Search

Venous thromboembolism (VTE) is an important cause of morbidity and mortality in the United States (US). The increasing rates of VTE in the US resulted in the surgeon general issuing a call to action to reduce VTE in 2008. The objective of our study was to analyze the national trends of inpatient VTE in the US from 2004 to 2013 (5 years before and after 2008). We used the dataset National Inpatient Sample, Healthcare Cost and Utilization Project and measured trends of inpatient VTE by annual % change using joinpoint regression software. From 2004 to 2013 the National Inpatient Sample contained data on 78 million hospitalizations (weighted n = 385 million). In these 1.6 million had a diagnosis of VTE (2.0%, weighted n = 7.7 million) including 1.2 million with deep venous thrombosis (DVT) (1.53%, weighted n = 5.9 million) and 588,878 with pulmonary embolism (PE) (0.74%, weighted n = 2.8 million). Joinpoint regression analysis showed that rates of DVT and PE are increasing consistently from 2004 to 2013(1.27% to 1.80% for DVT and 0.52% to 0.92% for PE). The increasing rates of DVT and PE were consistent in all subgroups except few exceptions. In conclusion inpatient VTE rates continue to rise even after 5 years from the surgeon general's a call to action except in certain high-risk patients. Further research is needed to curb the VTE in patients especially among those perceived to be at lower risk of VTE.

Background Hospital readmission rate is an important indicator of the quality of care, healthcare economic burden, and post-discharge care. Multiple sclerosis (MS) is a potentially progressive neurological disease predominantly affecting young women. The natural history of the disease involves intermittent relapses and/or accrued baseline disability overtime especially in older patients contributing to frequent hospitalizations. The readmission metrics for patients with MS have not been studied. Objective To estimate nationwide 30-day readmission (30-DR) rate among patients hospitalized with MS and to study the predictors of readmission based on age and gender. Methods This was a retrospective observational cohort study of patients hospitalized with primary discharge diagnosis of MS using 2013 Nationwide Readmission Database (NRD). The cases were identified by ICD 9-CM code (340) linked to MS diagnosis. We used patient unique identifiers 'NRD visit link' to identify MS index hospitalizations and readmissions. Age ( 40 years) and gender-based analyses were performed using multivariable logistic regression adjusting co-variables to identify the patient/system-specific factors associated with 30-DR. Results The overall 30-day readmission rate (30-DRR) was 10.2%. No gender difference was seen in the readmission rates (men 10.7% vs. women 10.1%, p = 0.56); higher readmission rates were observed in older patients (11.2% vs. 8.8%; p = 0.0055). However, readmission cost was higher in younger age group (≈ $ 12,586 vs. ≈$ 11,827; p = 0.62) and among women (≈$ 12,217 vs. ≈$ 11,746; p = 0.75). The common causes of 30-DR were MS exacerbation (42.5%), sepsis (13.7%) and respiratory complications (7.3%). The predictors of higher 30-DRR in younger patients were diabetes (OR 1.87, p = 0.02), intravenous immunoglobulin (IVIG) use (OR 3.64, p = 0.016), and discharge to a nursing facility (OR 1.66, p = 0.03), whereas in older age group, higher Charlson-Deyo Comorbidity Index (CCI) (OR 1.15, p = 0.0057), and plasma exchange (PLEX) (OR 2.38, p = 0.03) were predictive of higher readmission rate. The longer length of stay (LOS) during index admission (OR 1.81, p = 0.03) in men and higher CCI (OR 1.15, p = 0.007) and intravenous immunoglobulin (IVIG) use (OR 2.27, p = 0.04) in women increased the odds of readmission. Conclusion The overall 30-day readmission rate among patients following hospitalization for MS was 10.2%. The readmission rate was higher in older (>40 years) patients. The common causes of readmission were MS exacerbation, respiratory complications, and sepsis. A higher systemic disease burden, longer length of stay, and treatment with IVIG and PLEX were associated with higher risk of readmission. The readmissions were associated with higher cost of care and longer LOS compared to index admissions highlighting the economic impact of readmissions. Future strategies to lower the risk of readmissions in patients with MS should focus on optimal management of medical co-morbidities and infections.

Objective This study sought to examine the trends and predictors of mechanical circulatory support (MCS) use in patients hospitalized after out-of-hospital cardiac arrest (OHCA). Background There is a paucity of data regarding MCS use in patients hospitalized after OHCA. Methods We conducted an observational analysis of MCS use in 960,428 patients hospitalized after OHCA between January 2008 and December 2014 in the Nationwide Inpatient Sample database. On multivariable analysis, we also assessed factors associated with MCS use and survival to discharge. Results Among the 960,428 patients, 51,863 (5.4%) had MCS utilized. Intra-aortic balloon pump (IABP) was the most commonly used MCS after OHCA with frequency of 47,061 (4.9%), followed by extracorporeal membrane oxygenation (ECMO) 3650 (0.4%), and percutaneous ventricular assist devices (PVAD) 3265 (0.3%). From 2008 to 2014, there was an increase in the utilization of MCS from 5% in 2008 to 5.7% in 2014 (P trend Conclusions There is a steady increase in the use of MCS in OHCA, especially PVAD and ECMO, despite lack of randomized clinical trial data supporting an improvement in outcomes. More definitive randomized studies are needed to assess accurately the optimal role of MCS in this patient population.

Background Despite limited randomized trial data demonstrating clinical efficacy, the utilization of Impella in ST-elevation myocardial infarction (STEMI) patients complicated with cardiogenic shock (CS) has increased over time. Methods We identified 75,769 hospitalizations with STEMI complicated by CS between October 2015 and December 2018 using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. From this cohort, hospitalizations were stratified according to IABP or Impella placement. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were divided into efficacy, safety, and device-related complications. Propensity-score matching was used to account for differences in the baseline characteristics between the groups. Logistic regression was performed to get the odds ratio and confidence intervals. Results Among 75,769 admissions with STEMI and CS, hospitalizations with Conclusion Impella compared with IABP in STEMI patients with CS was associated with higher in-hospital mortality and other adverse clinical and procedural outcomes.

Pulmonary arteriovenous malformations (PAVMs) are pathologic low-resistance conduits between a pulmonary artery and vein. Over 80% PAVMs occur in patients with hereditary hemorrhagic telangiectasia (HHT) and result from mutations in the transforming growth factor-beta signaling pathway. Mutations in the Growth Differentiation Factor 2 (GDF2) gene have recently been described to result in a vascular-anomaly syndrome with phenotypic overlap with HHT. We report a 43-year-old woman with a PAVM related ischemic stroke who was subsequently found to have a novel GDF2 gene mutation. The patient underwent coil-embolization of the PAVM with stable clinical and radiographic follow-up. It is important to diagnose PAVMs as they are an important cause of stroke-in-young; and can be treated definitively, reducing risk of recurrent stroke and migraine.

The unique conditions of space harbor considerable challenges for astronauts to overcome. Namely, the ionizing content of space radiation and the effects of microgravity have been implicated in the pathogenesis of cardiovascular disease. Post-flight carotid arterial stiffness was demonstrated in astronaut studies while early arteriosclerosis has been linked with microgravity-induced oxidative stress in cellular studies. Similarly, radiation has been shown to disrupt molecular pathways, enhance reactive oxygen species and increase risk of cardiovascular disease in exposed populations. These results may bear even more significance in space owing to the propensity for microgravity and space radiation to yield synergistic and/or additive interactions. Potential countermeasures such as α-tocopherol and captopril target these oxidative pathways and may help to protect against the effects of microgravity and radiation-induced cardiac damage. However, more research needs to be conducted in this area to facilitate a safe passage for humans to the Moon, Mars and beyond.

The data on racial disparities in HIV-associated infective endocarditis (IE) is limited. This sought us to analyze racial trend of IE and its complication in HIV. Trends analysis for incidence and complications with racial disparity were analyzed using NIS database 2010-2014 and ICD-9 CM codes with

Long term mechanical circulatory support (L-MCS) devices have emerged as an effective life prolonging modality among patients with advance heart failure awaiting cardiac transplant or deemed ineligible for transplant. Exploring trends of utilization, mortality and cost burden associated with use of

Background: Pulmonary hypertension (PH) is a serious unrelenting disorder that affects the functionality and quality of life of patients in addition to significantly decreasing their life span. The true prevalence of PH in general population is unknown. We evaluated hospitalization (HOSP) trends of

Background: The national estimates of 30-day readmission in AMI (acute myocardial infarction) patients are unknown in the United States (US). Our objective is to identify 30-day readmission rates, causes, predictors, and financial burden of readmission in the AMI patients. Methods: We used national

Background: Atrial fibrillation (AFib) accounts for high rates of unfavorable outcomes in cardiac as well as non-cardiac patients. The unplanned 30-day readmission rate, cost burden and predictors in AFib patients treated with or without Endovascular Ablation (EVA) remain unclear. Methods: We used

Background: Thrombolytic therapy (systemic (ST) or Cather Directed (CDT)) leads to early hemodynamic improvement in pulmonary embolism (PE) but it is unclear whether this beneficial effect persists. Limited data is available on risk of recurrent thromboembolism and bleeding on hospital discharge and its implications on hospital readmissions. Methods: The study cohort was derived from the HCUP’s National Readmission Data (NRD) 2013, sponsored by AHRQ. PE was identified by ICD 9 CM diagnosis code (415.11/12/19) in primary diagnosis filed. Readmission was defined as a subsequent hospital admission within 30 days following an index admission. The propensity score matching was used to eliminate the confounders including but not limited to age, gender, comorbidities and hospital teaching status. Hierarchical two level logistic models were used to evaluate study outcomes. Results: During the study year, of 2060 pts admitted with PE, 591 (28.69%) were treated with CDT and 1469 (71.31%) with ST. Out of this, 164 pts (7.92%) were readmitted within 30 days. The propensity score matched comparison revealed similar readmissions in CDT group compared to ST group (7.79 % vs. 8.71%, p=NS). Odds ratio for readmissions in CDT group by multivariate analysis showed similar trend (OR 0.80, 95% CI 0.59 - 1.09, p=NS). Amongst the etiologies of readmission, ST showed increased trends towards readmission secondary to bleeding complications (14.2% vs. 7.9%, p = NS), while decreased trends towards readmission secondary to hypercoagulable state (20% vs. 23.7%, p = NS) (fig 1). Significant predictors of 30 day readmissions included Age group 35-49 yrs, renal failure, anemia/ coagulopathy (fig 2). Conclusion: There is trend towards higher bleeding with ST and higher hypercoagulable state related readmissions with CDT. Large scale trials are needed to further confirm these findings which in turn may help transitioning care to outpatient settings for these patients.