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Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, Iwai S, Jain D, Sule S, Ahmed A, Cooper HA, Frishman WH, Bhatt DL, Panza JA, Fonarow GC. Regional Variation in the Incidence and Outcomes of In-Hospital Cardiac Arrest in the United States. Circulation 2015; 131:1415-25. [PMID: 25792560 DOI: 10.1161/circulationaha.114.014542] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 02/13/2015] [Indexed: 11/16/2022]
Abstract
Background—
Regional variation in the incidence and outcomes of in-hospital cardiac arrest (IHCA) is not well studied and may have important health and policy implications.
Methods and Results—
We used the 2003 to 2011 Nationwide Inpatient Sample databases to identify patients ≥18 years of age who underwent cardiopulmonary resuscitation (
International Classification of Diseases, Ninth Edition, Clinical Modification
procedure codes 99.60 and 99.63) for IHCA. Regional differences in IHCA incidence, survival to hospital discharge, and resource use (total hospital cost and discharge disposition among survivors) were analyzed. Of 838 465 patients with IHCA, 162 270 (19.4%) were in the Northeast, 159 581 (19.0%) were in the Midwest, 316 201 (37.7%) were in the South, and 200 413 (23.9%) were in the West. Overall IHCA incidence in the United States was 2.85 per 1000 hospital admissions. IHCA incidence was lowest in the Midwest and highest in the West (2.33 and 3.73 per 1000 hospital admissions, respectively). Compared with the Northeast, risk-adjusted survival to discharge was significantly higher in the Midwest (odds ratio, 1.33; 95% confidence interval, 1.31–1.36), South (odds ratio, 1.21; 95% confidence interval, 1.19–1.23), and West (odds ratio, 1.25; 95% confidence interval, 1.23–1.27). IHCA survival increased significantly from 2003 to 2011 in the United States and in all regions (all
P
trend
<0.001). Total hospital cost was highest in the West, whereas discharge to skilled nursing facility and use of home health care among survivors was highest in the Northeast.
Conclusions—
We observed significant regional variation in IHCA incidence, survival, and resource use in the United States. This variation was explained only partially by differences in patient and hospital characteristics. Further studies are needed to identify other potential factors responsible for these regional differences to improve outcomes after IHCA.
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Gupta T, Harikrishnan P, Kolte D, Khera S, Subramanian KS, Mujib M, Masud A, Palaniswamy C, Sule S, Jain D, Ahmed A, Lanier GM, Cooper HA, Frishman WH, Bhatt DL, Fonarow GC, Panza JA, Aronow WS. Trends in management and outcomes of ST-elevation myocardial infarction in patients with end-stage renal disease in the United States. Am J Cardiol 2015; 115:1033-41. [PMID: 25724782 DOI: 10.1016/j.amjcard.2015.01.529] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 12/01/2022]
Abstract
Acute myocardial infarction in patients with end-stage renal disease (ESRD) is associated with increased risk of morbidity and mortality. Limited data are available on the contemporary trends in management and outcomes of ST-elevation myocardial infarction (STEMI) in patients with ESRD. We analyzed the 2003 to 2011 Nationwide Inpatient Sample databases to examine the temporal trends in STEMI, use of mechanical revascularization for STEMI, and in-hospital outcomes in patients with ESRD aged ≥18 years in the United States. From 2003 to 2011, whereas the number of patients with ESRD admitted with the primary diagnosis of acute myocardial infarction increased from 13,322 to 20,552, there was a decrease in the number of STEMI hospitalizations from 3,169 to 2,558 (ptrend <0.001). The overall incidence rate of cardiogenic shock in patients with ESRD and STEMI increased from 6.6% to 18.3% (ptrend <0.001). The use of percutaneous coronary intervention for STEMI increased from 18.6% to 37.8% (ptrend <0.001), whereas there was no significant change in the use of coronary artery bypass grafting (ptrend = 0.32). During the study period, in-hospital mortality increased from 22.3% to 25.3% (adjusted odds ratio [per year] 1.09; 95% confidence interval 1.08 to 1.11; ptrend <0.001). The average hospital charges increased from $60,410 to $97,794 (ptrend <0.001), whereas the average length of stay decreased from 8.2 to 6.5 days (ptrend <0.001). In conclusion, although there have been favorable trends in the utilization of percutaneous coronary intervention and length of stay in patients with ESRD and STEMI, the incidence of cardiogenic shock has increased threefold, with an increase in risk-adjusted in-hospital mortality, likely because of the presence of greater co-morbidities.
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Zak M, Castiblanco SA, Garg J, Palaniswamy C, Jacobs LE. Periprocedural Management of New Oral Anticoagulants in Atrial Fibrillation Ablation. J Cardiovasc Pharmacol Ther 2015; 20:457-64. [PMID: 25827857 DOI: 10.1177/1074248415576193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 02/08/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients who undergo catheter ablation for atrial fibrillation (AF) are at increased risk of developing thromboembolic and bleeding complications periprocedurally. Many patients are now on newer oral anticoagulants (NOACs), but data regarding their safety and efficacy during AF ablation are limited. METHODS AND RESULTS This article reviews the literature in PubMed from 1998 to 2014 and includes clinical trials and meta-analysis that analyzed the safety and efficacy of NOACs during AF catheter ablation. Dabigatran seems to be as effective and safe as warfarin, although most data are from single-center studies, with small samples and very low overall bleeding and thromboembolic complications. Periprocedural anticoagulation protocols also vary greatly between studies. Some recent meta-analysis has shown that warfarin could still be a safer and more effective alternative. There are fewer studies with rivaroxaban in AF ablation, and there have been no meta-analysis yet comparing rivaroxaban to warfarin or dabigatran. There seems to be no significant differences in safety or efficacy of rivaroxaban compared to warfarin. Interestingly, there are no available data for apixaban in AF ablation yet. DISCUSSION There are no consensus guidelines regarding the use of NOACs during AF ablation. Dabigatran and rivaroxaban seem as safe and effective as warfarin, although larger studies with standardized protocols are needed, as available studies may be underpowered to detect small differences in bleeding and thromboembolic rates.
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Harikrishnan P, Gupta T, Kolte D, Palaniswamy C, Khera S, Aronow W, Mujib M, Jain D, Sule S, Fonarow G, Ahmed A, Frishman W, Cooper H, Jacobson J, Iwai S, Panza J. TEMPORAL TRENDS IN INCIDENCE OF VENTRICULAR ARRHYTHMIAS AND ASSOCIATION OF VENTRICULAR ARRHYTHMIAS WITH OUTCOMES IN ST-ELEVATION MYOCARDIAL INFARCTION. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60041-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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30
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Khera S, Kolte D, Subramanian K, Khanna N, Mujib M, Aronow W, Ahn C, Palaniswamy C, Timmermans R, Cooper H, Fonarow G, Frishman W, Panza J, Bhatt D. TEMPORAL TRENDS IN REVASCULARIZATION AND OUTCOMES OF ST-ELEVATION MYOCARDIAL INFARCTION IN YOUNGER ADULTS IN THE UNITED STATES. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60002-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mujib M, Mazumder NK, Kolte D, Khera S, Aronow W, Harikrishnan P, Palaniswamy C, Sule S, Ahmed A, Jain D, Lanier G, Gass A, Cooper HA, Fonarow G, Panza J. DONOR-RECIPIENT RACE MISMATCH INCREASES GRAFT FAILURE AND MORTALITY AFTER ADULT HEART TRANSPLANTATION: A PROPENSITY-MATCHED STUDY OF THE UNITED NETWORK FOR ORGAN SHARING DATABASE. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60900-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gupta T, Harikrishnan P, Kolte D, Khera S, Aronow W, Mujib M, Palaniswamy C, Ahmed A, Jain D, Sule S, Lanier G, Cooper H, Fonarow G, Panza J. OUTCOMES OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: A UNITED STATES POPULATION-BASED STUDY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60951-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harikrishnan P, Gupta T, Kolte D, Palaniswamy C, Khera S, Aronow W, Mujib M, Balasubramaniyam N, Jain D, Sule S, Fonarow G, Ahmed A, Cooper H, Jacobson J, Iwai S, Panza J. ASSOCIATION OF ARRHYTHMIAS WITH OUTCOMES IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY: AN ANALYSIS OF THE NATIONWIDE INPATIENT SAMPLE 2003-2011. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Harikrishnan P, Gupta T, Kolte D, Palaniswamy C, Khera S, Aronow W, Mujib M, Subramanian K, Jain D, Sule S, Fonarow G, Ahmed A, Cooper H, Jacobson J, Iwai S, Panza J. BURDEN OF ARRHYTHMIAS IN PATIENTS WITH ALCOHOLIC CARDIOMYOPATHY: FINDINGS FROM THE NATIONWIDE INPATIENT SAMPLE 2003-2011. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60297-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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35
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Mujib M, Khanna N, Mazumder NK, Aronow WS, Kolte D, Khera S, Palaniswamy C, Jain D, Lanier GM, Sule S, Ahmed A, Levy WC, Prabhu SD, Cooper HA, Panza JA, Gass AL, Fonarow GC. Pretransplant coagulopathy and in-hospital outcomes among heart transplant recipients: a propensity-matched nationwide inpatient sample study. Clin Cardiol 2015; 38:300-8. [PMID: 25684174 DOI: 10.1002/clc.22391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/05/2015] [Accepted: 01/07/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The prevalence and contemporary trends of pre-heart transplantation (HT) coagulopathy and associated clinical outcomes have not been studied from a national database. HYPOTHESIS Pre-HT coagulopathy is associated with increased in-hospital mortality. METHODS Among 2454 adult HT recipients from the 2003 to 2010 Nationwide Inpatient Sample databases, 707 (29%) had pre-HT coagulopathy (defined as a comorbidity variable, based on International Classification of Diseases, Ninthe Revision, Clinical Modification and Diagnosis Related Group codes). We used propensity scores for coagulopathy to assemble a matched cohort of 664 pairs of patients with and without coagulopathy balanced in 54 baseline characteristics. RESULTS The prevalence of pre-HT coagulopathy increased from 17% in 2003 to 44% in 2010 (P for trend <0.001). In-hospital mortality occurred in 8.6% and 4.7% of matched HT recipients with and without coagulopathy, respectively (hazard ratio: 1.81; 95% confidence interval [CI]: 1.17-2.80; P = 0.008). Coagulopathy was not significantly associated with post-HT graft complications (odds ratio [OR]: 1.20; 95% CI: 0.95-1.52; P = 0.131) but was associated with increased blood transfusions (OR: 1.92; 95% CI, 1.54-2.41; P < 0.001). Coagulopathy and no-coagulopathy groups had no difference in median length of stay (22 days in each group, P = 0.746), but median total hospital charges were higher among patients with coagulopathy compared to those without (US$425 643 vs US$389 656; P = 0.008). CONCLUSIONS In this national study of HT recipients, pretransplant coagulopathy was common, increased over time, and was not significantly associated with post-HT graft complications or increased hospital stay. However, it was associated with increased bleeding risk, in-hospital mortality, and total hospital charges. These findings may have implications for the selection of patients for HT.
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Palaniswamy C, Garg J, Dutta T, Shah A, Gass A, Lanier GM. Cavitation phenomenon: A Novel Echocardiographic Finding in Pump Thrombosis. J Card Fail 2014; 20:874-5. [DOI: 10.1016/j.cardfail.2014.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 07/24/2014] [Accepted: 07/25/2014] [Indexed: 10/24/2022]
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Pandey A, Garg J, Krishnamoorthy P, Palaniswamy C, Doshi J, Lanier G, Ahmad H. Predictors of Coronary Artery Disease in Patients with Behçet's Disease. Cardiology 2014; 129:203-6. [DOI: 10.1159/000365139] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 06/06/2014] [Indexed: 11/19/2022]
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Khera S, Kolte D, Iwai S, Palaniswamy C, Harikrishnan P, Gupta T, Mujib M, Jain D, Cooper HA, Aronow WS, Fonarow GC, Panza JA. Permanent pacemaker utilization in older patients with syncope and carotid sinus syndrome. Int J Cardiol 2014; 176:1137-8. [PMID: 25156837 DOI: 10.1016/j.ijcard.2014.07.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/27/2014] [Indexed: 10/24/2022]
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40
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Khera S, Kolte D, Aronow WS, Palaniswamy C, Subramanian KS, Hashim T, Mujib M, Jain D, Paudel R, Ahmed A, Frishman WH, Bhatt DL, Panza JA, Fonarow GC. Non-ST-elevation myocardial infarction in the United States: contemporary trends in incidence, utilization of the early invasive strategy, and in-hospital outcomes. J Am Heart Assoc 2014; 3:jah3604. [PMID: 25074695 PMCID: PMC4310389 DOI: 10.1161/jaha.114.000995] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background There has been a paradigm shift in the definition of timing of early invasive strategy (EIS) for patients admitted with non‐ST‐elevation myocardial infarction (NSTEMI) in the last decade. Data on trends of EIS for NSTEMI and associated in‐hospital outcomes are limited. Our aim is to analyze temporal trends in the incidence, utilization of early invasive strategy, and in‐hospital outcomes of NSTEMI in the United States. Methods and Results We analyzed the 2002–2011 Nationwide Inpatient Sample databases to identify all patients ≥40 years of age with the principal diagnosis of acute myocardial infarction (AMI) and NSTEMI. Logistic regression was used for overall, age‐, sex‐, and race/ethnicity‐stratified trend analysis. From 2002 to 2011, we identified 6 512 372 patients with AMI. Of these, 3 981 119 (61.1%) had NSTEMI. The proportion of patients with NSTEMI increased from 52.8% in 2002 to 68.6% in 2011 (adjusted odds ratio [OR; per year], 1.055; 95% confidence interval [CI], 1.054 to 1.056) in the overall cohort. Similar trends were observed in age‐, sex‐, and race/ethnicity‐stratified groups. From 2002 to 2011, utilization of EIS at day 0 increased from 14.9% to 21.8% (Ptrend<0.001) and utilization of EIS at day 0 or 1 increased from 27.8% to 41.4% (Ptrend<0.001). Risk‐adjusted in‐hospital mortality in the overall cohort decreased during the study period (adjusted OR [per year], 0.976; 95% CI, 0.974 to 0.978). Conclusions There have been temporal increases in the proportion of NSTEMI and, consistent with guidelines, greater utilization of EIS. This has been accompanied by temporal decreases in in‐hospital mortality and length of stay.
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Gupta T, Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Jain D, Sule S, Ahmed A, Iwai S, Eugenio P, Lessner S, Frishman WH, Panza JA, Fonarow GC. Relation of smoking status to outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest. Am J Cardiol 2014; 114:169-74. [PMID: 24878124 DOI: 10.1016/j.amjcard.2014.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
In-hospital cardiac arrest (IHCA) is common and is associated with poor prognosis. Data on the effect of smoking on outcomes after IHCA are limited. We analyzed the Nationwide Inpatient Sample databases from 2003 to 2011 for all patients aged≥18 years who underwent cardiopulmonary resuscitation (CPR) for IHCA to examine the differences in survival to hospital discharge and neurologic status between smokers and nonsmokers. Of the 838,464 patients with CPR for IHCA, 116,569 patients (13.9%) were smokers. Smokers were more likely to be younger, Caucasian, and male. They had a greater prevalence of dyslipidemia, coronary artery disease, hypertension, chronic pulmonary disease, obesity, and peripheral vascular disease. Atrial fibrillation, heart failure, and diabetes mellitus with complications were less prevalent in smokers. Smokers were more likely to have a primary diagnosis of acute myocardial infarction (14.8% vs 9.1%, p<0.001) and ventricular tachycardia or ventricular fibrillation as the initial cardiac arrest rhythm (24.3% vs 20.5%, p<0.001). Smokers had a higher rate of survival to hospital discharge compared with nonsmokers (28.2% vs 24.1%, adjusted odds ratio 1.06, 95% confidence interval 1.05 to 1.08, p<0.001). Smokers were less likely to have a poor neurologic status after IHCA compared with nonsmokers (3.5% vs 3.9%, adjusted odds ratio 0.92, 95% confidence interval 0.89 to 0.95, p<0.001). In conclusion, among patients aged ≥18 years who underwent CPR for IHCA, we observed a higher rate of survival in smokers than nonsmokers-consistent with the "smoker's paradox." Smokers were also less likely to have a poor neurologic status after IHCA.
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Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, Jain D, Gass A, Ahmed A, Panza JA, Fonarow GC. Abstract 29: Temporal Trends in Incidence and Outcomes of Peripartum Cardiomyopathy in the United States: A Nationwide Population-Based Study. Circ Cardiovasc Qual Outcomes 2014. [DOI: 10.1161/circoutcomes.7.suppl_1.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
The reported incidence of peripartum cardiomyopathy (PPCM) in the United States varies widely. Furthermore, limited information is available on the temporal trends in incidence and outcomes of PPCM.
Objectives:
To determine the overall incidence and complication rates of PPCM, and to analyze temporal trends in incidence and outcomes of PPCM in the United States.
Methods:
We queried the 2004 to 2011 Nationwide Inpatient Sample databases to identify all women aged 15 to 54 years with the diagnosis of PPCM using ICD-9-CM codes 674.5x. Temporal trends in incidence (per 10,000 live births), maternal major adverse events (MAE defined as in-hospital mortality, cardiac arrest, heart transplant, mechanical circulatory support, acute pulmonary edema, thromboembolism or implantable cardioverter defibrillator/permanent pacemaker implantation), cardiogenic shock, and length of stay were analyzed.
Results:
From 2004 to 2011, we identified 34,219 women aged 15 to 54 years with PPCM. The overall PPCM rate was 10.3 per 10,000 (or 1 in 968) live births. PPCM incidence increased from 8.5 to 11.8 per 10,000 live births (p
trend
<0.001) during the study period. MAE occurred in 13.5% of patients. The most common complication in women with PPCM was thromboembolism (6.6%). The incidence of other complications was - in-hospital mortality in 1.3%, cardiac arrest in 2.1%, heart transplant in 0.5%, use of mechanical circulatory support in 1.5%, acute pulmonary edema in 1.8%, ICD/PPM placement in 2.9%, and cardiogenic shock in 2.6% There was no temporal change in MAE rate, except a small increase in in-hospital mortality [0.7% in 2004 to 1.8% in 2011, adjusted OR (per year) 1.08, 95% CI 1.02-1.14, p
trend
=0.006] and use of mechanical circulatory support [0.9% in 2004 to 2.2% in 2011, adjusted OR (per year) 1.08, 95% CI 1.03-1.14, p
trend
=0.002]. Cardiogenic shock increased from 1.0% in 2004 to 4.0% in 2011 [adjusted OR (per year) 1.16, 95% CI 1.11-1.21, p
trend
<0.001]. Mean length of stay decreased during the study period.
Conclusion:
From 2004 to 2011, the incidence of PPCM has increased in the United States. Maternal MAE rates overall have remained unchanged while cardiogenic shock, need for mechanical circulatory support, and in-hospital mortality have increased during the study period. Further study of the mechanisms underlying these adverse trends in the incidence and outcomes of PPCM are warranted.
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Kolte D, Khera S, Aronow WS, Palaniswamy C, Mujib M, Ahn C, Jain D, Gass A, Ahmed A, Panza JA, Fonarow GC. Temporal trends in incidence and outcomes of peripartum cardiomyopathy in the United States: a nationwide population-based study. J Am Heart Assoc 2014; 3:e001056. [PMID: 24901108 PMCID: PMC4309108 DOI: 10.1161/jaha.114.001056] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 04/29/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND The reported incidence of peripartum cardiomyopathy (PPCM) in the United States varies widely. Furthermore, limited information is available on the temporal trends in incidence and outcomes of PPCM. METHODS AND RESULTS We queried the 2004-2011 Nationwide Inpatient Sample databases to identify all women aged 15 to 54 years with the diagnosis of PPCM. Temporal trends in incidence (per 10 000 live births), maternal major adverse events (MAE; defined as in-hospital mortality, cardiac arrest, heart transplant, mechanical circulatory support, acute pulmonary edema, thromboembolism, or implantable cardioverter defibrillator/permanent pacemaker implantation), cardiogenic shock, and mean length of stay were analyzed. From 2004 to 2011, we identified 34 219 women aged 15 to 54 years with PPCM. The overall PPCM rate was 10.3 per 10 000 (or 1 in 968) live births. PPCM incidence increased from 8.5 to 11.8 per 10 000 live births (Ptrend<0.001) over the past 8 years. MAE occurred in 13.5% of patients. There was no temporal change in MAE rate, except a small increase in in-hospital mortality and mechanical circulatory support (Ptrend<0.05). Cardiogenic shock increased from 1.0% in 2004 to 4.0% in 2011 (Ptrend<0.001). Mean length of stay decreased during the study period. CONCLUSION From 2004 to 2011, the incidence of PPCM has increased in the United States. Maternal MAE rates overall have remained unchanged while cardiogenic shock, utilization of mechanical circulatory support, and in-hospital mortality have increased during the study period. Further study of the mechanisms underlying these adverse trends in the incidence and outcomes of PPCM are warranted.
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Krishnamoorthy P, Garg J, Palaniswamy C, McClung J, Cuomo L, Lanier G, Ahmad H, Frishman W. PREDICTORS OF MORTALITY AND GENDER DIFFERENCES IN TAKOTSUBO CARDIOMYOPATHY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60831-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Harikrishnan P, Kolte D, Palaniswamy C, Khera S, Mujib M, Aronow W, Iwai S, Eugenio P, Lessner S, Ahmed A, Ferrick A, Fonarow G, Frishman W, Panza J. CATHETER ABLATION OF VENTRICULAR TACHYCARDIA: TEN-YEAR TRENDS IN UTILIZATION, IN-HOSPITAL COMPLICATIONS, AND IN-HOSPITAL MORTALITY IN PATIENTS WITH ISCHEMIC CARDIOMYOPATHY. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60294-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Garg J, Krishnamoorthy P, Palaniswamy C, Aronow W, Doshi J, Lanier G, Cuomo L, Ahmad H, Panza J. PREVALENCE AND PREDICTORS OF CORONARY ARTERY DISEASE IN BEHCET'S DISEASE. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)61324-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kolte D, Khera S, Aronow W, Mujib M, Palaniswamy C, Jain D, Sule S, Frishman W, Ahmed A, Fonarow G, Panza J. PRIMARY PAYER STATUS AND OUTCOMES IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION UNDERGOING PRIMARY PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60056-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Krishnamoorthy P, Garg J, Palaniswamy C, Lanier G, Cuomo L, Ahmad H, Frishman W. RACIAL AND GENDER DIFFERENCES IN RISK FACTORS AND OUTCOMES ASSOCIATED WITH LONG QTC SYNDROME: INSIGHTS FROM THE NATIONAL INPATIENT SAMPLE DATABASE 2009-10. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60447-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khera S, Kolte D, Aronow W, Mujib M, Palaniswamy C, Ahmed A, Jain D, Sule S, Fonarow G, Iwai S, Eugenio P, Lessner S, Panza J. SMOKING STATUS AND SURVIVAL AFTER CARDIOPULMONARY RESUSCITATION FOR IN-HOSPITAL CARDIAC ARREST: ANALYSIS OF THE 2003-2011 NATIONWIDE INPATIENT SAMPLE DATABASES. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mujib M, Aronow W, Lanier G, Kolte D, Khera S, Palaniswamy C, Sule S, Fonarow G, hmed L, Frishman W, Gass A, Prabhu S, Panza J. A SMOKER'S PARADOX IN HEART TRANSPLANT RECIPIENTS: FINDINGS FROM THE NATIONWIDE INPATIENT SAMPLE 2003-2010. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60883-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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