Primary Diagnosis Of Myocardial Infarction Research Articles

Abstract 4134692: In-Hospital Mortality Rate and Predictors of 30-Day Readmission in Cancer Patients with MI Undergoing PCI -A Cross Sectional Study From Nationwide Readmission Database

Background and objectives: Data regarding readmission rates and predictors of readmission in cancer patients undergoing PCI are sparce. With the increasing survival rates and prevalence of cardiovascular complications in cancer patients, understanding the patterns and predictors of readmission in this population is paramount for optimizing their outcomes. Cancer patients pose unique clinical challenges due to their combined prothrombotic state and propensity for bleeding. We attempted to identify factors associated with readmission in cancer patients. Methods: We utilized the Nationwide Readmission Database from 2016 to 2020 and included patients more than 18 years of age with primary diagnosis of myocardial infarction(MI) who underwent percutaneous coronary intervention(PCI) and have a preexisting diagnosis of cancer. We used International Classification of Disease, Tenth Revision, Clinical Modification (ICD10 CM) codes to define MI, PCI, and cancer. The primary outcome was the 30-day readmission rate, and secondary outcomes were mortality rates, predictors of readmission, and common causes of readmission. The independent predictors of readmission were analyzed using cox regression analysis. Results: Of the 52,307 cancer patients who underwent PCI, 7,767 were readmitted within a 30-day period. The readmission rate for these patients was 15.70%. The mortality rate was 6.05% for index admission and 6.80% for readmitted cases. Among the readmitted patients in the strongest independent predictor for readmission were leaving against medical advice(AMA), anemia, congestive heart failure, and discharge to a skilled nursing facility or home health. Common causes of readmission within this time included hypertensive heart disease with concomitant CKD stage I-IV and heart failure (6.21%), sepsis (6.12%), NSTEMI (5.60%), hypertensive heart disease with concomitant heart failure (4.62%) and acute kidney injury (1.98%). Conclusions: Thirty-day readmission rate was 15.70%. Independent predictors of readmission were anemia, diabetes mellitus, congestive heart failure, malnutrition, peripheral artery disease, leaving against medical advice, and discharge to facility. Most common cause of readmission was hypertensive heart and kidney disease with heart failure, which comprised 6.21%.

Chronic Myeloid Leukemia and Myocardial Infarction: A Nationwide Readmission Database Analysis

Introduction Chronic myeloid leukemia (CML) is a hematological malignancy with an excellent outcome. After advancements in CML treatment and the introduction of different Tyrosine kinase inhibitors (TKI), their life expectancy is equivalent to the normal population. As a result of that, coronary artery disease is anticipated to be the leading cause of death among CML patients. It was particularly noted that TKI use is associated with the risk of endothelial dysfunction and it associated risk of cardiovascular events, including myocardial infarction. In this study, we compare the outcome of PCI in patients with CML to their matched non-CML group. Method The National readmission database (NRD) was searched from January 2016 to December 2020 for the study population. Adults above (age ≥ 18 years) with chronic myeloid leukemia hospitalized with a primary diagnosis of myocardial infarction, ST Elevation Myocardial Infarction (STEMI), and Non-ST-elevation myocardial infarction (NSTEMI) were identified using ICD 10 code. The primary outcomes were in-hospital mortality and 30-day readmission, and the secondary outcome was to compare the complications. The weighting of patient-level observations was implemented to obtain national estimates. Multivariate regression analysis models were built by including all confounders significantly associated with the outcome on univariable analysis with a cutoff P-value of 0.2. Variables deemed important determinants of the outcomes based on literature were forced into the models. For readmission comparison, we used the time-to-event Cox regression analysis. Propensity matching was done by the Greedy method. Proportions were compared using the Mantel-Haenszel Chi-square test or Fisher exact test, and continuous variables were compared using the Student t-test. All P values were two-sided, with .05 as the threshold for statistical significance. Results Out of 2727619 patients with myocardial infarction, 2124 CML patients were identified, and 888 CML patients had Percutaneous Coronary Intervention (PCI). Patients' baseline characteristics and major outcomes were compared (table 1). The mean age of CML patients was 68.34 ± 11.14 (P<0.001). The analysis showed no significant difference between CML and non-CML patients after PCI for the primary outcome of death 0.93 (CI 0.49-1.80) P value 0.527 and 30 days readmission rate 1.41 (0.99-2.01) P value 0.056. Also, there was no statistical significance in developing major complications, including cardiac arrest, coronary artery dissection, cardiac tamponade, stroke, thrombosis, major bleeding, AKI, and dialysis. Discussion and Conclusion Patients with hematologic malignancies, including chronic myeloid leukemia, are at increased risk of thrombosis. In CML, thrombosis can be venous or arterial (myocardial infarction, cerebrovascular accidents, and peripheral artery disease). Arterial thrombosis in CML is primarily linked to using different TKIs, and thrombotic events were reported with the second-generation TKIs like nilotinib, dasatinib, and ponatinib more often than with first-generation TKIs. The mechanism of TKI use-associated thrombosis is likely related to TKI-associated endothelial dysfunction and vascular toxicity that lead to accelerated atherosclerosis and subsequent vascular thrombosis. This increased risk might lead to an assumption of an increased risk of complications with vascular intervention like PCI. Some studies showed that PCI for hematological cancer patients with STEMI have no significant difference regarding in-hospital mortality. This analysis of patients with CML with myocardial infarction ( STEMI and NSTEMI ) showed no statistically significant difference in outcome after PCI between the two groups. There were no significant differences in mortality, 30 days readmission rate, and other complications post PCI. Therefore, diagnosis of chronic myeloid leukemia shouldn't prevent patients from receiving routine therapy and intervention because of the theoretical risk of thrombosis. This information aid in patient counseling and achieving the objective of maintaining a normal quality of life for chronic myeloid leukemia patients.

Frailty measured using an electronic frailty index and outcomes in older patients with myocardial infarction

Abstract Background Frailty is common amongst older patients with myocardial infarction and is an independent predictor of poor clinical outcomes. Despite this, frailty is not systematically or objectively measured nor routinely used in risk stratification. The electronic Frailty Index (eFI) is a frailty assessment tool which uses electronic health records to identify and classify frailty and has been shown to correlate well with in-person frailty assessment. However, the performance of the eFI in disease specific populations and its ability to predict individual patient outcomes is unclear. Purpose To assess the relationship between frailty, measured using the eFI, and the management and outcomes of older patients with myocardial infarction. Methods Consecutive patients admitted to hospital in the South East of Scotland between 01/10/2014 and the 01/03/2021 with a primary diagnosis of myocardial infarction were identified using International Classification of Disease (ICD-10) code I21 or I22. Patients under the age of 65 (n= 3,601) and those with no biomarker evidence of myocardial injury were excluded (n=1,301). The provision of guideline recommended therapy, recurrent hospital admission due to myocardial infarction, heart failure or stroke and 12-month all-cause mortality were compared between groups based on eFI classification (fit, mild, moderate or severely frail). Results Of the 3,930 patients (mean age 78 [SD 8] years, 43% female, 83% Caucasian), 2,324 (59%) were classified as frail with 1,421 (36%), 664 (17%), and 239 (6%) classified as mild, moderate and severely frail, respectively. The eFI was measurable in all patients. Patients with any degree of frailty were less likely to receive anti-platelet therapy, ACE inhibitor or angiotensin receptor blocker or beta-blocker therapy or undergo revascularisation with fewer than 1 in 10 patients with severe frailty undergoing inpatient coronary catheterisation (7.5% vs 57% non-frail, P <0.001 for all). Frailty was independently associated with an increased incidence of recurrent myocardial infarction, heart failure or stroke within 12 months with the odds greatest in those with severe frailty (OR 1.93 (95% CI 1.42-2.61%)). The primary outcome of all-cause death at 12-months occurred in 355 (25%), 226 (34%) and 109 (46%) patients with mild, moderate and severe frailty compared with 176 (11%) in non-frail patients (Figure 1). Frailty status was an independent risk factor for all-cause mortality with the risk of death greatest in those with severe frailty (HR 2.64 (95% CI 1.63 – 3.67, p<0.001)). Conclusion The eFI identified patients at increased risk of in-patient death, major adverse cardiovascular events, and all-cause mortality within 12 months following myocardial infarction. Measurement of the eFI from linked healthcare data is feasible and could be used to aide personalised risk stratification and service utilisation in older patients admitted with myocardial infarction.Cumulative incidence plotForest plot with adjusted hazard ratio

Abstract 17428: Severity of Diastolic Dysfunction Predicts Risk of Myocardial Infarction

Background: Diastolic dysfunction (DD) is known to be a predictor of mortality. However, the impact of DD on the risk for myocardial infarction (MI) is not well defined. Research Question: We sought to examine whether DD is an independent predictor of risk of MI in patients with a preserved ejection fraction. Methods: This was a retrospective study of consecutive patients who underwent an echocardiogram that showed normal systolic function and had ≥3 months of follow-up. DD was graded using the contemporaneous guidelines at the time of the echocardiogram. Subsequent MI was determined by the presence of an inpatient encounter with a primary diagnosis of MI. Results/Data: 136,455 patients were included (mean age 56 years; 58% women). DD was present in 18.3% of patients (14.1% Grade 1, 3.8% Grade 2, 0.4% Grade 3). Patients with DD were more likely to be older (71 vs 53 years) and have coronary artery disease (27% vs 12%), diabetes (27% vs 14%), hypertension (69% vs 47%) and hyperlipidemia (64% vs 41%), among other comorbidities. Survival free from MI was significantly lower as diastolic dysfunction severity increased (Figure 1). Multivariate Cox proportional hazards modeling demonstrated that DD was an independent predictor of MI (hazard ratios [CI]: Grade 1: 1.51 [1.35-1.69]; Grade 2: 1.92 [1.64-2.25]; Grade 3: 2.82 [1.94-4.09]). Conclusions: Our data demonstrate that the risk of MI is significantly increased in the presence of DD, with higher risk at higher grades of DD. The increased risk associated with grade 3 DD is comparable to that from a prior history of coronary artery disease. These findings suggest that the severity of DD may be a useful tool in risk stratifying patients for risk of MI.

Abstract 12409: Ambient Fine Particulate Matter and Ozone Air Pollution Are Differentially Associated With Hospitalization for Unstable Angina and Acute Myocardial Infarction During Wildfire and Inversion Seasons

Background: Short-term increases (days to weeks) in fine particulate matter (PM 2.5 ) air pollution are associated with hospitalization for acute coronary syndromes (ACS). A changing climate is shifting sources of PM 2.5 toward summer wildfires in the western US. This study evaluated if short-term increases in PM 2.5 and ozone were associated with ACS risks in wildfire (June-October) and winter inversion (Nov.-March) seasons. Methods: Case-crossover analyses examined N=21,414 subjects with emergency or inpatient hospitalization at 11 Intermountain hospitals for ACS, including the primary diagnosis of myocardial infarction (AMI, n=20,287) or unstable angina (USA, n=1,127). PM 2.5 data were collected in January 1, 1999 to March 31, 2022 (ozone: 2006-2022) from community monitors on Utah’s Wasatch Front. Odds ratios (OR) and 95% confidence intervals (CI) were computed by Poisson regression with adjustment for weather data. Results: Subjects averaged 66±14 years of age and 31.0% were female. Overall PM 2.5 increases were associated with concurrent day (lag 0 days) ACS hospitalizations (OR=1.024 per +10 μg/m 3 , CI: 1.004, 1.043, p=0.019), driven by AMI (OR=1.025 per +10 μg/m 3 , CI: 1.004, 1.045, p=0.017). USA admissions were delayed to the second week [lag moving average (mAvg) days 7-13] after PM 2.5 increases (OR=1.090 per +10 μg/m 3 , CI: 1.024, 1.159, p=0.007) and PM 2.5 associations with USA were strengthened by adjustment for ozone. Analyzed by wildfire and inversion seasons, PM 2.5 associations differed for AMI and USA (Figure). Short-term increases in ozone in wildfire season were associated with lower USA risk at lag 1, lag 2, 3-day mAvg 0-2, and 1-week mAvg 0-6 and lower AMI risk at mAvg 7-13, but not with inversion season risks. Conclusions: Short-term increases in PM 2.5 air pollution were associated with ACS hospitalizations for AMI and USA, with patterns of risk differing between wildfire and inversion seasons. Ozone increases were not associated with greater risk.

Individualized assessment and optimization of post myocardial infarction care by introducing a hybrid clinic - A DGH experience

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Optimal secondary prevention remains key in improving cardiovascular outcomes post myocardial infarction. Barriers to achieving timely and individualized medical optimization include unavailability of close follow up’s, compliance to secondary prevention, and more recently, the impact of COVID pandemic on outpatient face to face clinic appointments. With the recent emphasis from the European Society of Cardiology on secondary prevention in addition to optimizing lipid therapy, a dedicated service for post MI patients to address individualized risks can provide a timely opportunity to improve holistic cardiovascular care. Purpose To assess established secondary prevention practices, we initially audited 52 patients who presented with ACS between Jan 2020 and July 2020. These patients were assessed for post MI care optimization at 6 weeks post discharge. Utilizing ESC guidelines as audit targets, in our 6-week post discharge audit, we identified that there was scope of ACE-inhibitor up titration in 55.8% of the patients, beta-blocker optimization in 9.6%, Lipid lowering agents in 15.4%, mineralocorticoid receptor antagonist addition in patients with impaired LV systolic function in 5.8% of the patients. 5% of patients with new diagnosis of diabetes required referral to specialist teams for diabetic medication initiation or optimization. These results provided an opportunity to introduce a structured post MI clinic that will allow individualized risk assessment on an outpatient basis. Method We proposed a one stop hybrid clinic where all patients discharged following a myocardial infarction received a consultation 6 – 8 weeks following a discharge. These patients were sent blood forms 2-3 weeks prior to their appointment for full blood count levels, renal functions, liver profile, HBa1c levels and lipid profile. Focus of this consultation was to assess and educate the patient on risk factors (smoking, diabetes, cardiac rehab program), assess and address compliance to secondary prevention medications and finally titrate medications to maximum tolerated doses whilst achieving ESC defined targets for secondary prevention (post MI target systolic BP<140mmHg in non diabetics and <130mmHg in diabetics, LDLc <1.4, smoking cessation, HBa1c <49). Where appropriately identified, referral to lipid specialist and diabetes specialist teams were made to provide holistic multi-disciplinary management. Results To understand the Impact made by the clinic we obtained patient list through local electronic records to filter those discharged with a primary diagnosis of myocardial infarction in 2022. An audit tool was created and data collection was performed including baseline characteristics as per table 1 and interventions made Table 2. Conclusion(s) By establishing the post MI clinic we were able to demonstrate efficient individualized assessment and optimization of secondary prevention risk factors and pharmacotherapy.

Outcomes Following Acute Coronary Syndrome in Patients With and Without Rheumatic Immune-Mediated Inflammatory Diseases.

Background Rheumatic immune mediated inflammatory diseases (IMIDs) are associated with high risk of acute coronary syndrome. The long-term prognosis of acute coronary syndrome in patients with rheumatic IMIDs is not well studied. Methods and Results We identified Medicare beneficiaries admitted with a primary diagnosis of myocardial infarction (MI) from 2014 to 2019. Outcomes of patients with MI and concomitant rheumatic IMIDs including systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, dermatomyositis, or psoriasis were compared with propensity matched control patients without rheumatic IMIDs. One-to-three propensity-score matching was done for exact age, sex, race, ST-segment-elevation MI, and non-ST-segment-elevation MI variables and greedy approach on other comorbidities. The study primary outcome was all-cause mortality. The study cohort included 1 654 862 patients with 3.6% prevalence of rheumatic IMIDs, the most common of which was rheumatoid arthritis, followed by systemic lupus erythematosus. Patients with rheumatic IMIDs were younger, more likely to be women, and more likely to present with non-ST-segment-elevation MI. Patients with rheumatic IMIDs were less likely to undergo coronary angiography, percutaneous coronary intervention or coronary artery bypass grafting. After propensity-score matching, at median follow up of 24 months (interquartile range 9-45), the risk of mortality (adjusted hazard ratio [HR], 1.15 [95% CI, 1.14-1.17]), heart failure (HR, 1.12 [95% CI 1.09-1.14]), recurrent MI (HR, 1.08 [95% CI 1.06-1.11]), and coronary reintervention (HR, 1.06 [95% CI, 1.01-1.13]) (P<0.05 for all) was higher in patients with versus without rheumatic IMIDs. Conclusions Patients with MI and rheumatic IMIDs have higher risk of mortality, heart failure, recurrent MI, and need for coronary reintervention during follow-up compared with patients without rheumatic IMIDs.

Characteristics and Outcomes of Critically Ill Patients with Raised Cardiac Troponins Admitted in the Intensive Care Unit: A single centre experience from Oman.

ObjectivesCritically ill patients have raised troponins. This study aimed to assess the incidence of myocardial injury in the intensive care unit (ICU) at a tertiary care hospital and assess the management and prognosis.MethodsThis retrospective study included adult patients who were admitted to the ICU of Sultan Qaboos University Hospital, Muscat, Oman, between January and December 2019 and had undergone a high-sensitive cardiac troponin (hs-cTn) assay. Patients admitted with a primary diagnosis of myocardial infarction were excluded.ResultsA total of 264 patients had their hs-cTn measured during the study period. Of these, 128 (64.3 ± 17.1 years; 58.6% male) had elevated levels, giving an incidence rate of approximately 48.5%. Those with raised troponin were older and had more co-morbidities. These patients were also more critically ill with lower blood pressure, higher heart rates and increased hypotensive episodes. Of these, 47 were treated for acute coronary syndrome, 32 underwent coronary angiography and only three required stenting. Patients with raised troponin had a poor outcome with only 45 (35.2%) surviving to discharge compared to 101 (74.3%) with normal troponin. Patients with raised troponin had shorter hospital stays than those with normal troponin (16 versus 19 days; P = 0.017).ConclusionA high proportion of critically ill patients showed evidence of myocardial injury without significant coronary artery disease, which is associated with a poor prognosis. Further prospective studies are required to ascertain the best course of treatment for these patients.

Trends in Hospitalization Rates for A First Myocardial Infarction In New Jersey 2000-2014

There has been a remarkable decline in the incidence of myocardial infarction (MI) for the past several decades. However, scant data are available on whether this decline has increased, diminished, or remained stable in recent years. Using the Myocardial Infarction Data Acquisition System (MIDAS), a statewide database of all cardiovascular hospital admissions in New Jersey, we identified 168,966 patients with a primary diagnosis of MI. We examined time trends in incidence from the year 2000 to the year 2014. A steep decline in MI incidence was observed in all age groups with an overall decline of 30.2% over the period. The decline was seen in all age groups but was most pronounced in the 80-84 age group. Hispanics had the greatest decline followed by whites and finally blacks. Males had a greater decline than females. The decline was seen to level off after 2008. This remarkable pattern of incidence decline may be related to the increase in use of interventional and pharmacological therapies that plateaued after 2008. In conclusion, this study shows a decline in MI incidence that leveled off after 2008.

Treatment Bias in Management of HIV Patients Admitted for Acute Myocardial Infarction: Does It Still Exist?

Previous studies have reported lower rates of coronary angiography and revascularization, and significantly higher mortality among patients infected with human immunodeficiency virus (HIV) presenting with acute myocardial infarction (AMI). This observational study was designed to evaluate characteristics and inpatient outcomes of patients with seropositive HIV infection presenting with AMI. Using the National Inpatient Sample (NIS) database, we identified patients (admissions) with a primary diagnosis of myocardial infarction and a co-occurring HIV. We described baseline characteristics and outcomes. Our primary outcomes of interest were prevalence of coronary angiography, revascularization (percutaneous coronary intervention (PCI) or CABG), and mortality. From 2010 to 2014, of about 2,977,387 patients with a primary diagnosis of AMI, 10,907 (0.4%) were HIV seropositive. Patients with HIV were younger and more likely to be African American or Hispanic. Coronary angiography and revascularization were performed more frequently in the HIV population. The higher prevalence of revascularization was driven by a higher incidence of PCI. In a multivariable model, patients with HIV were no more likely to undergo revascularization than the general population. This was also the case for PCI. Unadjusted all-cause mortality was lower among patients with HIV. After controlling for confounders, this finding was not significant (OR 0.97, 95% CI 0.75-1.25, p = 0.79). The length of stay between both groups was comparable. In this current analysis, we did not note any treatment bias or difference in the rate of in-hospital total mortality for HIV-seropositive patients presenting with AMI compared with the general population.

Palliative Care in Myocardial Infarction: Patient Characteristics and Trends of Service Utilization in a National Inpatient Sample.

Myocardial infarction (MI) remains a leading cause of mortality. Palliative care (PC) has recently expanded in scope to include noncancer-related conditions. There is little data available regarding the use of PC in critical MI patients. We used discharge data from the National Inpatient Sample for the years 2012 to 2014. We examined discharges with a primary diagnosis of MI. We measured the rate of PC referral, trend in utilization during the study period and possible predictors of PC utilization. Among 1 667 520 discharges of those patients ≥18 years of age and with a primary diagnosis of MI, use of PC was seen in 2.5% of all patients and in 24% of patients who died. In a multivariable logistic regression, we found the presence of cancer, cardiogenic shock, dementia, stroke, hemiplegia, the use of circulatory support, and mechanical ventilation were associated with higher likelihood of PC referral. Palliative care referral increased during the study period, odds ratio of 1.18 per year (95% confidence interval: 1.14-1.21; P value <.001). Palliative care was not associated with prolonged length of stay. Several comorbidities were associated with the use of PC, most notably the use of mechanical ventilation and the presence of metastatic cancer. There was a trend of increasing use of PC during the study period.

Relation of Venous Thromboembolism Risk to Ischemic Stroke Risk in Hospitalized Patients with Cancer

Patients with cancer are at increased risk for venous thromboembolism (VTE). However, the relationship of cancer type to the risk of arterial thrombosis in patients with high VTE risk has not been described. The goal of this study is to determine the rate of arterial thrombosis in patients with different types of solid tumors stratified by VTE risk. Using the 2012 National Inpatient Sample, we identified 373,789 hospitalizations involving patients ≥18 years associated with solid tumors, stratified by type. Data were collected on clinical characteristics, VTE (deep vein thrombosis [DVT] and pulmonary embolism [PE]), and arterial thrombosis (primary diagnosis of myocardial infarction [MI] and ischemic stroke). Subjects with solid tumors (stages I to IV) were stratified by VTE risk - high versus low. Certain solid tumor types (esophageal, lung, melanoma, ovarian, pancreatic, stomach, and uterine) were found to be associated with a higher rate of VTE compared with other cancer types (6.8% vs 3.9%, p < 0.001). Multivariate analysis applied to the high VTE risk group showed no increased risk for MI (odds ratio [OR] 0.93, p = 0.74), however, the rate of ischemic stroke was increased (OR 1.22, p < 0.001). Those in the high VTE risk group who had metastatic disease were at higher risk for arterial thrombosis (MI OR 1.35, p < 0.001, ischemic stroke OR 2.43, p < 0.001). In conclusion, different cancer types are associated with increased risk of both venous and arterial thrombosis and the risk is further increased by the presence of metastatic disease.

A National Population-based Study of Adults With Coronary Artery Disease and Coarctation of the Aorta

Adults with repaired coarctation of the aorta (CoA) suffer reduced long-term survival compared with the general population, in part due to coronary artery disease (CAD). There is conflicting evidence as to whether or not CoA is an independent risk factor for CAD. The primary aim was to determine if CoA is independently associated with premature myocardial infarction (MI) in the contemporary era. The secondary aim was to determine if CoA is independently associated with early coronary intervention. In a cross-sectional study using the National Inpatient Sample database from 2005 to 2014, we compared the age at MI and the age at coronary intervention (coronary artery bypass grafting or percutaneous coronary intervention, in the absence of MI diagnosis) in patients with and without CoA using weighted linear regression. Among 5,472,416 observations with a primary diagnosis of MI, 174 had a diagnosis of CoA. Patients with CoA had MI 7.2 years younger than those without CoA, after adjusting for potential confounders (95% CI -11.3, -3.1, p = 0.001). Among 3,631,718 patients without a diagnosis of MI who underwent coronary artery bypass grafting or percutaneous coronary intervention, 279 had a diagnosis of CoA. Patients with CoA who underwent coronary intervention were 15.6 years younger than those without CoA, after adjusting for potential confounders (95% CI -18.3, -12.9, p < 0.001). In conclusion, patients with CoA have MI at a slightly younger age and undergo coronary intervention at a significantly younger age than those without CoA in the contemporary era. Our findings support continued close surveillance for and treatment of modifiable risk factors for CAD.

Impact of delirium on patients hospitalized for myocardial infarction: A propensity score analysis of the National Inpatient Sample.

Delirium is associated with worse outcomes in critically ill patients. In the subset of patients with myocardial infarction (MI), the impact on clinical outcomes of delirium is not as well elucidated. Delirium is associated with increased mortality in patients hospitalized for MI. The study used data from the National Inpatient Sample 2012 to 2014, Healthcare Cost and Utilization Project. We included discharges associated with the primary diagnosis of MI using the relevant International Classification of Diseases, Ninth Revision, Clinical Modification codes. The outcome was inpatient mortality between the delirium group and propensity score-matched controls without delirium. The study included 1 330 020 weighted discharges with MI as the principal diagnosis. Within this cohort, 18 685 discharges (1.4%) had delirium. Delirium was associated with older age, lower rates of percutaneous coronary intervention, and increased comorbid conditions. The delirium group had higher mortality (10.5% vs 2.6%, P < 0.001). Propensity score-matching analysis showed increased mortality in the delirium group (10.5% vs 7.6%, relative risk: 1.39 [95% confidence interval: 1.2-1.6, P < 0.001) using nearest neighbor 1:1 matching. In individuals with MI, delirium was associated with increased inpatient mortality.

Factors that influence care priority for chest pain patients using the manchester triage system.

To analyse crucial factors for determining care priority for patients with acute myocardial infarction based on the Manchester Triage System. Triage is the first potentially critical step in the care of myocardial infarction patients. However, there are still very few studies on the factors interfering in the lack of care priority for these patients, impacting their treatment and prognosis. Retrospective cohort study with 217 patients in the emergency department of a Brazilian hospital. Data were collected from patients' records with a primary diagnosis of myocardial infarction, from March 2014-February 2015. Patients were divided into two groups for statistical analysis: high priority (immediate and very urgent) and low priority (urgent, standard and nonurgent). Most of the patients were male, with a mean age of 62.1years, with a prevalence of high blood pressure and smoking as risk factors. Lower care priority level was assigned to 116 (53.4%) patients. Sixty-four (29.5%) patients had ST-segment elevation acute myocardial infarction, and 29 (45.3%) of these patients were assigned lower care priority level. Coughing, abdominal pain, onset of symptoms over 24hr ago and pain of mild to moderate intensity were clinical predictors associated with lower care priority level. Sweating and high blood pressure were associated with high care priority level. Lower care priority level was associated with increased door-to-electrocardiogram and door-to-troponin times. There was no significant difference between the two groups for door-to-needle and door-to-balloon times. Most of the patients with myocardial infarction were classified as low care priority, showing triage failure either due to symptom variability or need for professional qualification in clinical data collection and interpretation. The results may support clinical evaluation, bringing chest pain assessment into focus.

Impact of type 2 diabetes mellitus on in-hospital-mortality after major cardiovascular events in Spain (2002\u20132014)

BackgroundDiabetes mellitus has long been associated with cardiovascular events. Nevertheless, the higher burden of traditional cardiovascular risk factors reported in high-income countries is offset by a more widespread use of preventive measures and revascularization or other invasive procedures. The aim of this investigation is to describe trends in number of cases and outcomes, in-hospital mortality (IHM) and length of hospital stay (LHS), of hospital admissions for major cardiovascular events between type 2 diabetes (T2DM) and matched non-diabetes patients.MethodsRetrospective study using National Hospital Discharge Database, analyzed in 4 years 2002, 2006, 2010, 2014, in Spain. We included patients (≥ 40 years old) with a primary diagnosis of myocardial infarction, ischemic and hemorrhagic stroke, aortic aneurysm and dissection and acute lower limb ischemia in people with T2DM. Cases were matched with controls (without T2DM) by ICD-9-CM codes, sex, age, province of residence and year.ResultsWe selected 130,011 matched couples (50,427 with myocardial infarction, 60,236 with stroke, 2599 with aortic aneurysm and dissection and 16,749 with acute lower limb ischemia. Among T2DM patients we found increasing numbers of admissions overtime for stroke (10,794 in 2002 vs 17,559 in 2014), aortic aneurysm and dissection (390 vs 841) and acute lower limb ischemia (3854 vs. 4548). People were progressively older (except for myocardial infarction), had more comorbidities (especially T2DM patients), and were more frequently coded overtime for cardiovascular risk factors (smoking, obesity, hypertension, lipid disorders) and renal diseases. LHS and IHM declined overtime, though IHM only did it significantly in T2DM patients. Multivariable adjustment showed that T2DM patients had a significantly 15% higher mortality rate during admission for myocardial infarction, a 6% higher mortality for stroke, and a 6% higher mortality rate for “all cardiovascular events combined”, than non-diabetic matched controls.ConclusionsThe number of hospital admissions for stroke, aortic aneurysm and dissection and acute lower limb ischemia increased overtime, but remained stable for myocardial infarction. T2DM is associated to higher IHM after major cardiovascular events. Further research is needed to help us understand the reasons for an apparently increased mortality in T2DM patients when admitted to hospital for some major cardiovascular events.

Is Walk Score associated with hospital admissions from chronic diseases? Evidence from a cross-sectional study in a high socioeconomic status Australian city-state

ObjectivesTo explore patterns of non-communicable diseases (NCDs) in the Australian Capital Territory (ACT).To ascertain the effect of the neighbourhood built environmental features and especially walkability on health outcomes, specifically for...

Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy

ObjectiveTo evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after...

The impact of anesthesia providers on major morbidity following screening colonoscopies.

Background and aimsFew studies evaluate the impact of anesthesia providers during procedures, such as colonoscopy, on low-risk patients. The objective of this study was to compare the effect of anesthesia providers on several outcome variables, including major morbidity, following screening colonoscopies.MethodsA propensity-matched cohort study of 14,006 patients who enrolled with a national insurer offering health maintenance organization (HMO), preferred provider organization (PPO), and Medicare Advantage plans for a screening colonoscopy between July 1, 2005 and June 30, 2007 were studied. Records were evaluated for completion of the colonoscopy, new cancer diagnosis (colon, anal, rectal) within 6 months of the colonoscopy, new primary diagnosis of myocardial infarction (MI), new primary diagnosis of stroke, hospital admission within 7 days of the colonoscopy, and adherence to guidelines for use of anesthesia providers.ResultsThe presence of an anesthesia provider did not affect major morbidity or the percent of completed exams. Overall morbidity within 7 days was very low. When an anesthesia provider was present, a nonsignificant trend toward greater cancer detection within 6 months of the procedure was observed. Adherence to national guidelines regarding the use of anesthesia providers for low-risk patients was poor.ConclusionA difference in outcome associated with the presence or absence of an anesthesia provider during screening colonoscopy in terms of MI, stroke, or hospital admission within 7 days of the procedure was not observed. Adherence to published guidelines for the use of anesthesia providers is low. The incidence of completed exams was unaffected by the presence of an anesthesia provider. However, a nonstatistically significant trend toward increased cancer detection requires further study.

The impact of anesthesia providers on major morbidity following screening colonoscopies

The impact of anesthesia providers on major morbidity following screening colonoscopies David A Lubarsky,1 Jason R Guercio,2 John W Hanna,3,4 Maria T Abreu,5 Qianli Ma,3 Claudia Uribe,3 David J Birnbach,1,6 David R Sinclair,1 Keith A Candiotti1 1Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami &ndash; Miller School of Medicine, Miami, FL, USA; 2Department of Anesthesiology, Duke University, Durham, NC, USA; 3Humana, Comprehensive Health Insights, Miami, FL, USA; 4University of Miami &ndash; Miller School of Medicine, Miami, FL, USA; 5Department of Medicine, Division of Gastroenterology, University of Miami &ndash; Miller School of Medicine, Miami, FL, USA; 6Department of Public Health Sciences, University of Miami &ndash; Miller School of Medicine, Miami, FL, USA Background and aims: Few studies evaluate the impact of anesthesia providers during procedures, such as colonoscopy, on low-risk patients. The objective of this study was to compare the effect of anesthesia providers on several outcome variables, including major morbidity, following screening colonoscopies. Methods: A propensity-matched cohort study of 14,006 patients who enrolled with a national insurer offering health maintenance organization (HMO), preferred provider organization (PPO), and Medicare Advantage plans for a screening colonoscopy between July 1, 2005 and June 30, 2007 were studied. Records were evaluated for completion of the colonoscopy, new cancer diagnosis (colon, anal, rectal) within 6 months of the colonoscopy, new primary diagnosis of myocardial infarction (MI), new primary diagnosis of stroke, hospital admission within 7 days of the colonoscopy, and adherence to guidelines for use of anesthesia providers. Results: The presence of an anesthesia provider did not affect major morbidity or the percent of completed exams. Overall morbidity within 7 days was very low. When an anesthesia provider was present, a nonsignificant trend toward greater cancer detection within 6 months of the procedure was observed. Adherence to national guidelines regarding the use of anesthesia providers for low-risk patients was poor. Conclusion: A difference in outcome associated with the presence or absence of an anesthesia provider during screening colonoscopy in terms of MI, stroke, or hospital admission within 7 days of the procedure was not observed. Adherence to published guidelines for the use of anesthesia providers is low. The incidence of completed exams was unaffected by the presence of an anesthesia provider. However, a nonstatistically significant trend toward increased cancer detection requires further study. Keywords: safety, complications, myocardial infarction, stroke, endoscopy, anesthesiology