted β [aβ] = 0.34; 95% confidence interval 0.23-0.45) and decreased quality of life (aβ = -0.42; 95% confidence interval -0.59 to -0.25) but not state anxiety, trait anxiety, or disordered sleep breathing. Pediatric patients with a recent diagnosis of EoE can experience higher EoE symptoms, somatization, and anxiety when compared with those with a longer-standing diagnosis. Patients earlier in their diagnosis and with neurodevelopmental disorders may experience increased somatization and anxiety that may warrant additional support services.

Abstract C010: Racial and ethnic differences in stage of presentation, comorbidity burden, and overall survival of oral cavity cancer

Abstract Background: Oral squamous cell carcinoma (OSCC) is one of the most common head and neck cancer subsites. Head and neck cancer (HNC) has the third worst Black vs. White five-year survival rate of all cancers in the United States. Among the most important determinants of survival in OSCC and HNC in general are clinical factors such as stage of disease presentation and patients' comorbidity burden. It is unclear, however, how these prognostic clinical factors differ based on sex, or race and ethnicity. This study aimed to examine racial/ethnic and sex differences in stage of presentation, comorbidity burden, and overall survival in a cohort of adult patients with OSCC in the United States. Methods: We used the 2004 to 2018 data from the National Cancer Data Base (NCDB) and created a cohort of adult patients with OSCC. Our outcomes of interests were stage of disease presentation, grouped as early-stage vs late-stage, comorbidity burden (scored as 0, 1, 2, 3+), and overall survival. We used multivariable logistic regression to estimate the odds of late-stage presentation and higher comorbidity burden based on race/ethnicity and sex, while controlling for other clinical and non-clinical covariates. We also calculated the adjusted hazard ratios to estimate overall survival using Cox regression model. Results: Our final sample included 185,358 patients, with the majority of our sample comprised of males (68%), Non-Hispanic (NH) White patients (85%), 62% presenting with late-stage disease, and 78% with a comorbidity score of 0. In our final models, male patients were significantly more likely to present with late-stage disease compared to females (aOR =1.21; 95% CI:1.15,1.26). NH Black patients (aOR = 1.85;95%CI:1.68,2.04), Hispanic patients (aOR =1.56; 95% CI:1.39,1.74), and NH Other patients (aOR = 1.22; 95% CI:1.091.37) were more likely to present with late-stage disease compared to NH White patients. Regarding comorbidity burden, NH Black patients (aOR =1.60; 95%CI: 1.26,2.03) were more likely to have the highest comorbidity burden (comorbidity score 3+) compared to NH White patients. Finally, female patients had slightly higher survival odds than male patients (aHR = 0.97; 95% CI:0.96,1.00), while Hispanic patients (aHR = 1.17; 95% CI:1.10,1.24) and NH Other patients (aHR =1.32; 95% CI:1.25,1.40) had worse survival odds compared to NH White patients. Conclusion: There is significant racial/ethnic and gender disparities in stage of presentation and comorbidity burden in patients with OSCC, and racial/ethnic minorities seem to fair worse. It is important to improve outcomes for patients with OSCC and to recognize and mitigate racial and gender disparities. Citation Format: Dina K. Abouelella, Alexandra Belcastro, Shreya P. Ramkumar, Meng Chen, Rong Jiang, Melissa C. White, Oluwole A. Babatunde, Eric Adjei Boakye, Tammara L. Watts, Trinitia Y. Cannon, Nosayaba Osazuwa-Peters. Racial and ethnic differences in stage of presentation, comorbidity burden, and overall survival of oral cavity cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C010.

Effectiveness of transitional-care heart failure programmes in multimorbid patiens: a population-based study with longitudinal real-world data in 77,554 patients

Abstract Background High comorbidity burden has a negative impact in terms of outcomes and medical resource use despite access to integrated care in universal health-care systems in patients with heart failure (HF). Whether the breach in outcomes determined by comorbidity burden can be mitigated by intensive HF management in integrated care programs is not known. Purpose To analyse the effectiveness across morbidity groups on health outcomes of integrated care before and after a pragmatic implementation of an intensive transitional care nurse-based HF management program in a healthcare area of 209,255 inhabitants. Methods We included all individuals discharged alive in Catalonia with HF as the primary diagnosis between 2015 and 2019. Morbidity and clinical complexity were evaluated using the Adjusted Morbidity Group (GMA) index. The GMA is an instrument developed and validated in Catalonia for grouping morbidity that identifies populations with multimorbidity and higher use of healthcare resources and has been shown better discrimination power than Charlson’s Index. For this study we classified patients into 3 morbidity groups: low or intermediate risk GMA, high risk GMA and very high-risk GMA. To evaluate the efficacy of the programme according to GMA strata, we compared outcomes between HF patients of the implementation area and HF patients of the remaining healthcare areas of Catalonia stratified in morbidity groups according to levels of GMA and across implementation periods (years 2015-2016 (pre-implementation), 2017 (transition) and 2018-2019 (consolidation). Results We included 77,554 patients: 3,396 exposed to the implementation area and 74,158 exposed to the rest of healthcare areas. 13,981 had a low or intermediate risk GMA 32,138 high risk and 31,435 very high risk. During the period of the study, 55,886 patients (72.1%) experienced at least one major adverse event. As shown in Table 1, multivariate adjusted Cox proportional hazards models stratified according to GMA groups showed that implementation of the program resulted in an improvement of all studied outcomes in the consolidation period compared to the pre-implementation period across all risk-group according to GMA. As shown in Figure 1, the implementation of the program resulted in a significant reduction of the risk adverse events compared to the rest of Catalonia during the consolidation period (left column) and this improvement was observed across all morbidity-group strata (Figure 1, central and right columns). Interestingly, the size effect of the improvement was particularly noticeable in patients in the high-risk and very high-risk group strata. Conclusions Transitional-care nurse-based HF programmes improve clinical outcomes in patients with HF and are effective regardless the comorbidity burden of patients. Individuals with a very high comorbidity index obtain even a greater reduction of readmissions when exposed to those programs than less comorbid patients.

Comorbidity Burden in Severe and Nonsevere Asthma: A Nationwide Observational Study (FINASTHMA)

Asthma, affecting more than 330 million people worldwide, is associated with a high level of morbidity, mortality, and socioeconomic costs. In this cross-sectional study, we analyzed the comorbidity burden in patients with severe asthma compared with nonsevere asthma and investigated the role of corticosteroid use on the risk of comorbidities. All adults (≥18 y) with a diagnosis of asthma (International Classification of Diseases-10th revision code J45.x) between 2014 and 2017 were identified and data were collected until 2018 from Finnish nationwide registers. Asthma was defined as continuously or transiently severe or nonsevere based on annual dispensed inhaled corticosteroids (ICS), oral corticosteroids (OCS), and hospitalizations. Of 193,730 adult identified patients diagnosed with asthma, 86.3% had nonsevere, 8.1% transiently severe, and 5.6% continuously severe asthma. Excess prevalence of pneumonia was observed in continuously (22%) and transiently severe (14%) compared with nonsevere patients after adjusting for age and sex. Cataract, osteoporosis, obesity, heart failure, and atrial fibrillation were also more frequent in severe asthma patients. The ICS and/or OCS use contributed to the risk of several comorbidities in a dose-dependent manner, particularly pneumonia, osteoporosis, obesity, heart failure, and atrial fibrillation. High OCS use and the presence of comorbidities were associated with increased health care resource use. Patients with severe asthma have a high burden of comorbidities, especially pneumonia. Many of the comorbidities have a strong dose-dependent association with ICS and OCS treatment, suggesting that corticosteroid doses should be carefully evaluated in clinical practice.

The Burden of Revision Total Ankle Replacement Has Markedly Increased from 2010 to 2020

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement (TAR) surgery has steadily increased in recent decades. The aim of the current study was to investigate the evolving burden of revision surgery and risk factors and timing of revision or implant removal. We hypothesized that there has been an increase in revision TAR and explant surgeries in the past decade and that younger age and higher comorbidity burden are risk factors for revision and explant. Methods: Using the 2010-2020 PearlDiver M151Ortho dataset, this retrospective cohort study identified primary TAR, TAR revision, and TAR explant patients. This is a large national database containing billing claims information on over 151 million patients in the United States across all payer types and sites of care. Patient factors investigated included age, sex, and Elixhauser Comorbidity Index (ECI, a longitudinal measure of patient comorbidity burden generated using ICD-9 and ICD-10 diagnosis codes). Annual incidence for primary and revision TAR, and explant were recorded. Multivariate logistic regression analyses were performed to determine independent risk factors for revision TAR or explant relative to primary TAR. For explants, the eventual intervention by two years was analyzed. Ten-year timing and survival to revision or explant surgery following patient-matched unilateral TAR were characterized. Results: Over the study period, there were 10,531 primary, 1,218 revision, and 1,735 explant TARs (increasing by 310%, 398%, and 9.6%, respectively). Independent predictors of revision TAR included: younger age (odds ratio [OR] 1.29 per decade decrease) and higher ECI (OR 1.23 per 2-point increase) (p &lt; 0.0001 for both). Independent predictors of explant surgery included: younger age (OR 1.80 per decade decrease, p&lt; 0.0001), female sex (OR 1.17, p=0.0011), and higher ECI (OR 1.35 per 2-point increase, p&lt; 0.0001). Explanted patients went on to arthrodesis (37.7%), amputation (26.1%), revision TAR (14.7%), or no identified procedure/other procedures (21.5%) within the subsequent two years. The 10-year implant survival rate following primary TAR was 91.8%. 73% and 83% of revisions and explants occurred in the first three years following index TAR, respectively. Conclusion: The burden of TAR revision has grown substantially over the past decade. Younger age, female sex, and higher patient comorbidity burden were associated with increased risk of revision or explant surgery. If explant is pursued, most went on to arthrodesis or amputation. These results suggest that care should be taken in patient selection for TAR to minimize the occurrence of revision and explant surgery. Treatment algorithms should be modified to optimize outcomes among patients who undergo explant or revision surgery.

Key drivers of 90-day costs in primary total elbow arthroplasty

BackgroundA comprehensive understanding of both surgical care costs and the factors influencing these costs is critical to make progress toward value-based care in orthopedics. Therefore, the purpose of this study was to assess 90-day health system costs in primary total elbow arthroplasty (TEA), the proportion of contribution from each cost group to total hospital cost, and to determine key drivers of 90-day costs in primary TEA. MethodsConsecutive patients who underwent primary TEA between 2014 and 2021 at a tertiary care academic medical center were included. An institutional accounting database was queried to determine direct costs to the health system attributed to TEA. All costs within 90 days of the surgical encounter were included for analysis to reflect the global postoperative period. Descriptive statistics were used to summarize patient and surgical characteristics, as well as cost data. Subcategories were determined to assess the key cost groups that contribute to total hospital fees for the entire cohort, and subanalysis was performed to evaluate only readmitted patients. Furthermore, a linear regression analysis was used to determine key drivers of 90-day costs in the setting of primary TEA. ResultsThirty-five patients who underwent primary TEA were identified from 2014 to 2021; 28 patients with 90-day cost data were included in this study. The mean surgical encounter cost was $18,075 (+/− $9772) and mean 90-day cost was $19,875 (+/− $9885). The largest proportion of health system costs in primary TEA was surgical implants (48%), followed by operating room fees (18%), surgical supplies (9%), and anesthesia (7%). Among readmitted patients, the most significant share of health system costs was attributed to surgical implants (30%) followed by operating room fees (22%). However, hospital fees (19%) experienced a substantial increase. In assessing the key drivers of 90-day health system costs, length of stay (B = 1304.30, 95% confidence interval [CI] 674.54 to 1934.05; P < .001), readmission (B = 16,148.55, 95% CI 7055.01 to 25,240.08; P = .001∗), and Charlson comorbidity index (B = 2247.43, 95% CI 68.64 to 4426.22; P = .044) were statistically significant predictors of increased 90-day costs. ConclusionImplant costs comprise nearly half of total 90-day costs in primary TEA, with operating room costs making the second largest contribution. Additionally, length of stay, readmission, and patient comorbidity burden were significantly associated with increased 90-day costs.

Meta-Analysis of the Prognostic Significance of Carotid Artery Stenosis in Patients Who Underwent Transcatheter Aortic Valve Implantation

Stroke is a known complication of both transcatheter aortic valve implantation (TAVI) and carotid artery stenosis (CAS). Whether CAS is a predictor of worse prognosis after TAVI is unclear. We performed a meta-analysis to assess the impact of CAS on the incidence of neurovascular complications and mortality after TAVI. We searched PubMed/MEDLINE and EMBASE databases from inception to January 2023. CAS was defined by ≥50% stenosis of at least 1 carotid artery. Studies comparing CAS versus non-CAS TAVI populations were included. Patients' baseline characteristics and 30-day clinical outcomes were extracted. End points included the 30-day incidence of neurovascular complications (stroke or transient ischemic attack) and 30-day all-cause mortality. We identified six studies, totaling 6,763 patients in the CAS group and 23,861 patients in the non-CAS group. Patients with CAS had a higher prevalence of hypertension, diabetes mellitus, dyslipidemia, previous myocardial infarction, coronary artery bypass graft, peripheral artery disease, previous neurovascular disease, and chronic kidney disease. There was no significant difference in the rates of 30-day neurovascular complications between CAS and non-CAS groups (relative risk 1.23, 95% confidence interval 0.63 to 2.40, p=0.54). CAS was associated with a higher risk of 30-day all-cause mortality (relative risk 1.28, 95% confidence interval 1.12 to 1.47, p<0.001), not found in a sensitivity analysis. In conclusion, patients with CAS presented with a significantly higher co-morbidity burden. CAS was not associated with an increased risk of 30-day neurovascular complications. 30-day mortality was higher in the CAS group but that may be a surrogate of the heavy co-morbidity burden of patients with CAS.

Comorbidities in palmoplantar pustulosis: aSwedish population-based register study.

This study investigated the comorbidity burden of Swedish patients with palmoplantar pustulosis (PPP) vs. the general population and patients with psoriasis vulgaris (PV). We found a significantly higher comorbidity burden in patients with PPP compared with the general population, represented by higher odds for disease across different categories (metabolic, cerebrovascular, cardiovascular, psychiatric). Although patients with PPP and PV showed similar comorbidity burdens overall, the comorbidity profiles differed significantly. Comorbidities such as type 2 diabetes and chronic obstructive pulmonary disorder, which showed both high prevalence (&amp;gt; 5%) in PPP and higher odds than PV, may be of particular importance for the specific comorbidity burden of PPP.

Increasing comorbidity burden of patients undergoing catheter ablation for atrial fibrillation in the past 10 years: An analysis of more than 8000 left-atrial ablation procedures

Abstract Funding Acknowledgements Type of funding sources: None. Background Catheter ablation is the most effective rhythm control treatment for atrial fibrillation (AF). While it was indicated as a symptomatic treatment in the past years, prognostic benefits of early rhythm control (ERC) were recently demonstrated and catheter ablation advances more and more into this indication. Restrictions in patient selection for catheter ablation seem to melt. Only few data on comorbidity burden in patients undergoing AF ablation is available. Purpose To determine prevalence of common cardiovascular and related comorbidities in patients undergoing left-atrial (LA) procedures between 2010 and 2021 at a large tertiary-care ablation center.. Method Eligible cases with LA procedures were identified through analysis of coded OPS data between 2010 and 2021. Analysis included patients with atrial fibrillation undergoing an ablation procedure including a transseptal puncture and mapping in the left atrium, not for other supraventricular tachycardias. Analysis accounted for different versions of the ICD-10-GM and OPS-ICHI catalogues. Comorbidities were defined as derived variables on a case-wise analysis from documented ICD-10 and OPS codes. CHA2DS2-VASc-score was calculated from these derived variables and demographic parameters. Procedures were clustered by intervention year in one of following ranges 2010-2012, 2013-2015, 2016-2018 and 2019-2021. Results 8396 left atrial procedures in 6184 individual patients (35% female, 63.6±11.0 years old at index procedure) were identified. Median CHA2DS2-VASc was 2 (IQR 1;3) in the overall cohort. Mean age increased constantly from 60.3±11.4 years in 2011 to 64.5±11.1 years in 2021. Median CHA2DS2-VASc-score remained constant at 2 points. While the share of non-paroxysmal AF patients was 52% between 2010 and 2012, it increased to 59% in 2016-2018 and decreased again to 55% in 2019-2021. The relative number of cases in which patients suffered from diabetes mellitus, chronic kidney disease, chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), pulmonary hypertension, coronary artery disease and prior myocardial infarction increased constantly between 2010-2012. While the share of patients with heart failure was highest between 2013 and 2015 (1368/2117 cases, 65%), it decreased to 833/2318 cases (36%) in 2019-2021. the absolute number of procedures nearly doubled from 2010-2012 to 2013-2015, it increased by only 36% from range 2013-2015 to 2016-2018. The number of procedures decreased again from 2016-2018 to 2019-2021 by 19%, likely due to COVID19-pandemic restrictions. Conclusion Over the last decade, the age and number of comorbidities increased in patients undergoing AF ablation procedures. These results put emphasis on offering safe procedures and perform adequate pre-procedural assessment of comorbidity burden.

Integration of primary care and mental health in a community health center: A quality improvement project to improve the health of patients with serious and persistent mental illness

BackgroundSevere Persistent Mental Illness (SPMI) is associated with increased morbidity compared with the general population. Our clinic serves a high percentage of SPMI patients. PurposeA Substance Abuse and Mental Health Services Administration (SAMHSA) grant enabled our clinic to integrate medical and mental health services with the aim of decreasing morbidity in SPMI patients. MethodsThis multiyear integration project included protocols for metabolic screening, increased staff to coordinate medical and mental health care, formation of an integrated treatment team, and increased patient engagement. Outcomes included biometrics and clinician feedback. DiscussionDespite significant challenges from the COVID-19 pandemic and civil unrest in our community, we saw improvements in patient biometric measurements by year 3 of the project. ConclusionThe results of this care model transformation project suggest that integration of primary and mental health care is a promising approach to decrease the burden of physical comorbidities in patients with SPMI.

Comorbidities in patients with myasthenia gravis in the USA: a retrospective claims database analysis (P1-5.003)

<h3>Objective:</h3> To characterize the comorbidity burden in patients with MG in the USA. <h3>Background:</h3> Patients with myasthenia gravis (MG) often have comorbidities that contribute to their overall disease burden. These comorbidities can be at risk of exacerbation due to the conventional treatments prescribed for MG. <h3>Design/Methods:</h3> This US retrospective observational cohort study utilized de-identified patient data (from 01/01/2006–06/30/2019) from the IQVIA insurance claims database. Eligible patients were ≥ 18 years old; had ≥ 2 claims (≥ 30 days apart) with MG diagnoses ICD9 or ICD10 codes; and had ≥ 1 year of continuous enrollment before and after MG diagnosis. Extracted data included demographic and clinical characteristics, comorbidities, treatment history and follow-up. The prevalence of comorbidities for the overall population and by conventional MG therapies were also assessed. <h3>Results:</h3> Data for 3,516 patients with MG were identified (51.2% male; mean age [standard deviation], 55.8 [13.9]; age range, 18–84 years). The most prevalent comorbidities were cardiovascular and endocrine disorders, including hypertension (41.9%), hyperlipidemia (37.1%), fatigue (24.8%), uncomplicated diabetes (18.2%), cerebrovascular disease (17.6%) and hypothyroidism (15.4%). Chronic pulmonary disease (13.5%) and sleep disorders (13.2%) were also common comorbidities. Patients were often prescribed conventional MG therapies, which have the potential exacerbate their comorbid conditions. Within 1 year prior to initiation of corticosteroids, 42.7%, 18.6% and 8.6% of patients were diagnosed with hypertension, uncomplicated diabetes and osteoporosis, respectively. Similarly, 6.5% of patients prescribed chronic intravenous immunoglobulin and 14.3% of patients prescribed azathioprine were diagnosed with venous thromboembolism and malignancy, respectively, within 1 year prior to treatment initiation. <h3>Conclusions:</h3> This study demonstrates the high rates of comorbidities in patients with MG and the importance of considering the potential impact of these comorbidities in treatment choice discussions. <b>Disclosure:</b> Dr. Basoff has received personal compensation for serving as an employee of Alexion Pharmaceuticals. Anju Parthan has received personal compensation for serving as an employee of Alexion. Anju Parthan has received personal compensation for serving as an employee of Alkermes. Anju Parthan has received stock or an ownership interest from Alexion. Mr. Bandaru has received personal compensation for serving as an employee of Alexion Pharmaceuticals. Dr. Thanataveerat has received personal compensation for serving as an employee of Genesis Research. Dr. Thanataveerat has received personal compensation for serving as an employee of Aetion. Mr. Kent has nothing to disclose. Dr. Hehir has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Argenx. Dr. Hehir has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alexion. Dr. Hehir has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB Pharma. Dr. Hehir has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for argenx. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Immunovant. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Habib has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Pfizer. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Genentech. Dr. Habib has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH/NINDS. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Habib has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for argenx. The institution of Dr. Habib has received research support from Alexion. The institution of Dr. Habib has received research support from RA pharmaceuticals. The institution of Dr. Habib has received research support from Immunovant. The institution of Dr. Habib has received research support from UCB. The institution of Dr. Habib has received research support from argenx. The institution of Dr. Habib has received research support from CabalettaBio. The institution of Dr. Habib has received research support from Genentech. The institution of Dr. Habib has received research support from Regeneron.

Lower Rates Of Social Deprivation And Co-morbidity Burden In Patients With V142I Transthyretin Cardiac Amyloidosis With Reduced Ejection Fraction

Lower Rates Of Social Deprivation And Co-morbidity Burden In Patients With V142I Transthyretin Cardiac Amyloidosis With Reduced Ejection Fraction

Rheumatoid arthritis patients are at increased risk for adverse events following lumbar discectomy

BACKGROUND CONTEXTLumbar discectomy is a common procedure for which patients with rheumatoid arthritis (RA) may be considered. RA is an autoinflammatory disease that may predispose patients to postoperative adverse outcomes. PURPOSETo assess the relative odds of adverse events after lumbar discectomy for those with versus without RA in a large, national, administrative dataset. STUDY DESIGN/SETTINGRetrospective cohort study using the 2010 to 2020 MSpine PearlDiver dataset. PATIENT SAMPLEAfter exclusion of patients under 18 years old, those with any trauma, neoplasm, or infection diagnosis within the month before lumbar discectomy, and any patients who had any alternative lumbar spinal surgery performed on the same day as lumbar discectomy, we identified 36,479 lumbar discectomy patients. 2,937 (8.1%) of these patients had a prior diagnosis of RA. After matching 4:1 by patient age, sex, and Elixhauser Comorbidity Index (ECI, a longitudinal measure of patient comorbidity burden generated via ICD-9 and 10 diagnosis codes), 8,485 lumbar discectomy patients without RA and 2,149 with RA were included. OUTCOME MEASURESIncidence of severe and minor adverse events in the 90-days following lumbar discectomy, predictive factors for adverse events within 90-days of lumbar discectomy, risk of adverse events within 90-days of lumbar discectomy stratified by patient medication regimen, 5-year survival to reoperation following lumbar discectomy. METHODSPatients undergoing lumbar discectomy were identified from the PearlDiver MSpine dataset. The subset of those with versus without RA were identified and matched 1:4 based on patient age, sex, and ECI scores. The incidence of 90-day adverse events in the two groups was determined and compared by univariate and multivariate analyses. Subgroup analysis was performed based on RA medications being taken. RESULTSMatched lumbar discectomy patients with RA (n=2,149) and without RA (n=8,485) were identified. Controlling for patient age, sex, and ECI, those with RA were at significantly higher odds of any (odds ratio [OR] 3.30), severe (OR 2.78), and minor (OR 3.30) adverse events (p<.0001 for all).Stratifying by medications being taken (and relative to those without RA), there was increasing odds of all adverse events (AAE) based on potency of medications (no biologic or disease modifying antirheumatic drugs [DMARDs] OR 2.33, DMARDs only OR 3.86, biologic±DMARDs OR 5.69 (p<.0001 for all). Despite this, no statistically significant difference in 5-year survival from subsequent lumbar surgery was found between those with versus without RA (p=.1000). CONCLUSIONSLumbar discectomy patients with RA were found to be at significantly higher risk for 90-day adverse events following lumbar discectomy, and this was incrementally greater for those on increasingly suppressive medications. Lumbar discectomy patients with RA bear specific consideration and perioperative monitoring when considered for lumbar discectomy.

Age and Comorbidity Burden of Patients Critically Ill with COVID-19 Affect Both Access to and Outcome of Ventilation Therapy in Intensive Care Units

During the COVID-19 pandemic, large numbers of elderly, multimorbid people required treatment in intensive care units. This study investigated how the inherent patient factors age and comorbidity burden affected the treatment strategy and the outcome achieved. Retrospective analysis of data from intensive care patients enrolled in the Lean European Open Survey on SARS-CoV2-Infected Patients (LEOSS) cohort found that a patient's age and comorbidity burden in fact influenced their mortality rate and the use of ventilation therapy. Evidence showed that advanced age and multimorbidity were associated with the restrictive use of invasive ventilation therapies, particularly ECMO. Geriatric patients with a high comorbidity burden were clustered in the sub-cohort of non-ventilated ICU patients characterized by a high mortality rate. The risk of death generally increased with older age and accumulating comorbidity burden. Here, the more aggressive an applied procedure, the younger the age in which a majority of patients died. Clearly, geriatric, multimorbid COVID-19 patients benefit less from invasive ventilation therapies. This implies the need for a holistic approach to therapy decisions, taking into account the patient's wishes.