Rates Of Congestive Heart Failure Research Articles

Comparative Analysis of Modified BT Shunt and Central Shunt in Pediatric Patients.

Cyanotic congenital heart diseases constitute 40-45% of all congenital heart diseases. In patients who are not suitable for primary repair, modified BT (MBT) shunt and central shunt (CS) procedures are still frequently used. This study included 62 pediatric patients who underwent MBT shunt or CS via median sternotomy. Patients' demographic, echocardiographic, operative, and postoperative data were collected retrospectively. The patients were classified as single ventricle and bi-ventricle according to their cardiac anatomy, and the presence of prematurity and heterotaxy was noted. Procedure details of the patients who underwent endovascular intervention prior to the surgery were investigated, and operation data were accessed from the surgery notes. Data regarding postoperative follow-ups were obtained and comparatively analyzed. Of the total 62 patients, 32 (51.6%) were newborns and 16 (25.8%) had a body weight < 3 kg. MBT shunt was applied to 48 patients (77.4%), while CS was applied to 14 patients (22.6%). There was no significant difference between the two surgical procedures in terms of requirement for urgent shunt or cardiopulmonary bypass, additional simultaneous surgical intervention, need for high postoperative inotropes, and in-hospital mortality (P>0.05). The rate of congestive heart failure in patients with in-hospital mortality was determined as 66.7% and it was significantly higher than in patients without heart failure (P<0.001). MBT shunt and CS are still frequently used in cyanotic patients. The use of small-diameter shunts, particularly when centrally located, can prevent the onset of congestive heart failure and lower mortality.

THE EFFECT OF ACUTE KIDNEY INJURY IN ELDERLY PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

This study aims to determine the frequency of acute kidney injury (AKI) in patients who undergo percutaneous coronary intervention (PCI) and its impact on elderly patients. To achieve this, 80 patients admitted to Ayub Teaching Hospital from March 2019 to August 2020 for PCI were studied for AKI after the procedure. The primary endpoint was mortality from all causes, while the secondary was mortality due to major cardiovascular events. The results showed that out of the 80 patients, 29 developed AKI, with a higher incidence observed in the older age group. These patients reported a higher rate of congestive heart failure, increased C-reactive proteins, and an increased rate of major adverse cardiovascular events, which was 39.43%. Furthermore, all-cause mortality was higher in patients suffering from AKI. In conclusion, this study highlights that one-fourth of elderly patients undergoing PCI face a higher risk of AKI. Further research is required to mitigate the mortality and morbidity associated with AKI in this vulnerable group.

FRI700 Adverse Events In Patients With Primary Hyperparathyroidism With And Without Successful Parathyroidectomy - A Propensity-matched Comparison

Abstract Disclosure: J. Han: None. Y. Yuan: None. J. Hu: None. C. Ghosh: None. E. Kebebew: None. Objective: The aim of the study was to evaluate the impact of successful parathyroidectomy on renal, skeletal and cardiovascular adverse events in patients with primary hyperparathyroidism (PHPT). Background: PHPT may be associated with renal, skeletal and cardiovascular diseases. In some but not all studies, successful parathyroidectomy has been reported to be associated with reduced risks of renal, skeletal or cardiovascular adverse events. To date, there has not been a comprehensive study with granular data looking at the impact of parathyroidectomy on all adverse events that have been associated with PHPT. Methods: A health system cohort study was performed in 3,048 patients with PHPT as defined by ICD10 or ICD9 codes who had successful parathyroidectomy defined by CPT codes (n=1,105) and no parathyroidectomy (n=1943). Comparison of cardiovascular (arrhythmias, myocardial infarction, congestive heart failure, cardiac admission, hypertension, diabetes mellitus), renal (kidney stone, end-stage renal disease requiring dialysis, GFR &amp;lt; 30 mL/min) and skeletal (all fractures, fragility fractures (hip/pelvis and spinal fractures), diagnosis of osteoporosis or osteopenia) adverse events by parathyroidectomy status (successful vs. no parathyroidectomy) in unmatched and basic matched analyses, and propensity score (PS) matched analysis at 10 years of follow up. Results: The mean age was higher in the no parathyroidectomy arm. The comorbidity score was higher (4.1 vs 3.6) in patients who did not have parathyroidectomy with higher rates of congestive heart failure and myocardial infarction at baseline. Patients who had parathyroidectomy had a lower rate of subsequent diagnosis of cardiovascular adverse events at 10 years of follow up (OR 0.57, p&amp;lt;0.001). There was also a lower odds of death at 10 years in those who had successful parathyroidectomy (OR 0.29, p&amp;lt;0.001). These differences were significant in the unmatched and basic matched analyses, but were not significant after PS matching. There was no significant difference in 10 years rates of any fractures , fragility fractures, or renal adverse events. The odds of diagnosis of osteoporosis or osteopenia at 10 years of follow up was significantly lower in patients who had successful parathyroidectomy in all 3 analyses (PS-matching: OR 0.507, p&amp;lt;0.001). Conclusions: Compared to patients who did not have parathyroidectomy for PHPT, patients who had successful parathyroidectomy have lower 10 years rates of osteoporosis/osteopenia diagnoses. Cardiovascular adverse events were lower in patients who had successful parathyroidectomy but this may be due to higher baseline comorbidities in those who did not have parathyroidectomy. Presentation: Friday, June 16, 2023

Clinical and financial outcomes of hospitalizations for cardiac device infection during the COVID-19 pandemic in the US.

Cardiac device infection (CDI) can occur in up to 2.2% of patients after device placement, with mortality rates exceeding 15%. Although device removal is standard management, the COVID-19 pandemic has been associated with resource diversion and decreased patient presentation for cardiovascular disease. We ascertained the association of the COVID-19 pandemic with outcomes and resource utilization after admission for CDI. The 2016-2020 National Inpatient Sample was used to retrospectively study all adult admissions for CDI. Patients admitted between March and December, 2020 were classified as the pandemic cohort, with the rest pre-pandemic. The primary outcome was major adverse events (MAE), with secondary outcomes of overall length of stay (LOS), post-device removal LOS, time to device replacement, and hospitalization costs. MAE was a combination of in-hospital mortality and select complications. Multivariable regression models were developed to determine the relationship between the pandemic and the aforementioned outcomes. Of an estimated 190,160 patients, 14.3% comprised the pandemic cohort; 2.4% of these patients were COVID-19 positive. The pandemic cohort was older, less commonly female, and had higher rates of congestive heart failure. After adjustment, the pandemic was not associated with altered odds of MAE, device removal, or subsequent device replacement. The pandemic was, however, associated with decreased adjusted overall LOS (β -0.38 days) and days to device replacement (β -0.83 days). The pandemic was likewise associated with $2,000 increased adjusted hospitalization costs. The pandemic did not have a significant impact on clinical outcomes in patients admitted for CDI, despite higher hospitalization costs and decreased length of stay.

Variance component estimates, phenotypic characterization, and genetic evaluation of bovine congestive heart failure in commercial feeder cattle.

The increasing incidence of bovine congestive heart failure (BCHF) in feedlot cattle poses a significant challenge to the beef industry from economic loss, reduced performance, and reduced animal welfare attributed to cardiac insufficiency. Changes to cardiac morphology as well as abnormal pulmonary arterial pressure (PAP) in cattle of mostly Angus ancestry have been recently characterized. However, congestive heart failure affecting cattle late in the feeding period has been an increasing problem and tools are needed for the industry to address the rate of mortality in the feedlot for multiple breeds. At harvest, a population of 32,763 commercial fed cattle were phenotyped for cardiac morphology with associated production data collected from feedlot processing to harvest at a single feedlot and packing plant in the Pacific Northwest. A sub-population of 5,001 individuals were selected for low-pass genotyping to estimate variance components and genetic correlations between heart score and the production traits observed during the feeding period. At harvest, the incidence of a heart score of 4 or 5 in this population was approximately 4.14%, indicating a significant proportion of feeder cattle are at risk of cardiac mortality before harvest. Heart scores were also significantly and positively correlated with the percentage Angus ancestry observed by genomic breed percentage analysis. The heritability of heart score measured as a binary (scores 1 and 2 = 0, scores 4 and 5 = 1) trait was 0.356 in this population, which indicates development of a selection tool to reduce the risk of congestive heart failure as an EPD (expected progeny difference) is feasible. Genetic correlations of heart score with growth traits and feed intake were moderate and positive (0.289-0.460). Genetic correlations between heart score and backfat and marbling score were -0.120 and -0.108, respectively. Significant genetic correlation to traits of high economic importance in existing selection indexes explain the increased rate of congestive heart failure observed over time. These results indicate potential to implement heart score observed at harvest as a phenotype under selection in genetic evaluation in order to reduce feedlot mortality due to cardiac insufficiency and improve overall cardiopulmonary health in feeder cattle.

Operative and long-term outcomes of combined and staged carotid endarterectomy and coronary bypass

ObjectiveOptimal temporal surgical management of significant carotid stenosis and coronary artery disease remains unknown. Carotid endarterectomy (CEA) and coronary artery bypass (CABG) are performed concurrently (CCAB) or in a staged (CEA-CABG or CABG-CEA) approach. Using the Vascular Quality Initiative-Vascular Implant Surveillance and Interventional Outcomes Coordinated Registry Network-Medicare-linked dataset, this study compared operative and long-term outcomes after CCAB and staged approaches. MethodsThe Vascular Quality Initiative-Vascular Implant Surveillance and Interventional Outcomes Coordinated Registry Network dataset was used to identify CEAs from 2011 to 2018 with combined CABG or CABG within 45 days preceding or after CEA. Patients were stratified based on concurrent or staged approach. Primary outcomes were stroke, myocardial infarction (MI), all-cause mortality, stroke and death as composite (SD) and all as composite within 30 days from the last procedure as well as in the long term. Univariate analysis and risk-adjusted analysis using inverse propensity weighting were performed. Kaplan-Meier curves of stroke, MI, and death were created and compared. ResultsThere were 1058 patients included: 643 CCAB and 415 staged (309 CEA-CABG and 106 CABG-CEA). Compared with staged patients, those undergoing CCAB had a higher preoperative rate of congestive heart failure (24.8% vs 18.4%; P = .01) and decreased renal function (14.9% vs 8.5%; P < .01), as well as fewer prior neurological events (23.5% vs 31.4%; P < .01). Patients undergoing CCAB had similar weighted rate of 30-day stroke (4.6% vs 4.1%; P = .72), death (7.0% vs 5.0%; P = .32), and composite outcomes (stroke and death, 9.8% vs 8.5%; P = .56; stroke, death, and MI, 14.7% vs 17.4%; P = .31), but a lower weighted rate of MI (5.5% vs 11.5%; P < .01) vs the staged cohort. Long-term adjusted risks of stroke (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.54-1.36; P = .51) and mortality (HR, 1.02; 95% CI, 0.76-1.36; P=.91) were similar between groups, but higher risk of MI long-term was seen in those staged (HR, 1.49; 95% CI, 1.07-2.08; P = .02). ConclusionsIn patients undergoing CCAB or staged open revascularization for carotid stenosis and coronary artery disease, the staged approach had an increased risk of postoperative cardiac event, but the short- and long-term rates of stroke and mortality seem to be comparable. Adverse cardiovascular event risk is high between operations when staged and should be a consideration when selecting an approach. Although factors leading to staged sequencing performance need further clarity, CCAB seems to be safe and should be considered an equally reasonable option.

COVID-19 in hospitalized adult patients with sickle cell disease: A 2020 US cohort using Cerner Real-World Data™ (CRWD).

We used Cerner Real-World Data™, representing hospital admission records from 2020, to examine patients with co-occurring sickle cell disease and COVID-19 by discharge disposition grouped as death/hospice versus transfers to other facilities, returned home, or left against medical advice. Among the death/hospice group, we found older age and higher rates of congestive heart failure and diabetes. There were also significant differences in tachypnea, mechanical ventilation, minimum O2 saturation, and length of stay with higher rates in the death/hospice group. Awareness of such factors and associated mortality risks for this population may aid in patient care.

The Effectiveness of Coronary Artery Bypass Grafting in Patients with Left Ventricular Dysfunction.

Coronary artery bypass grafting (CABG) in patients with left ventricular dysfunction (LVD) remains a surgical challenge and is still controversial. The aim of this study was to evaluate the effectiveness of CABG in patients with LVD. This retrospective study included a total of 160 consecutive patients (133 males, 27 females, mean age 62.1±10.12 years [range 37 to 86 years]) who had a left ventricular ejection fraction (LVEF) ≤ 45% determined by echocardiography and underwent elective isolated CABG between September 2013 and December 2018. Preoperative echocardiographic data, such as ejection fraction, left ventricular (LV) end-systolic diameter, and LV end-diastolic diameter, were collected and evaluated. Preoperatively, 85 (53.13%) patients were in New York Heart Association functional class III or IV and the mean LVEF was 38.65±5.72% (range 20 to 45). The overall hospital mortality was 5% (eight patients). Late follow-up was obtained in 152 (90%) cases (median follow-up time was 56,5 [3-87] months postoperatively). During follow-up, mortality developed in 11.3% (16 patients). Mean LVEF increased significantly from 38.78±5.59% before surgery to 43.29±8.46% after surgery (P<0.01). Mean late survival, freedom from coronary reintervention, and congestive heart failure rates were 86.3±3.3%, 88.7±3.9%, and 89.4±3.1%, respectively. In patients with LVD, CABG can be performed with low postoperative morbidity and mortality rates. Patients with LVD could benefit from coronary bypass surgery regarding postoperative LV systolic function and higher quality of life.

The Effect of Hemodialysis on Cardiac Biomarker Levels

Background: According to the United States Renal Data System (USRD), the 2013 Annual Data Report indicates that patients with chronic kidney disease (CKD) have higher rates of congestive heart failure, acute myocardial infraction (MI), and cerebral vascular accidents compared to non-CKD patients. Aim of the Study: This study aimed to investigate the effects of the hemodialysis process on cardiac biomarker levels in hemodialysis patients. Method: A prospective study was carried conducted at Emssalata central hospital's hemodialysis department. The study involved a total of 25 individuals, 15 males and 10 females who were undergoing dialysis. A chemistry analyzer was used to measure the serum troponin I (cTn-I), creatin phosphokinase (CPK), and creatine kinase-MB (CK-MB) iso-enzyme in hemodialysis (HD) patients before and after the dialysis process. Results: The results showed that total CPK, CK-MB, and cTn-I levels had no significant differences in CKD patients' pre and post-dialysis, with (p = 0.989, 0.586, and 0.284) respectively. Hemodialysis patients have none significantly higher CPK, CK-MB and cTn-I ratios after hemodialysis process when compared to the values determined to each marker before hemodialysis process. Conclusion: The dialysis process had no effect on the levels of cardiac biomarkers (CPK, CK-MB, and cTn-I) in hemodialysis patients. The cardiac biomarker in hemodialysis patients appears to be unaffected by age, gender, or dialysis duration

Impact of COVID-19 on volume of elective and nonelective ventral hernia repair

BackgroundThe significant decrease in elective surgery during the COVID-19 pandemic prompted fears that there would be an increase in emergency or urgent operations for certain disease states. The impact of COVID-19 on ventral hernia repair is unknown. This study aimed to compare volumes of elective and nonelective ventral hernia repairs performed pre–COVID-19 with those performed during the COVID-19 pandemic. MethodsAn analysis of a prospective database from 8 hospitals capturing patient admissions with the International Classification of Diseases, Tenth Revision Procedure Coding System for ventral hernia repair from January 2017 through June 2021 were included. During, COVID-19 was defined as on or after March 2020. ResultsComparing 3,558 ventral hernia repairs pre–COVID-19 with 1,228 during COVID-19, there was a significant decrease in the mean number of elective ventral hernia repairs per month during COVID-19 (pre–COVID-19: 61 ± 5 vs during COVID-19 19: 39 ± 11; P < .001), and this persisted after excluding the initial 3-month COVID-19 surge (61 ± 5 vs 42 ± 9; P < .001). There were fewer nonelective cases during the initial 3-month COVID-19 surge (32 ± 9 vs 24 ± 4; P = .031), but, excluding the initial surge, there was no difference in nonelective volume (32 ± 9 vs 33 ± 8; P = .560).During COVID-19, patients had lower rates of congestive heart failure (elective: 9.0% vs 6.6%; P = .0047; nonelective: 17.7% vs 11.6%; P < .001) and chronic obstructive pulmonary disease (elective: 13.7% vs 10.2%; P = .017; nonelective: 17.9% vs 12.0%; P < .001) and underwent fewer component separations (10.2% vs 6.4%; P ≤ .001). Intensive care unit admissions decreased for elective ventral hernia repairs (7.7% vs 5.0%; P = .016). Length of stay, cost, and readmission were similar between groups. ConclusionElective ventral hernia repair volume decreased during COVID-19 whereas nonelective ventral hernia repairs transiently decreased before returning to baseline. During COVID-19, patients appeared to be lower risk and less complex. The possible impact of the more complex patients delaying surgery is yet to be seen.

First-Line Therapy for Type 2 Diabetes With Sodium-Glucose Cotransporter-2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists : A Cost-Effectiveness Study.

Guidelines recommend sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP1) receptor agonists as second-line therapy for patients with type 2 diabetes. Expanding their use as first-line therapy has been proposed but the clinical benefits may not outweigh their costs. To evaluate the lifetime cost-effectiveness of a strategy of first-line SGLT2 inhibitors or GLP1 receptor agonists. Individual-level Monte Carlo-based Markov model. Randomized trials, Centers for Disease Control and Prevention databases, RED BOOK, and the National Health and Nutrition Examination Survey. Drug-naive U.S. patients with type 2 diabetes. Lifetime. Health care sector. First-line SGLT2 inhibitors or GLP1 receptor agonists. Life expectancy, lifetime costs, incremental cost-effectiveness ratios (ICERs). First-line SGLT2 inhibitors and GLP1 receptor agonists had lower lifetime rates of congestive heart failure, ischemic heart disease, myocardial infarction, and stroke compared with metformin. First-line SGLT2 inhibitors cost $43000 more and added 1.8 quality-adjusted months versus first-line metformin ($478000 per quality-adjusted life-year [QALY]). First-line injectable GLP1 receptor agonists cost more and reduced QALYs compared with metformin. By removing injection disutility, first-line GLP1 receptor agonists were no longer dominated (ICER, $327000 per QALY). Oral GLP1 receptor agonists were not cost-effective (ICER, $823000 per QALY). To be cost-effective at under $150000 per QALY, costs for SGLT2 inhibitors would need to be under $5 per day and under $6 per day for oral GLP1 receptor agonists. U.S. population and costs not generalizable internationally. As first-line agents, SGLT2 inhibitors and GLP1 receptor agonists would improve type 2 diabetes outcomes, but their costs would need to fall by at least 70% to be cost-effective. American Diabetes Association.

Hastaneden taburculuk sırasında yüksek PaCO2 seviyeleri, evde non-invaziv mekanik ventilatörü olmayan kronik solunum yetmezliği hastalarında orta vadeli mortaliteyi öngörüyor mu?

Aim: Long-term domiciliary use of a non-invasive mechanical ventilator (NIV) is a controversial form of therapy for patients with chronic obstructive pulmonary disease (COPD) and moderate hypercapnia. The present research attempted to examine hospital admissions, hospitalizations, and medium-term (6-8 months) mortality in a group of patients with compensated but moderate hypercapnia who were discharged from our clinic without a domiciliary NIV. Material and Method: The sample of this retrospective, observation-based cohort study consisted of compensated hypercapnic cases that were hospitalized in our Pulmonology Intensive Care Unit (ICU) between 01.01.2019 and 12.31.2020. Results: A total of 245 patients discharged with high partial pressure of carbon dioxide (PaCO2) levels between 01.01.2019 and 12.31.2020 were included in the study. While 58% of the cases were males (n=142), we found the mean age of the patients to be 71.89±12.63 years. The findings yielded no significant differences between the groups by sex, use of NIV during hospitalization, number of days of NIV use during hospitalization, use of LTOT or Oxygen tube at home, and intubation history before ICU admission (p&amp;gt;0.05). Similarly, we could not conclude significant differences between the groups by hospitalization, discharge, and follow-up arterial blood gas (ABG) parameters. Yet, the rates of congestive heart failure, coronary artery disease, and atrial fibrillation were significantly higher in the mortality group (p=0.017, p=0.032, and p=0.002, respectively). Besides, high PaCO2 levels versus mortality rates at 1, 3, 6, 8, and 12 months and in the entire follow-up period were subjected to the ROC analysis. Accordingly, when accepting 50.25 mmHg as the cut-off value for determining the 8-month mortality for discharge PaCO2 levels, we calculated the sensitivity to be 78.6% and the specificity to be 43%. Conclusion: Overall, it is highly convenient to consider the possible positive effects of NIV therapy on mortality among patients with heart-related diseases and with moderate hypercapnia (PaCO2&amp;gt;50 mmHg) at discharge.

Outcomes of Myocardial Revascularization in Diabetic Patients With Left Main Coronary Artery Disease: A Multicenter Observational Study From Three Gulf Countries

BackgroundReal-world data for managing patients with diabetes and left main coronary artery (LMCA) disease are scarce. We compared percutaneous coronary intervention (PCI) outcomes versus coronary artery bypass grafting (CABG) in diabetes and LMCA disease patients. MethodsWe retrospectively studied patients with LMCA presented to 14 centers from 2015 to 2019. The study included 2138 patients with unprotected LMCA disease; 1468 (68.7 %) had diabetes. Patients were grouped into; diabetes with PCI (n = 804) or CABG (n = 664) and non-diabetes with PCI (n = 418) or CABG (n = 252). ResultsIn diabetes, cardiac (34 (5.1 %) vs. 22 (2.7 %); P = 0.016), non-cardiac (13 (2 %) vs. 6 (0.7 %); P = 0.027) and total hospital mortality (47 (7.1 %) vs. 28 (3.5 %); P = 0.0019), myocardial infarction (45 (6.8 %) vs. 11 (1.4 %); P = 0.001), cerebrovascular events (25 (3.8 %) vs. 12 (1.5 %); P = 0.005) and minor bleeding (65 (9.8 %) vs. 50 (6.2 %); P = 0.006) were significantly higher in CABG patients compared to PCI; respectively. The median follow-up time was 20 (10–37) months. In diabetes, total mortality was higher in CABG (P = 0.001) while congestive heart failure was higher in PCI (P = 0.001). There were no differences in major adverse cerebrovascular events and target lesion revascularization between PCI and CABG. Predictors of mortality in diabetes were high anatomical SYNTAX, peripheral arterial disease, chronic kidney disease, and cardiogenic shock. ConclusionsIn this multicenter retrospective study, we found no significant difference in clinical outcomes during the short-term follow-up between PCI with second-generation DES and CABG except for lower total mortality and a higher rate of congestive heart failure in PCI group of patients. Randomized trials to characterize patients who could benefit from each treatment option are needed.

Characterization of Necrotizing Soft Tissue Infections in Obese and Non-Obese Patients.

Background: The impact of obesity on the pathogenesis and prognosis of necrotizing soft tissue infections (NSTIs) is unclear. The goal of this study was to characterize differences in NSTI presentation and outcomes by obesity status. Patients and Methods: A retrospective analysis of institutional data for patients diagnosed with NSTIs were identified (n = 619; 2011-2020). Patients were divided based on obesity (body mass index [BMI] ≥ 30 kg/m2) and non-obese (BMI <30 kg/m2). Primary outcomes included NSTI location, micro-organisms, and index hospitalization data. Multiple logistic regression was used to model predictors of in-hospital and 90-day mortality. Results: The obese cohort (n = 390; 63%) had higher rates of congestive heart failure and type 2 diabetes mellitus. There were no differences in length of stay, mortality, or discharge disposition between groups. A higher rate of respiratory failure was observed in the obese versus non-obese group (36.7% vs. 20.9%; p < 0.0005). The obese cohort was associated with perineal (40.8% vs. 27.0%) and torso NSTIs (20.9% vs. 15.8%; p < 0.005) but reduced staphylococcal (19.2% vs. 27.4%; p = 0.02) and group A streptococcal (2.6% vs. 6.5%; p = 0.03) infections, and increased polymicrobial infections. Class 2 obesity was a negative predictor for in-hospital mortality (odds ratio [OR], 0.1; 95% confidence interval [CI], 0.03-0.5) and 90-day mortality (OR, 0.3; 95% CI, 0.1-0.8), when adjusting for demographic data, type of infection, and baseline comorbidities. Conclusions: Necrotizing soft tissue infections in obesity may present with unique distributions and microbial characteristics. Class 2 obesity may exhibit a survival benefit compared with non-obese patients, suggestive of an obesity paradox.

The Impact of Interfacility Transfer on Postoperative Outcomes of Ruptured Abdominal Aortic Aneurysm Repair

Interfacility transfer (IFT) of patients with ruptured abdominal aortic aneurysms (rAAAs) is an important management option for patients presenting to centers where optimal care is unavailable. The aim of this study was to assess the impact of IFT on postoperative outcomes of patients undergoing rAAA repair using multi-institutional registry data. A retrospective review of the Vascular Quality Initiative database of all patients who had undergone rAAA repair between 2011 and 2021 was undertaken. The primary outcome was in-hospital death. The secondary outcomes included rates of postoperative myocardial infarction, permanent dialysis, lower extremity ischemia, and bowel ischemia. Logistic regression modeling was used to control for confounding variables. A total of 6049 rAAA repairs were analyzed, of which 3769 patients (62.3%) had been transferred (IFT) and 2280 (37.7%) had been treated at the initial hospital (NIFT). Compared with the IFT patients, the NIFT patients were significantly more likely to be non-White (14.7% vs 12.0%; P = .002) and Hispanic or Latino (3.5% vs 2.5%; P = .026). The IFT patients demonstrated significantly higher rates of smoking (46.5% vs 44.8%; P = .017) and chronic obstructive pulmonary disease (31.0% vs 28.4%; P = .030). In contrast, the NIFT patients had significantly higher rates of congestive heart failure (12.2% vs 10.5%; P = .049) and greater rates of statin use (45.4% vs 42.2%; P = .018) and beta-blocker use (38.3% vs 35.3%; P = .022; Table I). In-hospital death was significantly higher for the NIFT patients (28.5% vs 25.5%; P = .011). The rates of postoperative myocardial infarction, permanent dialysis, lower extremity ischemia, and bowel ischemia did not significantly differ between the two groups. After adjusting for potential confounders, the IFT patients were 20% less likely to experience in-hospital death (adjusted odds ratio, 0.80; 95% confidence interval, 0.7-0.9; P = .009; Table II). A subanalysis of postoperative outcomes stratified by repair type revealed a significantly lower in-hospital death rate for IFT patients who had undergone open aortic repair (adjusted odds ratio, 0.8; 95% confidence interval, 0.6-0.9; P = .038). However, for patients who had undergone endovascular aneurysm repair, the rate of in-hospital death did not significantly differ between the IFT and NIFT patients (P = .077). More than 60% of rAAA repairs are performed after IFT; however, IFT does not adversely affect the postoperative outcomes. Although timely management of rAAA is mandatory, prompt transfer of patients to a higher level of care might provide survival benefit, especially for patients needing open repair.Table IBaseline and clinical characteristics stratified by interfacility transfer (IFT)CharacteristicIFT (n = 3769; 62.3%)NIFT (n = 2280; 37.7%)P valueAge, years72.5 ± 9.772.4 ± 9.7.885Male sex2903 (77.0)1750 (76.8).833Race (non-White)450 (12.0)335 (14.7).002Ethnicity (Hispanic or Latino)93 (2.5)79 (3.5).026Obesity1408 (37.4)836 (36.7).590Insurance.347 Medicare2099 (58.9)1238 (57.6) Medicaid114 (3.2)82 (3.8) Other1348 (37.9)831 (38.6)Smoking.017 Never713 (19.3)504 (22.4) Prior1259 (34.1)738 (32.8) Current1717 (46.5)1006 (44.8)Comorbidity HTN2848 (77.2)1733 (77.2).988 DM555 (14.9)377 (16.7).060 CAD787 (21.2)489 (21.8).605 Prior CABG/PCI803 (21.6)518 (23.0).199 CHF391 (10.5)274 (12.2).049 COPD1154 (31.0)638 (28.4).030 Dialysis39 (1.0)28 (1.2).481 CKD2015 (56.6)1285 (58.3).203 Nonambulatory33 (1.5)16 (1.2).417Medication Aspirin1448 (39.5)887 (39.6).892 P2Y12 inhibitor304 (8.3)197 (8.8).483 Statin1550 (42.2)1015 (45.4).018 Beta-blocker1296 (35.3)856 (38.3).022 RAAS inhibitor110 (31.7)653 (30.8).457 Anticoagulant432 (12.4)274 (12.9).590Iliac artery aneurysm786 (21.9)528 (24.1).062Minimum SBP, mm Hg92.4 ± 32.591.9 ± 33.8.577Mental status.088 Normal2817 (76.2)1681 (74.6) Disoriented455 (12.3)322 (14.3) Unconscious426 (11.5)251 (11.1)Anesthesia.049 Local1754 (46.2)993 (43.6) Regional64 (1.7)46 (2.0) General1936 (51.6)1240 (54.4)Cardiac arrest370 (9.9)231 (10.2).683Conversion to open128 (3.5)65 (2.9).232Surgery type (EVAR)2350 (62.4)1438 (63.1).575Clamp<.001 Endovascular2350 (63.3)1438 (64.1) Infrarenal629 (17.0)459 (20.5) Suprarenal417 (11.2)205 (9.1) Supraceliac316 (8.5)142 (6.3)CABG, Coronary artery bypass graft; CAD, coronary artery disease; CHF, congestive heart failure; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; EVAR, endovascular aortic repair; HTN, hypertension; NIFT, no interfacility transfer; PCI, percutaneous coronary intervention; RAAS, renin-angiotensin-aldosterone system; SBP, systolic blood pressure. Open table in a new tab Table IIPostoperative outcomes of ruptured abdominal aortic aneurysm (rAAA) repair stratified by interfacility transfer (IFT)OutcomeUnadjusted, No. (%)AdjustedIFT (n = 3769; 62.3%)NIFT (n = 2280; 37.7%)P valueaORa (95% CI)P valueIn-hospital death960 (25.5)649 (28.5).0110.8 (0.7-0.9).009Postoperative MI400 (11.0)214 (9.7).1341.2 (0.9-1.4).196Postoperative PD140 (3.9)82 (3.7).8101.1 (0.8-1.5).562Postoperative LEI184 (5.1)115 (5.2).7781.0 (0.8-1.2).726Postoperative BI381 (10.5)211 (9.6).2761.1 (0.9-1.4).321aOR, Adjusted odds ratio; BI, bowel ischemia; CI, confidence interval; LEI, lower extremity ischemia; MI, myocardial infarction; NIFT, no interfacility transfer; PD, permanent dialysis.aReference, IFT. Open table in a new tab

Nationwide Trends in Hospitalizations and Outcomes of Pulmonary Circulation Disorders Among Patients With Cannabis Use Disorder in the United States.

Background and objectiveThe use of cannabis through smoking and vaping has increased significantly over the past decade. However, the prevalence of pulmonary circulation disorder (PCD)-related hospitalizations among cannabis users and their outcomes remain poorly understood. In this study, we used a nationally representative sample to assess the prevalence and trends of hospitalization among cannabis users with PCD.MethodsThe National Inpatient Sample (NIS) datasets (2007-2014) were used to analyze hospitalizations of patients with cannabis user disorder with PCD (C-PCD arm) versus those without PCD (C-non-PCD arm) to ascertain demographics, comorbidities, and in-hospital outcomes including all-cause mortality and healthcare resource utilization.ResultsA total of 3,307,310 hospitalizations involving cannabis users were reported, of which 20,328 (0.61%) were related to PCD. We noted a 200% relative increase in hospitalizations in the C-PCD arm (linearly increasing from 0.3% to 0.9% from 2007 to 2014, ptrend<0.001). When compared to the C-non-PCD arm, patients in the C-PCD arm tended to be older (mean age: 47 vs. 34 years), predominantly males (65.6% vs. 62.9%), with significantly higher rates of congestive heart failure (CHF, 28.8%), hypertension (HTN, 22%), chronic obstructive pulmonary disease (COPD, 21.5%), deficiency anemia (19.4%), and valvular heart disease (17.7%). The C-PCD arm had a statistically higher proportion of tobacco and amphetamine abusers (p<0.01) while the C-non-PCD arm had more cocaine and alcohol abusers (p<0.01). Urban teaching hospital admissions were more commonly associated with the PCD arm than the non-PCD arm (65.4% vs. 56.9%). In terms of hospital resource utilization, patients in the C-PCD arm had higher median hospital stay (six vs. three days) and more frequent discharges to a skilled nursing facility or home healthcare than the C-non-PCD group. All-cause mortality during hospitalization was found to be much higher in the C-PCD arm than the C-non-PCD arm (4.1% vs. 0.5%, p<0.001). Multivariable analysis revealed a two-fold higher risk for all-cause mortality with an adjusted odds ratio (OR) of 2.17 (95% CI: 1.99-2.36, p<0.001) with PCD.ConclusionThe findings of this nationwide study revealed significantly increased rates of hospitalizations among cannabis users with PCD with two times higher odds of all-cause in-hospital mortality. Further prospective studies are warranted in this subgroup of patients to confirm these findings and facilitate the management of these patients.

Determinants of Longitudinal Measure Pulse Rate of Chronic Heart Failure Patients at Felege Hiwot Referral Hospital, Ethiopia: A Longitudinal Modeling Data Analysis.

BackgroundHeart rate is a significant modifiable factor in lowering mortality in heart failure patients. The heart rate, often known as the pulse rate, is the number of times the heart beats in a given amount of time. Irregular pulse rate or heart block are all measured using heart rate data. A higher heart rate has been associated with worse clinical outcomes. The main purpose of this study was to identify factors associated with the longitudinal pulse rate of congestive heart failure patients.MethodsHospital-based retrospective studies were conducted among 249 congestive heart failure patients who were 18 years old or older and who were on treatment follow-up from first February 2016 to thirty-one December 2017 in Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia.ResultsData were explored using descriptive statistics, individual and mean profile plots, and analyzed using linear mixed models. Out of the total 249 patients, 139 (55.8%) were females. The majority 179 (71.9%) of the CHF patients were rural residents. 65 (26.1%) patients had Hypertension, 30 (12.5%) patients had Diabetes Mellitus, 58 (23.3%) patients had Pneumonia. Thus age, LVEF, follow-up time in a month had a negative significant effect whereas NYHA class, male gender, pneumonia had a positive significant effect on the average evaluation of pulse rate of patients. The time interaction effect of NYHA Class (Time* NYHA Class), and LVEF (Time*LVEF) had a significant effect on average pulse rate evolution.ConclusionThe variables age, LVEF, and follow-up time were negatively associated whereas, male gender, NYHA class, and presence of pneumonia were positively associated with the progression change of pulse rate of patients rate of progression of pulse rate decreases over time. Furthermore, health professionals give more attention to patients who are NYHA class IV, had low LVEF, pneumonic patients to reduce pulse rate during the follow-up time.

Association Between CRP/Albumin Ratio and Long-Term Mortality in Patients With cHronIc Limb-Threatening Ischemia Undergoing EndovaScular Therapy Below The Knee: The ACHILES-BTK Registry

Chronic limb-threatening ischemia (CLTI), which presents with ischemic rest pain, ulceration, or gangrene, is a complex form of peripheral artery disease that can cause mortality and amputation. C-reactive protein (CRP), an inflammatory marker, indicates vascular inflammation resulting from the cytokine-dependent inflammatory process in the arterial wall, and arterial atherosclerosis resulting from the inflammation. Lower albumin levels are also associated with peripheral artery disease. We investigated the association between CRP/Albumin ratio (CAR) and long-term mortality in patients with CLTI. A total of 172 patients who underwent endovascular treatment (EVT) for below the knee (BTK) lesions were enrolled in this study. Patients with acute infection requiring antibiotic therapy, chronic inflammatory disease, end-stage liver disease, malignancy were excluded from the study. Besides, patients with pre-follow-up intervention to the same vascular bed were also excluded from the study. The primary endpoint of the study was all-cause mortality. Patients were divided into 2 groups according to mortality. A total of 70 patients (40.6%) died during 32 ± 21 months of follow-up in the present study. The major amputation rate was 21.5%. The mortality (+) group was older and had higher rates of congestive heart failure, chronic kidney disease, history of stroke, and CRP levels. Moreover, statin and ACE inhibitor/angiotensin receptor blocker (ACE/ARB) use, GFR, and albumin levels were lower in the mortality (+) group. CAR was significantly higher in the mortality (+) group when comparing both groups (3.25 [1.46 - 7.86] vs. 9.75 [4.5 - 17.71], P < 0.001). CAR, congestive heart failure, chronic kidney disease, history of stroke, ACE/ARB, or statin use were independent predictors of all-cause mortality in multivariable Cox regression analysis. CAR was associated with mortality in CLTI patients undergoing EVT for BTK lesions. CAR may be a simple method to help patient selection, assessment, and intervention strategy for EVT and may improve patient outcomes.

Abstract P890: Associating Cryptogenic Ischemic Stroke In The Young With Cardiovascular Risk Factor Phenotypes In A Diverse Urban Community

Introduction: Acute Ischemic Stroke (AIS) in the young is increasing in prevalence and the largest sub-type within this cohort is cryptogenic. The risk factors and etiologies for these strokes likely differ by socioeconomic, racial, and ethnic background. To curb this trend, new ways of defining cryptogenic stroke and its risk factors are needed that can be applied to different populations. We aimed to create such a framework using patients in one of the poorest and most diverse urban counties in the country: Bronx, NY. Methods: We conducted a retrospective cohort study of AIS patients aged 18-49 who presented to an urban tertiary care center. Stroke risk factor phenotypes were determined by multivariate analysis and resultant models were applied to cryptogenic stroke cases. Results: A total 449 patients met inclusion criteria. The mean age was 41, 49% were women, 39% were Black, and 32% were Hispanic. 133 patients had strokes due to small and large vessel disease (vascular phenotype); these patients had higher rates of hypertension, intracranial atherosclerosis, and diabetes mellitus, and higher admission glucose, HbA1c, admission blood pressure, and cholesterol compared to the patients with cardioembolic AIS. The 69 patients with strokes due to cardioembolism (cardiac phenotype) had significantly higher rates of congestive heart failure (CHF), rheumatic heart disease, atrial fibrillation, clotting disorders, left ventricular hypertrophy, larger left atrial sizes, lower ejection fractions, and higher B-type natriuretic peptide and troponin levels. There were no differences in stroke subtype by race or ethnicity. Adjusted multivariate analysis produced 6 variables independently associated with the vascular phenotype (age, male sex, hemoglobin A1c, EF, LDL cholesterol, and family history of AIS) and 5 independently associated with the cardiac phenotype (age, female sex, decreased EF, CHF, and absence of intracranial atherosclerosis). Applying these models to 97 cryptogenic stroke cases yielded that 51.5% fit the vascular phenotype and 3.1% fit the cardiac phenotype. Conclusion: In our cohort of young patients in a low-resource, diverse urban community, half of cryptogenic cases fit the risk factor phenotype of small and large vessel strokes.

Associating cryptogenic ischemic stroke in the young with cardiovascular risk factor phenotypes

Acute Ischemic Stroke (AIS) in the young is increasing in prevalence and the largest subtype within this cohort is cryptogenic. To curb this trend, new ways of defining cryptogenic stroke and associated risk factors are needed. We aimed to gain insights into the presence or absence of cardiovascular risk factors in cases of cryptogenic stroke. We conducted a retrospective cohort study of patients aged 18–49 who presented to an urban tertiary care center with AIS. We manually collected predefined demographic, clinical, laboratory and radiological variables. Clinical risk phenotypes were determined using these variables through multivariate analysis of patients with the small and large vessel disease subtypes (vascular phenotype) and cardioembolic subtype (cardiac phenotype). The resultant phenotype models were applied to cases deemed cryptogenic. Within the 449 patients who met criteria, patients with small and large vessel disease (vascular phenotype) had higher rates of hypertension, intracranial atherosclerosis, and diabetes mellitus, and higher admission glucose, HbA1c, admission blood pressure, and cholesterol compared to the patients with cardioembolic AIS. The cardioembolic subgroup (cardiac phenotype) had significantly higher rates of congestive heart failure (CHF), rheumatic heart disease, atrial fibrillation, clotting disorders, left ventricular hypertrophy, larger left atrial sizes, lower ejection fractions, and higher B-type natriuretic peptide and troponin levels. Adjusted multivariate analysis produced six variables independently associated with the vascular phenotype (age, male sex, hemoglobin A1c, ejection fraction (EF), low-density lipoprotein (LDL) cholesterol, and family history of AIS) and five independently associated with the cardiac phenotype (age, female sex, decreased EF, CHF, and absence of intracranial atherosclerosis). Applying these models to cryptogenic stroke cases yielded that 51.5% fit the vascular phenotype and 3.1% fit the cardiac phenotype. In our cohort, half of young patients with cryptogenic stroke fit the risk factor phenotype of small and large vessel strokes.