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2. Temporal trends and outcomes of peripheral artery disease revascularization and amputation among the HIV population

Author

Teng, Alexandra E, Kennedy, Kevin F, Parikh, Rushi V, Armstrong, Ehrin J, Hsue, Priscilla Y, and Secemsky, Eric A

Subjects
Biomedical and Clinical Sciences, Public Health, Health Sciences, Infectious Diseases, Prevention, HIV/AIDS, Clinical Research, Cardiovascular, Amputation, Surgical, Endovascular Procedures, HIV Infections, Hospital Mortality, Humans, Limb Salvage, Peripheral Arterial Disease, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, amputation, HIV-associated cardiovascular disease, peripheral arterial disease, peripheral vascular intervention, Biological Sciences, Medical and Health Sciences, Psychology and Cognitive Sciences, Virology, Biomedical and clinical sciences, Health sciences
Abstract

ObjectiveWith antiretroviral therapy, people with HIV (PWH) are developing age-related diseases, including peripheral arterial disease (PAD). This study examined frequency and outcomes of peripheral vascular intervention (PVI) and primary amputation in PWH.DesignWe used the National Inpatient Sample (NIS) database to examine demographics, comorbidities, and temporal trends among PVI and primary amputation admissions by HIV status from 2012 to 2018.MethodsInverse probability of treatment weighting was used to calculate adjusted odds of in-hospital death and amputation. Cost of hospitalization and length of stay were compared by HIV status and revascularization approach.ResultsOf the 347 824 hospitalizations for PVI/amputation, 0.6% were PWH, which was stable over time. PWH had more renal and hepatic disease, whereas uninfected individuals had more traditional PAD risk factors. 55.2% of HIV+ admissions were endovascular compared with 49.3% in HIV- admissions, and 28.9% of the HIV+ admissions were elective compared with 42.1% among HIV-. HIV status did not impact amputation following PVI. In-hospital death was similar between groups following PVI or primary amputation. PWH had lower costs of hospitalization and a trend towards shorter hospital stays.ConclusionAlthough PWH are developing more age-related chronic illnesses, the number of PAD-associated procedures has remained flat. Despite being younger with fewer traditional PAD risk factors, PWH had higher rates of unplanned PVI admissions and endovascular revascularization but similar in-hospital outcomes. These findings suggest PWH have different risk factors for PAD and are likely underdiagnosed and undertreated, whereas those who are treated have similar outcomes to the general population.

Published
2022

22. Bleeding and thrombotic events in adults supported with venovenous extracorporeal membrane oxygenation: an ELSO registry analysis

Author

Nunez, Jose I., Gosling, Andre F., O'Gara, Brian, Kennedy, Kevin F., Rycus, Peter, Abrams, Darryl, and Brodie, Daniel

Subjects
Stroke (Disease) -- Conferences, meetings and seminars -- Risk factors -- Health aspects -- Analysis, Mortality -- Conferences, meetings and seminars -- Analysis, Blood clot -- Risk factors -- Conferences, meetings and seminars -- Analysis -- Health aspects, Thrombosis -- Risk factors -- Conferences, meetings and seminars -- Analysis -- Health aspects, Medical colleges -- Conferences, meetings and seminars -- Health aspects -- Analysis, Adults -- Conferences, meetings and seminars -- Health aspects -- Analysis, Health care industry
Abstract

Purpose This study aimed at analyzing the prevalence, mortality association, and risk factors for bleeding and thrombosis events (BTEs) among adults supported with venovenous extracorporeal membrane oxygenation (VV-ECMO). Methods We queried the Extracorporeal Life Support Organization registry for adults supported with VV-ECMO from 2010 to 2017. Multivariable logistic regression modeling was used to assess the association between BTEs and in-hospital mortality and the predictors of BTEs. Results Among 7579 VV-ECMO patients meeting criteria, 40.2% experienced [greater than or equal to] 1 BTE. Thrombotic events comprised 54.9% of all BTEs and were predominantly ECMO circuit thrombosis. BTE rates decreased significantly over the study period (p < 0.001). The inpatient mortality rate was 34.9%. Bleeding events (1.69 [1.49-1.93]) were more strongly associated with in-hospital mortality than thrombotic events (1.23 [1.08-1.41]) p < 0.01 for both. The BTEs most strongly associated with mortality were ischemic stroke (4.50 [2.55-7.97]) and medical bleeding, including intracranial (5.71 [4.02-8.09]), pulmonary (2.02 [1.54-2.67]), and gastrointestinal (1.54 [1.2-1.98]) hemorrhage, all p < 0.01. Risk factors for bleeding included acute kidney injury and pre-ECMO vasopressor support and for thrombosis were higher weight, multisite cannulation, pre-ECMO arrest, and higher PaCO.sub.2 at ECMO initiation. Longer time on ECMO, younger age, higher pH, and earlier year of support were associated with bleeding and thrombosis. Conclusions Although decreasing over time, BTEs remain common during VV-ECMO and have a strong, cumulative association with in-hospital mortality. Thrombotic events are more frequent, but bleeding carries a higher risk of inpatient mortality. Differential risk factors for bleeding and thrombotic complications exist, raising the possibility of a tailored approach to VV-ECMO management., Author(s): Jose I. Nunez [sup.1], Andre F. Gosling [sup.2], Brian O'Gara [sup.3], Kevin F. Kennedy [sup.4], Peter Rycus [sup.5], Darryl Abrams [sup.6], Daniel Brodie [sup.6], Shahzad Shaefi [sup.3], A. Reshad [...]

Published
2022
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32. Treatment Variability Among Patients Hospitalized for Chronic Limb‐Threatening Ischemia: An Analysis of the 2016 to 2018 US National Inpatient Sample

Author

Foley, Katelyn M., primary, Kennedy, Kevin F., additional, Lima, Fabio V., additional, Secemsky, Eric A., additional, Banerjee, Subhash, additional, Goodney, Philip P., additional, Shishehbor, Mehdi H., additional, Soukas, Peter A., additional, Hyder, Omar N., additional, Abbott, J. Dawn, additional, and Aronow, Herbert D., additional

Published
2024
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40. Interobserver Agreement Among Pathologists in the Differentiation of Sessile Serrated From Hyperplastic Polyps

Author

Vennelaganti, Sreekar, Cuatrecasas, Miriam, Vennalaganti, Prashanth, Kennedy, Kevin F., Srinivasan, Sachin, Patil, Deepa T., Plesec, Thomas, Lanas, Angel, Hörndler, Carlos, Andraws, Nevene, Cherian, Rachel, Mathur, Sharad, Hassan, Cesare, Repici, Alessandro, Klotz, Dagmar, Musulen, Eva, Risio, Mauro, Castells, Antoni, Gupta, Neil, and Sharma, Prateek

Published
2021
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43. Efficacy and Safety of Endoscopic Resection of Sessile Serrated Polyps 10 mm or Larger: A Systematic Review and Meta-Analysis

Author

Thoguluva Chandrasekar, Viveksandeep, Aziz, Muhammad, Patel, Harsh K., Sidhu, Naaz, Duvvuri, Abhiram, Dasari, ChandraShekhar, Kennedy, Kevin F., Ashwath, Ashwini, Spadaccini, Marco, Desai, Madhav, Jegadeesan, Ramprasad, Sathyamurthy, Anjana, Vennalaganti, Prashanth, Kohli, Divyanshoo, Hassan, Cesare, Pellise, Maria, Repici, Alessandro, Sharma, Prateek, and Bourke, Michael J.

Published
2020
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44. Limited English Proficiency, Cardiovascular Risk Factors, Cardiovascular Disease, and In-Hospital COVID-19 Outcomes.

Author

Berkowitz, Julia L., Kennedy, Kevin F., Font, Cristina, Nerenz, David R., Abbott, J. Dawn, and Aronow, Herbert D.

Subjects
*RISK assessment, *CARDIOVASCULAR diseases, *PATIENTS, *T-test (Statistics), *HYPERLIPIDEMIA, *HOSPITAL admission & discharge, *MULTIPLE regression analysis, *SEX distribution, *HOSPITAL care, *HYPERTENSION, *SMOKING, *CARDIOVASCULAR diseases risk factors, *HOSPITAL mortality, *EVALUATION of medical care, *RETROSPECTIVE studies, *DESCRIPTIVE statistics, *HOSPITALS, *MANN Whitney U Test, *MULTIVARIATE analysis, *HEART failure, *LONGITUDINAL method, *HEALTH facility translating services, *LIVER diseases, *INTENSIVE care units, *MEDICAL records, *ACQUISITION of data, *LUNG diseases, *ARTIFICIAL respiration, *SLEEP apnea syndromes, *CORONARY artery disease, *LENGTH of stay in hospitals, *VASOCONSTRICTORS, *DEMENTIA, *DATA analysis software, *COMMUNICATION barriers, *COVID-19, *VASCULAR diseases, *DIABETES, *COMORBIDITY, *DISEASE complications
Abstract

OBJECTIVES: Cardiovascular risk factors and history of cardiovascular disease are associated with greater morbidity and mortality in patients hospitalized with COVID-19. Limited English proficiency (LEP) has also been associated with worse outcomes in this setting, including requiring intensive care unit (ICU) level of care and in-hospital death. Whether non-- English-language preference (NELP) modifies the association between cardiovascular risk factors or disease and outcomes in patients hospitalized with COVID-19 is unknown. STUDY DESIGN: Retrospective cohort study of adult patients admitted to a large New England health system between March 1 and December 31, 2020, who tested positive for COVID-19. NELP was defined as having a preferred language that was not English noted in the electronic health record. METHODS: Cardiovascular risk factors, history of cardiovascular disease, and NELP were related to the primary composite clinical outcome--death or ICU admission--using multivariable binary logistic regression adjusted for demographic and clinical characteristics. Interaction terms for NELP and model covariates were evaluated. RESULTS: Of 3582 patients hospitalized with COVID-19, 1024 (28.6%) had NELP; 812 (79.3%) of the patients with NELP received interpreter services. Death or ICU admission occurred in 794 (22.2%) of the hospitalized patients. NELP was not significantly associated with the primary composite outcome in unadjusted or adjusted analyses. In the adjusted analyses, only male gender, coronary artery disease, pulmonary circulatory disease, and liver disease significantly predicted the primary outcome. NELP did not modify the effect of these associations. CONCLUSIONS: NELP was not significantly associated with odds of death or ICU admission, nor did it modify the association between cardiovascular risk factors or history of cardiovascular disease and this composite outcome. Because most patients with NELP received interpreter services, these findings may support the role of such services in ensuring equitable outcomes. [ABSTRACT FROM AUTHOR]

Published
2024
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