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Conroy PD, Rastogi V, Yadavalli SD, Solomon Y, Romijn AS, Dansey K, Verhagen HJM, Giles KA, Lombardi JV, Schermerhorn ML. The Rise of Endovascular Repair for Abdominal, Thoracoabdominal, and Thoracic Aortic Aneurysms. J Vasc Surg 2024:S0741-5214(24)01482-4. [PMID: 38942397 DOI: 10.1016/j.jvs.2024.06.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/18/2024] [Accepted: 06/23/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Given changes in intervention guidelines and the growing popularity of endovascular treatment for aortic aneurysms, we examined the trends in admissions and repairs of abdominal aortic aneurysms (AAA), thoracoabdominal aortic aneurysms (TAAA), and thoracic aortic aneurysms (TAA). METHODS We identified all patients admitted with ruptured aortic aneurysms and intact aortic aneurysms repaired in the Nationwide Inpatient Sample (NIS) between 2004-2019. We then examined the utilization of open, endovascular, and complex endovascular repair (OAR,EVAR,cEVAR) for each aortic aneurysm location (AAA,TAAA,TAA), alongside their resulting in-hospital mortality, over time. cEVAR included branched, fenestrated, and physician modified endograft. RESULTS 715,570 patients were identified with AAA (87% Intact-Repairs, 13% Rupture-Admissions). Both intact AAA repairs and ruptured AAA admissions decreased significantly between 2004 and 2019 (intact 41,060-34,215,p<.01; ruptured 7,175-4,625,p=.02). Out of all AAA repairs done in a given year, the use of EVAR increased (2004-2019: intact 45%-66%,p<.01; ruptured 10%-55%,p<.01) as well as cEVAR (2010-2019: intact 0%-23%,p<.01; ruptured 0%-14%,p<.01). Mortality after EVAR of intact AAAs decreased significantly by 29% (2004-2019, 0.73%-0.52%,p<.01) while mortality after OAR increased significantly by 16% (2004-2019, 4.4%-5.1%,p<.01). In the study, 27,443 patients were identified with TAAA (80% Intact, 20% Ruptured). In the same period, intact TAAA repairs trended upwards (2004-2019 1,435-1,640,p=.055) and cEVAR became the most common approach (2004-2019, 3.8%-72%,p=.055). 141,651 patients were identified with ascending, arch, or descending TAA (90% Intact, 10% Ruptured). Intact TAA repairs increased significantly (2004-2019 4,380-10,855,p<.01). From 2017-2019, the mortality after OAR of descending TAAs increased and mortality after TEVAR decreased (2017-2019: OAR 1.6%-3.1%; TEVAR 5.2%-3.8%). CONCLUSION Both intact AAA repairs and ruptured AAA admissions significantly decreased between 2004 and 2019. The use of endovascular techniques for the repair of all aortic aneurysm locations, both intact and ruptured, increased over the past two decades. Most recently in 2019, 89% of intact AAAs repairs, infrarenal through suprarenal, were endovascular (EVAR or cEVAR, respectively). cEVAR alone has risen to 23% of intact AAA repairs in 2019, from 0% a decade earlier. In this period of innovation, with many new options to repair aortic aneurysms while maintaining arterial branches, endovascular repair is now used for the majority of all intact aortic aneurysm repairs. Long-term data are needed to evaluate the durability of these procedures.
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Affiliation(s)
- Patrick D Conroy
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Vascular and Endovascular Surgery, Cooper University Hospital, Camden, New Jersey
| | - Vinamr Rastogi
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sai Divya Yadavalli
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Yoel Solomon
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | - Anne-Sophie Romijn
- Department of Trauma Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Kirsten Dansey
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Vascular Surgery, University of Washington Medical Center, Seattle, WA
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Kristina A Giles
- Department of Vascular Surgery, Maine Medical Center, Portland, ME
| | - Joseph V Lombardi
- Department of Vascular and Endovascular Surgery, Cooper University Hospital, Camden, New Jersey
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Szotek M, Drużbicki Ł, Sabatowski K, Amoroso GR, De Schouwer K, Matusik PT. Transcatheter Aortic Valve Implantation and Cardiac Conduction Abnormalities: Prevalence, Risk Factors and Management. J Clin Med 2023; 12:6056. [PMID: 37762995 PMCID: PMC10531796 DOI: 10.3390/jcm12186056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating aortic stenosis in patients at moderate and high surgical risk and those disqualified from surgery. The method evolved what translates into a noticeable decrease in the incidence of complications and more beneficial clinical outcomes. However, the incidence of conduction abnormalities related to TAVI, including left bundle branch block and complete or second-degree atrioventricular block (AVB), remains high. The occurrence of AVB requiring permanent pacemaker implantation is associated with a worse prognosis in this group of patients. The identification of risk factors for conduction disturbances requiring pacemaker placement and the assessment of their relation to pacing dependence may help to develop methods of optimal care, including preventive measures, for patients undergoing TAVI. This approach is crucial given the emerging evidence of no worse outcomes for intermediate and low-risk patients undergoing TAVI in comparison to surgical aortic valve replacement. This paper comprehensively discusses the mechanisms, risk factors, and consequences of conduction abnormalities and arrhythmias, including AVB, atrial fibrillation, and ventricular arrhythmias associated with aortic stenosis and TAVI, as well as provides insights into optimized patient care, along with the potential of conduction system pacing and cardiac resynchronization therapy, to minimize the risk of unfavorable clinical outcomes.
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Affiliation(s)
- Michał Szotek
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Łukasz Drużbicki
- Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Karol Sabatowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Kraków, Poland
| | - Gisella R. Amoroso
- Department of Cardiovascular Medicine, “SS Annunziata” Hospital, ASL CN1-Savigliano, Via Ospedali 9, 12038 Savigliano, Italy
| | - Koen De Schouwer
- Department of Cardiology, Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Paweł T. Matusik
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
- Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 80 Prądnicka St., 31-202 Kraków, Poland
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Antwi-Amoabeng D, Sathappan S, Firzli TR, Beutler BD, Ulanja MB, Gbadebo TD. A nationwide analysis of the outcomes in hospitalized patients with atrial fibrillation and temperature-related illnesses. Clinics (Sao Paulo) 2023; 78:100269. [PMID: 37557004 PMCID: PMC10432905 DOI: 10.1016/j.clinsp.2023.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVES The authors evaluated mortality and indices of cost of care among inpatients with Atrial Fibrillation (AF) and a diagnosis of a Temperature-Related Illness (TRI). The authors also assessed trends in the prevalence of TRIs among AF hospitalizations. METHODS In this cross-sectional study, the authors used discharge data from the Nationwide Inpatient Sample (NIS) collected between January 2005 and September 2015 to identify patients with a diagnosis of AF and TRI. Outcomes of interest included in-hospital mortality, invasive mechanical ventilation, hospital length of stay, and cost of hospitalization. RESULTS A total of 37,933 encounters were included. The median age was 79 years. Males were slightly overrepresented relative to females (54.2% vs. 45.8%, respectively). Although Blacks were only 6.6% of the cohort, they represented 12.2% of the TRI cases. Compared to non-TRI-related hospitalizations, a diagnosis of a TRI was associated with an increased likelihood of invasive mechanical ventilation (16.5% vs. 4.1%, p < 0.001), longer length-of-stay (5 vs. 4 days, p < 0.001), higher cost of care (10,082 vs. 8,607, in US dollars p < 0.001), and increased mortality (18.6% vs. 5.1%, p < 0.001). Compared to non-TRI, cold-related illness portends higher odds of mortality 4.68, 95% Confidence Interval (4.35-5.04), p < 0.001, and heat-related illness was associated with less odds of mortality, but this was not statistically significant 0.77 (0.57-1.03), p = 0.88. CONCLUSION The occurrence of TRI among hospitalized AF patients is small but there is an increasing trend in the prevalence, which more than doubled over the decade in this study. Individuals with AF who are admitted with a TRI face significantly poorer outcomes than those admitted without a TRI including higher mortality. Cold-related illness is associated with higher odds of mortality. Further research is required to elucidate the pathogenic mechanisms underlying these findings and identify strategies to prevent TRIs in AF patients.
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Affiliation(s)
| | | | - Tarek R Firzli
- University of Nevada, Reno School of Medicine, Reno, USA
| | - Bryce D Beutler
- University of Southern California, Keck School of Medicine, Los Angeles, USA.
| | - Mark B Ulanja
- Christus Ochsner St. Patrick Hospital, Lake Charles, USA
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Petersen JK, Fosbøl EL, Strange JE, Schou M, Brems DA, Køber L, Østergaard L. Impact of first-time detected atrial fibrillation after transcatheter aortic valve replacement: A nationwide study. IJC HEART & VASCULATURE 2023; 47:101239. [PMID: 37484063 PMCID: PMC10359858 DOI: 10.1016/j.ijcha.2023.101239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/08/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
Background The prognostic implications of new-onset atrial fibrillation (AF) in conjunction with transcatheter aortic valve replacement (TAVR) is sparsely examined. Therefore, we aimed to examine the impact of first-time detected AF after TAVR on all-cause mortality and heart failure (HF). Methods With Danish nationwide data from 2008 to 2021, we identified all patients who underwent TAVR and were alive 30 days after discharge (index date). Patients were categorized into i) no AF; ii) history of AF; and iii) first-time detected AF within 30 days after discharge. From the index date, two-year rates of all-cause mortality and HF admissions were compared using multivariable adjusted Cox analysis. Results We identified 6,807 patients surviving 30 days beyond TAVR: 4,229 (62.1%) without AF (55% male, median age 81), 2,283 (33.6%) with history of AF (58% male, median age 82), and 291 (4.3%) with first-time detected AF (56% male, median age 81). Compared with patients without AF, adjusted analysis yielded increased associated hazard ratio (HR) of all-cause mortality in patients with history of AF (1.53 [95% confidence interval [CI], 1.32-1.77]) and in patients with first-time detected AF (2.06 (95%CI, 1.55-2.73]). Further, we observed increased associated HRs of HF admissions in patients with history of AF (1.70 [95%CI, 1.45-1.99]) and in patients with first-time detected AF (1.77 [95%CI, 1.25-2.50]). Conclusion In TAVR patients surviving 30 days beyond discharge, first-time detected AF appeared to be at least as strongly associated with two-year rates of all-cause mortality and HF admissions, as compared with patients with history of AF.
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Affiliation(s)
- Jeppe Kofoed Petersen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Emil Loldrup Fosbøl
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jarl Emanuel Strange
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Daniel Alexander Brems
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lauge Østergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Banga S, Abela GS, Saltiel F, Fischell T, Kalavakunta JK, Sood A, Jolly G, Najib K, Al-Ali H, Qintar M, Bazil J, Singh Y, Gupta V. Management of Atrial Fibrillation Post Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 200:171-177. [PMID: 37329837 DOI: 10.1016/j.amjcard.2023.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 05/01/2023] [Accepted: 05/16/2023] [Indexed: 06/19/2023]
Abstract
Atrial fibrillation (AF) is a common complication in patients who underwent transcatheter aortic valve implantation. Some of these patients have preexisting AF as well. The management of these patients is complex, especially after the procedure, when there is a sudden change in hemodynamics. There are no established guidelines about the management of the patients who underwent transcatheter aortic valve replacement with preexisting or new-onset AF. This review article discusses the management of these patients with rate and rhythm control strategies with medications. This article also highlights the role of newer oral anticoagulation medications and left atrial occlusion devices to prevent stroke after the procedure. We will also discuss new advances in the care of this patient population to prevent the occurrence of AF after transcatheter aortic valve implantation. In conclusion, this article is a synopsis of both pharmacologic and device interventions for the management of AF in patients who underwent transcatheter aortic valve replacement.
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Affiliation(s)
- Sandeep Banga
- Department of Cardiology, Sparrow Hospital, Michigan State University, Lansing, Michigan.
| | - George S Abela
- Department of Cardiology, Sparrow Hospital, Michigan State University, Lansing, Michigan
| | - Frank Saltiel
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - Tim Fischell
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - Jagadeesh K Kalavakunta
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - Abhinav Sood
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - George Jolly
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - Khalid Najib
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
| | - Haya Al-Ali
- Department of Physiology, Michigan State University, Lansing, Michigan
| | - Mohammed Qintar
- Department of Cardiology, Sparrow Hospital, Michigan State University, Lansing, Michigan
| | - Jason Bazil
- Department of Physiology, Michigan State University, Lansing, Michigan
| | - Yashbir Singh
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Vishal Gupta
- Department of Cardiology, Ascension Borgess Hospital, Western Michigan University, Homer Stryker M.D. School of Medicine, Michigan State University, Kalamazoo, Michigan
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Madhavan MV, Kodali SK, Thourani VH, Makkar R, Mack MJ, Kapadia S, Webb JG, Cohen DJ, Herrmann HC, Williams M, Greason K, Pibarot P, Hahn RT, Jaber W, Xu K, Alu M, Smith CR, Leon MB. Outcomes of SAPIEN 3 Transcatheter Aortic Valve Replacement Compared With Surgical Valve Replacement in Intermediate-Risk Patients. J Am Coll Cardiol 2023; 82:109-123. [PMID: 37407110 DOI: 10.1016/j.jacc.2023.04.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/03/2023] [Accepted: 05/05/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Previous studies demonstrated transcatheter aortic valve replacement (TAVR) with an earlier generation balloon-expandable valve to be noninferior to surgical aortic valve replacement (SAVR) for death and disabling stroke in intermediate-risk patients with symptomatic, severe aortic stenosis at 5 years. However, limited long-term data are available with the more contemporary SAPIEN 3 (S3) bioprosthesis. OBJECTIVES The aim of this study was to compare 5-year risk-adjusted outcomes in intermediate-risk patients undergoing S3 TAVR vs SAVR. METHODS Propensity score matching was performed to account for baseline differences in intermediate-risk patients undergoing S3 TAVR in the PARTNER 2 (Placement of Aortic Transcatheter Valves) S3 single-arm study and SAVR in the PARTNER 2A randomized clinical trial. The primary composite endpoint consisted of 5-year all-cause death and disabling stroke. RESULTS A total of 783 matched pairs of intermediate-risk patients with severe aortic stenosis were studied. There were no differences in the primary endpoint between S3 TAVR and SAVR at 5 years (40.2% vs 42.7%; HR: 0.87; 95% CI: 0.74-1.03; P = 0.10). The incidence of mild or greater paravalvular regurgitation was more common after S3 TAVR. There were no differences in structural valve deterioration-related stage 2 and 3 hemodynamic valve deterioration or bioprosthetic valve failure. CONCLUSIONS In this propensity-matched analysis of intermediate-risk patients, 5-year rates of death and disabling stroke were similar between S3 TAVR and SAVR. Rates of structural valve deterioration-related hemodynamic valve deterioration were similar, but paravalvular regurgitation was more common after S3 TAVR. Longer-term follow-up is needed to further evaluate differences in late adverse clinical events and bioprosthetic valve durability. (PII S3i [PARTNER II Trial: Placement of Aortic Transcatheter Valves II - S3 Intermediate], NCT03222128; PII A (PARTNER II Trial: Placement of Aortic Transcatheter Valves II - XT Intermediate and High Risk], NCT01314313).
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Affiliation(s)
- Mahesh V Madhavan
- Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Susheel K Kodali
- Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA.
| | | | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - John G Webb
- St Paul's Hospital, Vancouver, British Columbia, Canada
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St Francis Hospital, Roslyn, New York, USA
| | - Howard C Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathew Williams
- New York University Langone Medical Center, New York, New York, USA
| | | | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Rebecca T Hahn
- Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | | | - Ke Xu
- Edwards Lifesciences, Irvine, California, USA
| | - Maria Alu
- Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Craig R Smith
- Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA
| | - Martin B Leon
- Columbia University Irving Medical Center and NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
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Savaie M, Sheikhi Y, Baghbanian R, Soltani F, Amiri F, Hesam S. Epidemiology, Risk Factors, and Outcome of Cardiac Dysrhythmias in a
Noncardiac Intensive Care Unit. SAGE Open Nurs 2023; 9:23779608231160932. [PMID: 36969363 PMCID: PMC10034271 DOI: 10.1177/23779608231160932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 03/24/2023] Open
Abstract
Introduction Several extrinsic factors contribute to the development of cardiac
dysrhythmias. In intensive care unit (ICU) settings and among critically ill
patients who are exposed to a large number of risk factors, cardiac
disturbances are more common. Objectives This study aimed to examine the epidemiology, risk factors, and outcome of
cardiac dysrhythmias in a non-cardiac ICU. Methods This is a retrospective, single-center, observational study conducted in a
tertiary noncardiac ICU at Imam Khomeini Hospital in Ahvaz, Iran. Out of the
360 adult patients aged 18 years and older who were admitted to ICU for
longer than 24 h, 340 cases who met the study inclusion criteria were
recruited between March 2018 until October 2018. Results The most common nonsinus dysrhythmias were new-onset atrial fibrillation
(NOAF) (12.9%) and ventricular tachycardia (21 patients—6.2%). According to
our results, previous percutaneous coronary instrumentation, acute kidney
injury, sepsis, and hyperkalemia act as risk factors in the development of
cardiac dysrhythmias. Additionally, we found out that thyroid dysfunction
and pneumonia can predict the development of NOAF in critically ill
patients. The estimated mortality rate among patients with NOAF in this
study was 15.7% (p < .05). Conclusion Cardiac dysrhythmias are common in ICU patients and treating the risk factors
can help to prevent their development and improve patient management and
outcome.
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Affiliation(s)
- Mohsen Savaie
- Pain Research Center, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran
- Mohsen Savaie, Post code 6155689768, No.
15, East Motahhari Street, Kianpars, Ahvaz, Iran.
| | - Yasaman Sheikhi
- School of Medicine, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran
| | - Reza Baghbanian
- Pain Research Center, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran
| | - Farhad Soltani
- Pain Research Center, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran
| | - Fereshteh Amiri
- Pain Research Center, Ahvaz Jundishapur University of Medical
Sciences, Ahvaz, Iran
| | - Saeed Hesam
- Ahvaz
Jundishapur University of Medical Sciences,
Ahvaz, Iran
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Nuche J, Panagides V, Nault I, Mesnier J, Paradis JM, de Larochellière R, Kalavrouziotis D, Dumont E, Mohammadi S, Philippon F, Rodés-Cabau J. Incidence and clinical impact of tachyarrhythmic events following transcatheter aortic valve replacement: A review. Heart Rhythm 2022; 19:1890-1898. [PMID: 35952981 DOI: 10.1016/j.hrthm.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is well established for treating severe symptomatic aortic stenosis. Whereas broad information on the epidemiology, clinical implications, and management of bradyarrhythmias after TAVR is available, data about tachyarrhythmic events remain scarce. Despite the progressively lower risk profile of TAVR patients and the improvement in device characteristics and operator skills, approximately 10% of patients develop new-onset atrial fibrillation (NOAF) after TAVR. The proportion of patients in whom NOAF actually corresponds to previously undiagnosed silent atrial fibrillation (AF) has not been properly determined. The transapical approach, the need for pre- or post- balloon dilation, and the presence of periprocedural complications have been associated with a higher risk of NOAF. Older age, left atrial volume, or worse functional class are patient-derived risk factors shared with preprocedural AF. NOAF after TAVR has been associated with poorer survival and a higher incidence of cerebrovascular events. However, patient management differs markedly among different centers, especially with regard to anticoagulation in patients with short-duration AF episodes detected in the periprocedural setting and in cases of silent NOAF detected during continuous electrocardiographic (ECG) monitoring. Evidence about ventricular arrhythmias is even more scarce than for AF. Some case reports of sudden cardiac death after TAVR in patients with a pacemaker have identified ventricular tachycardia or ventricular fibrillation in device interrogation. TAVR has been shown to reduce the arrhythmic burden, but a significant proportion of patients (16%) present with complex premature ventricular complex arrhythmias within the year after TAVR. Whether these events are related to poorer outcomes is unknown. Continuous ECG monitoring after TAVR may help describe the frequency, risk factors, and prognostic implications of tachyarrhythmias in this population.
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Affiliation(s)
- Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Vassili Panagides
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Isabelle Nault
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Francois Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Antwi-Amoabeng D, Ghuman J, Sathappan S, Beutler BD, Ulanja MB, Dave M, Canaday O. Influence of HIV on in-hospital outcomes in patients with atrial fibrillation. Acta Cardiol 2022; 78:349-356. [PMID: 36222563 DOI: 10.1080/00015385.2022.2129185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The development of highly active anti-retroviral therapy (HAART) has markedly prolonged the life expectancy of individuals with human immunodeficiency virus (HIV). The prevalence of age-related cardiovascular disease (CVD) and arrhythmias is therefore expected to increase among the HIV-positive population. OBJECTIVES We aimed to assess the trends in prevalence, and inpatient outcomes among patients with HIV and atrial fibrillation (AF). METHODS Using ICD-9-CM coding, we identified 38,252,858 HIV-negative and 31,224 HIV-positive encounters with AF from the National Inpatient Sample (NIS) database from January 2005 to September 2015. Trends in prevalence of HIV in AF patients, length and cost of hospital stay, and inpatient mortality, were determined. t-Test was used for continuous variables and Chi-square test for categorical variables. Final multivariable logistic regression models were constructed to determine predictors of outcomes. RESULTS Among the 31,224 HIV-positive encounters, 78.6% were males. The median age was 56 years for HIV-positive patients and 78 years for HIV-negative patients. Black patients were markedly overrepresented among HIV-positive as compared to HIV-negative hospitalisations (48.6 vs. 7.6%). The prevalence of alcohol and drug use, smoking, chronic kidney disease, chronic liver disease, and cancer was higher among HIV-positive as compared to HIV-negative patients. The prevalence of HIV among the AF hospitalisations increased from 2005 to 2015. As compared to HIV-negative patients, individuals with HIV demonstrated increased inpatient mortality (9.2 vs. 5.1%), longer length of stay (6 [3-11] vs. 4 [2-7] days), and increased cost of treatment ($12,464 vs. $8606). CONCLUSION The prevalence of HIV among patients with AF increased between 2005 and 2015. As compared to HIV-negative individuals with AF, a diagnosis of HIV was associated with increased inpatient mortality, length of stay, and cost of care. Future research on the underlying mechanisms of these findings is warranted to inform the treatment of AF in patients with HIV.
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Affiliation(s)
| | - Joban Ghuman
- Dr. D.Y. Patil Medical College and Research Centre, Pimpri, India
| | - Sunil Sathappan
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Bryce D Beutler
- Department of Radiology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Mark B Ulanja
- Christus Ochsner St. Patrick Hospital, Lake Charles, LA, USA
| | - Mihir Dave
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV, USA
| | - Omar Canaday
- Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, NV, USA
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10
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The role of mechanical valves in the aortic position in the era of bioprostheses and TAVR: Evidence-based appraisal and focus on the On-X valve. Prog Cardiovasc Dis 2022; 72:31-40. [PMID: 35738422 DOI: 10.1016/j.pcad.2022.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 06/05/2022] [Indexed: 11/24/2022]
Abstract
Patients who need a prosthetic aortic heart valve may decide, working with their cardiologist and cardiac surgeon, among a variety of options: surgical or transcatheter approach, bioprosthetic or mechanical valve, or a Ross procedure if suitable to their age and anatomy. This review article examines the evidence for survival benefit with mechanical aortic valves, discusses bioprosthetic structural valve degeneration and its consequences, and considers the risks of redo aortic valve surgery or subsequent valve-in-valve (ViV) transcatheter intervention. It highlights the unique characteristics of the On-X aortic valve, including the US Food and Drug Administration approved and American College of Cardiology/American Heart Association guideline supported reduced anticoagulation target INR of 1.5 to 2.0, and discusses the PROACT Xa trial comparing apixaban vs warfarin anticoagulation. The choice of prosthetic valve should be individualized, carefully considering each patient's unique circumstances. In that context, the On-X aortic valve offers a potential lifetime solution without need for a repeat operation, while minimizing the risks of long-term anticoagulation. In an era of enthusiasm for bioprosthetic and transcatheter-based approaches, the option of a second-generation bileaflet mechanical valve with optimized hemodynamics-the On-X aortic valve-may well align with patient expectations.
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11
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Chapalain X, Oilleau JF, Henaff L, Lorillon PharmD P, Saout DL, Kha P, Pluchon K, Bezon E, Huet O. Short acting intravenous beta-blocker as a first line of treatment for atrial fibrillation after cardiac surgery: a prospective observational study. Eur Heart J Suppl 2022; 24:D34-D42. [PMID: 35706899 PMCID: PMC9190753 DOI: 10.1093/eurheartjsupp/suac025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Post-operative atrial fibrillation (POAF) defined as a new-onset of atrial fibrillation (AF) following surgery occurs frequently after cardiac surgery. For non-symptomatic patients, rate control strategy seems to be as effective as rhythm control one in surgical patients. Landiolol is a new highly cardio-selective beta-blocker agent with interesting pharmacological properties that may have some interest in this clinical situation. This is a prospective, monocentric, observational study. All consecutive adult patients (age >18 years old) admitted in the intensive care unit following cardiac surgery with a diagnosed episode of AF were eligible. Success of landiolol administration was defined by a definitive rate control from the beginning of infusion to the 72th h. We also evaluated rhythm control following landiolol infusion. Safety analysis was focused on haemodynamic, renal and respiratory side effects. From 1 January 2020 to 30 June 2021, we included 54 consecutive patients. A sustainable rate control was obtained for 49 patients (90.7%). Median time until a sustainable rate control was 4 h (1, 22). Median infusion rate of landiolol needed for a sustainable rate control was 10 µg/kg/min (6, 19). Following landiolol infusion, median time until pharmacological cardioversion was 24 h. During landiolol infusion, maintenance of mean arterial pressure target requires a concomitant very low dose of norepinephrine. We did not find any other side effects. Low dose of landiolol used for POAF treatment was effective and safe for a rapid and sustainable rate and rhythm control after cardiac surgery.
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Affiliation(s)
- X Chapalain
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
| | - J F Oilleau
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
| | - L Henaff
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
| | - P Lorillon PharmD
- Department of Pharmacy, Brest University Hospital, 29200 Brest, France
| | - D Le Saout
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
| | - P Kha
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
| | - K Pluchon
- Department of Cardiovascular and Thoracic Surgery, Brest University Hospital, 29200 Brest, France
| | - E Bezon
- Department of Cardiovascular and Thoracic Surgery, Brest University Hospital, 29200 Brest, France
| | - O Huet
- Department of Anesthesiology and Surgical intensive care unit, Brest University Hospital, 29200 Brest, France
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12
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Rouleau SG, Brady WJ, Koyfman A, Long B. Transcatheter aortic valve replacement complications: A narrative review for emergency clinicians. Am J Emerg Med 2022; 56:77-86. [DOI: 10.1016/j.ajem.2022.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/11/2022] [Accepted: 03/20/2022] [Indexed: 02/07/2023] Open
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13
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Ryan T, Grindal A, Jinah R, Um KJ, Vadakken ME, Pandey A, Jaffer IH, Healey JS, Belley-Coté ÉP, McIntyre WF. New-Onset Atrial Fibrillation After Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis. JACC Cardiovasc Interv 2022; 15:603-613. [PMID: 35331452 DOI: 10.1016/j.jcin.2022.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES The authors aimed to identify risk factors and outcomes associated with new-onset atrial fibrillation (NOAF) after transcatheter aortic valve replacement (TAVR). BACKGROUND NOAF is a common complication after TAVR, although estimates of the precise occurrence are variable. This study sought to quantify the occurrence of NOAF after TAVR and to explore the outcomes and predictors associated with this complication. METHODS We searched Medline, EMBASE, and the Cochrane database from 2016 to 2020 for articles that reported NOAF after TAVR. We extracted data for studies published before 2016 from a previous systematic review. We pooled data using a random effects model. RESULTS We identified 179 studies with 241,712 total participants (55,271 participants with pre-existing atrial fibrillation (AF) were excluded) that reported NOAF from 2008 to 2020. The pooled occurrence of NOAF after TAVR was 9.9% (95% CI: 8.1%-12%). NOAF after TAVR was associated with a longer index hospitalization (mean difference = 2.66 days; 95% CI: 1.05-4.27), a higher risk of stroke in the first 30 days (risk ratio [RR]: 2.35; 95% CI: 2.12-2.61), 30-day mortality (RR: 1.76; 95% CI: 1.12-2.76), major or life-threatening bleeding (RR: 1.60; 95% CI: 1.39-1.84), and permanent pacemaker implantation (RR: 1.12; 95% CI: 1.05-1.18). Risk factors for the development of NOAF after TAVR included higher Society of Thoracic Surgeons score, transapical access, pulmonary hypertension, chronic kidney disease, peripheral vascular disease, and severe mitral regurgitation, suggesting that the risk for NOAF is highest in more comorbid TAVR patients. CONCLUSIONS NOAF is common after TAVR. Whether AF after TAVR is a causal factor or a marker of sicker patients remains unclear.
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Affiliation(s)
- Tammy Ryan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alexander Grindal
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Rehman Jinah
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kevin J Um
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Maria E Vadakken
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Avinash Pandey
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Iqbal H Jaffer
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Émilie P Belley-Coté
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - William F McIntyre
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
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14
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Petronio AS, Giannini C. Atrial Fibrillation After Transcatheter Aortic Valve Replacement: Which Came First, the Chicken or the Egg? JACC Cardiovasc Interv 2022; 15:614-617. [PMID: 35331453 DOI: 10.1016/j.jcin.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
Affiliation(s)
- A Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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15
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Wang MK, Meyre PB, Heo R, Devereaux P, Birchenough L, Whitlock R, McIntyre WF, Peter Chen YC, Ali MZ, Biancari F, Butt JH, Healey JS, Belley-Côté EP, Lamy A, Conen D. Short-term and Long-term Risk of Stroke in Patients With Perioperative Atrial Fibrillation After Cardiac Surgery: Systematic Review and Meta-analysis. CJC Open 2022; 4:85-96. [PMID: 35072031 PMCID: PMC8767142 DOI: 10.1016/j.cjco.2021.09.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/12/2021] [Indexed: 11/24/2022] Open
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16
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Altaii H, Morcos R, Riad F, Abdulameer H, Khalili H, Maini B, Lieberman E, Vivas Y, Wiegn P, A Joglar J, Mackall J, G Al-Kindi S, Thal S. Incidence of Early Atrial Fibrillation After Transcatheter versus Surgical Aortic Valve Replacement: A Meta-Analysis of Randomized Controlled Trials. J Atr Fibrillation 2021; 13:2411. [PMID: 34950322 DOI: 10.4022/jafib.2411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/15/2020] [Accepted: 07/25/2020] [Indexed: 11/10/2022]
Abstract
Background Post-operative atrial fibrillation (POAF) is common after aortic valve replacement (AVR) and is associated with worse outcomes. We performed a meta-analysis of randomized controlled trials comparing Surgical Aortic Valve Replacement (SAVR) and Transcatheter Aortic Valve Replacement (TAVR) for incidence of POAF at 30 days. Methods We searched databases from 1/1/1990 to 1/1/2020 for randomized studies comparing TAVR and SAVR. POAF was defined as either worsening or new-onset atrial fibrillation. Random effects model was used to estimate the risk of POAF with TAVR vs SAVR in all trials, and in subgroups (low, intermediate, high risk, and in self-expandable vs balloon expandable valves). Sensitivity analysis was performed including only studies reporting new-onset atrial fibrillation. Results Seven RCTs were identified that enrolled 7,934 patients (3,999 to TAVR and 3,935 to SAVR). The overall incidence of POAF was 9.7% after TAVR and 33.3% after SAVR. TAVR was associated with a lower risk of POAF compared with SAVR (OR 0.21 [0.18-0.24]; P < 0.0001). Compared with SAVR, TAVR was associated with a significantly lower risk of POAF in the high-risk cohort (OR 0.37 [0.27-0.49]; P < 0.0001), in the intermediate-risk cohort (OR 0.23 [0.19-0.28]; P < 0.0001), low-risk cohort (OR 0.13 [0.10-0.16]; P < 0.0001). Sensitivity analysis of 4 trials including only new-onset POAF showed similar summary estimates (OR 0.21, 95% CI [0.18-0.25]; P< 0.0001). Conclusions TAVR is associated with a significantly lower risk of post-operative atrial fibrillation compared with SAVR in all strata. Further studies are needed to identify the contribution of post-operative atrial fibrillation to the differences in clinical outcomes after TAVR and SAVR.
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Affiliation(s)
- Haider Altaii
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL
| | - Ramez Morcos
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL
| | - Fady Riad
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Halah Abdulameer
- Department of Surgery, Florida Atlantic University, Boca Raton, FL
| | - Houman Khalili
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL.,Tenet Healthcare, Delray Medical Center, Delray Beach, FL
| | - Brijeshwar Maini
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL.,Tenet Healthcare, Delray Medical Center, Delray Beach, FL
| | - Eric Lieberman
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL.,Tenet Healthcare, Delray Medical Center, Delray Beach, FL
| | - Yoel Vivas
- Division of Cardiology, Florida Atlantic University, Boca Raton, FL
| | - Phi Wiegn
- Clinical Cardiac Electrophysiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jose A Joglar
- Clinical Cardiac Electrophysiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Judith Mackall
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Sergio Thal
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
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17
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Jeong HK, Yoon N, Kim JH, Lee N, Hyun DY, Kim MC, Lee KH, Jeong YC, Jeong IS, Yoon HJ, Kim KH, Park HW, Ahn Y, Jeong MH, Cho JG. Post-operative Atrial Fibrillation Impacts on Outcomes in Transcatheter and Surgical Aortic Valve Replacement. Front Cardiovasc Med 2021; 8:789548. [PMID: 34912871 PMCID: PMC8667320 DOI: 10.3389/fcvm.2021.789548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Atrial fibrillation (AF) in severe aortic stenosis (AS) has poor outcomes after transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively). We compared the incidence of AF after aortic valve replacement (AVR) according to the treatment method and the impact of AF on outcomes. Methods: We investigated the incidence of AF and clinical outcomes of AVR according to whether AF occurred after TAVR and SAVR after propensity score (PS)-matching for 1 year follow-up. Clinical outcomes were defined as death, stroke, and admission due to heart failure. The composite outcome comprised death, stroke, and admission due to heart failure. Results: A total of 221 patients with severe AS were enrolled consecutively, 100 of whom underwent TAVR and 121 underwent SAVR. The incidence of newly detected AF was significantly higher in the SAVR group before PS-matching (6.0 vs. 40.5%, P < 0.001) and after PS-matching (7.5 vs. 35.6%, P = 0.001). TAVR and SAVR showed no significant differences in outcomes except in terms of stroke. In the TAVR group, AF history did not affect the outcomes; however, in the SAVR group, AF history affected death (log rank P = 0.038). Post-AVR AF had a worse impact on admission due to heart failure (log rank P = 0.049) and composite outcomes in the SAVR group. Post-AVR AF had a worse impact on admission due to heart failure (log rank P = 0.008) and composite outcome in the TAVR group. Conclusion: Post-AVR AF could be considered as a predictor of the outcomes of AVR. TAVR might be a favorable treatment option for patients with severe symptomatic AS who are at high-risk for AF development or who have a history of AF because the occurrence of AF was more frequent in the SAVR group.
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Affiliation(s)
- Hyung Ki Jeong
- Division of Cardiology, Department of Internal Medicine, School of Medicine, Wonkwang University, Iksan, South Korea.,Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Namsik Yoon
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Ju Han Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Nuri Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Dae Yong Hyun
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Ki Hong Lee
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Yo Cheon Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School, Gwangju, South Korea
| | - In Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyun Ju Yoon
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Kye Hun Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyung Wook Park
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Myung Ho Jeong
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jeong Gwan Cho
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
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18
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Xiang B, Ma W, Yan S, Chen J, Li J, Wang C. Rhythm outcomes after aortic valve surgery: Treatment and evolution of new-onset atrial fibrillation. Clin Cardiol 2021; 44:1432-1439. [PMID: 34390255 PMCID: PMC8495075 DOI: 10.1002/clc.23703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/30/2021] [Accepted: 07/19/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The impact of new-onset atrial fibrillation (AF) after aortic valve (AV) surgery on mid- and long-term outcomes is under debate. Here, we sought to follow up heart rhythms after AV surgery, and to evaluate the mid-term prognosis and effectiveness of treatment for patients with new-onset AF. METHODS This single-center cohort study included 978 consecutive patients (median age, 59 years; male, 68.5%) who underwent surgical AV procedures between 2017 and 2018. All patients with postoperative new-onset AF were treated with Class III antiarrhythmic drugs with or without electrical cardioversion (rhythm control). Status of survival, stroke, and rhythm outcomes were collected and compared between patients with and without new-onset AF. RESULTS New-onset AF was detected in 256 (26.2%) patients. For them, postoperative survival was comparable with those without new-onset AF (1-year: 96.1% vs. 99.3%; adjusted P = .30), but rate of stroke was significantly higher (1-year: 4.0% vs. 2.2%; adjusted P = .020). With rhythm control management, the 3-month and 1-year rates of paroxysmal or persistent AF between patients with and without new-onset AF were 5.1% versus 1.3% and 7.5% versus 2.1%, respectively (both P < .001). Multivariate models showed that advanced age, impaired ejection fraction, new-onset AF and discontinuation of beta-blockers were predictors of AF at 1 year. CONCLUSIONS In most cases, new-onset AF after AV surgery could be effectively converted and suppressed by rhythm control therapy. Nevertheless, new-onset AF predisposed patients to higher risks of stroke and AF within 1 year, for whom prophylactic procedures and continuous beta-blockers could be beneficial.
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Affiliation(s)
- Bitao Xiang
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenrui Ma
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Shixin Yan
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinmiao Chen
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jun Li
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
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19
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Khan MZ, Patel K, Zarak MS, Gupta A, Hussian I, Patel K, Figueredo VM, Miskiel S, Franklin S, Kutalek S. Association between atrial fibrillation and bundle branch block. J Arrhythm 2021; 37:949-955. [PMID: 34386121 PMCID: PMC8339096 DOI: 10.1002/joa3.12556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/19/2021] [Accepted: 05/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between atrial fibrillation (Afib) and sinus and AV nodal dysfunction has previously been reported. However, no data are available regarding the association between Afib and bundle branch block (BBB). METHODS Patient data were obtained from the Nationwide Inpatient Sample (NIS) database between years 2009 and 2015. Patients with a diagnosis of Afib and BBB were identified using validated International Classification of Diseases, 9th revision, and Clinical Modification (ICD-9-CM) codes. Statistical analysis using the chi-square test and multivariate linear regression analysis were performed to determine the association between Afib and BBB. RESULTS The total number of patients with BBB was 3,116,204 (1.5%). Patients with BBB had a mean age of 73.5 ± 13.5 years, 53.6% were males, 39.1% belonged to the age group ≥80 years, and 72.9% were Caucasians. The prevalence of Afib was higher in the BBB group, as compared to the non-BBB group (29% vs 11.8%, p value<.001). This association remained significant in multivariate regression analysis with an odds ratio of 1.25 (CI: 1.24-1.25, P < .001). Among the subtypes of BBB, Afib was comparatively more associated with RBBB (1.32, CI 1.31-1.33, p value<.0001) than LBBB (1.17, CI 1.16-1.18, p value<.0001). The mean cost was higher among Afib with BBB, compared with Afib patients without BBB ($15 795 vs $14 391, p value<.0001). There was no significant difference in the mean length of stay (5.6 vs 5.9 days, p value<.0001) or inpatient mortality (4.9% vs 4.8%). CONCLUSION This study demonstrates that prevalence of Afib is higher in patients with BBB than without BBB. Cost are higher for Afib patients with BBB, compared to those without BBB, with no significant increase in mortality or length of stay.
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Affiliation(s)
| | - Kirtenkumar Patel
- Department of CardiologyNorth Shore University HospitalManhassetNYUSA
| | | | - Ashwani Gupta
- Department of CardiologySt. Mary Medical CenterLanghornePAUSA
| | | | - Krunalkumar Patel
- Department of Internal MedicineSt. Mary Medical CenterLanghornePAUSA
| | | | - Sandra Miskiel
- Department of Internal MedicineSt. Mary Medical CenterLanghornePAUSA
| | - Sona Franklin
- Department of Internal MedicineSt. Mary Medical CenterLanghornePAUSA
| | - Steven Kutalek
- Department of CardiologyDrexel University college of medicinePhiladelphiaPAUSA
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20
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Zubair Khan M, Gupta A, Hodge J, Patel K, Patel K, Zarak MS, Franklin S, Patel H, Jesani S, Savani S, Shah V, Figueredo VM, Cavale AR, Kutalek S. Clinical outcomes of atrial fibrillation with hyperthyroidism. J Arrhythm 2021; 37:942-948. [PMID: 34386120 PMCID: PMC8339080 DOI: 10.1002/joa3.12550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/23/2021] [Accepted: 04/18/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Atrial fibrillation (Afib) is a common cardiac manifestation of hyperthyroidism. The data regarding outcomes of Afib with and without hyperthyroidism are lacking. HYPOTHESIS We hypothesized that patients with Afib and hyperthyroidism have better clinical outcomes, compared with Afib patients without hyperthyroidism. METHODS We queried the National Inpatient Sample database for years 2015-2017 using Validated ICD-10-CM codes for Afib and hyperthyroidism. Patients were separated into two groups, Afib with hyperthyroidism and without hyperthyroidism. RESULTS The study was conducted with 68 095 278 patients. A total of 9 727 295 Afib patients were identified, 90 635 (0.9%) had hyperthyroidism. The prevalence of hyperthyroidism was higher in patients with Afib (0.9% vs 0.4%, P < .001), compared with patients without Afib. Using multivariate regression analysis adjusting for various confounding factors, the odds ratio of Afib with hyperthyroidism was 2.08 (CI 2.07-2.10; P < .0001). Afib patients with hyperthyroidism were younger (71 vs 75 years, P < .0001) and more likely to be female (64% vs 47%; P < .0001) as compared with Afib patients without hyperthyroidism. Afib patients with hyperthyroidism had lower prevalence of CAD (36% vs 44%, P < .0001), cardiomyopathy (24.1% vs 25.9%, P < .0001), valvular disease (6.9% vs 7.4%, P < .0001), hypertension (60.7% vs 64.4%, P < .0001), diabetes mellitus (29% vs 32%, P < .0001) and obstructive sleep apnea (10.5% vs 12.2%, P < .0001). Afib with hyperthyroidism had lower hospitalization cost ($14 968 ± 21 871 vs $15 955 ± 22 233, P < .0001), shorter mean length of stay (5.7 ± 6.6 vs 5.9 ± 6.6 days, P < .0001) and lower in-hospital mortality (3.3% vs 4.8%, P < .0001. The disposition to home was higher in Afib with hyperthyroidism patients (51% vs 42; P < .0001). CONCLUSION Hyperthyroidism is associated with Afib in both univariate and multivariate analysis. Afib patients with hyperthyroidism have better clinical outcomes, compared with Afib patients without hyperthyroidism.
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Affiliation(s)
| | - Ashwani Gupta
- Division of CardiologySt. Mary Medical CenterLanghornePAUSA
| | - Jordesha Hodge
- Department of Internal MedicineSt. Mary Medical CenterLanghornePAUSA
| | - Kirtenkumar Patel
- Department of CardiologyNorth Shore University HospitalManhassetNYUSA
| | - Krunalkumar Patel
- Department of Internal MedicineSt. Mary Medical CenterLanghornePAUSA
| | | | - Sona Franklin
- Department of Internal MedicineSt. Mary Medical CenterLanghornePAUSA
| | - Harsh Patel
- Department of Internal MedicineLouis A Weiss Memorial HospitalChicagoILUSA
| | - Shruti Jesani
- Department of Internal MedicineTrinitas Regional Medical CenterElizabethNJUSA
| | | | - Vraj Shah
- Division of CardiologyMedical College of BarodaVadodaraIndia
| | | | | | - Steven Kutalek
- Department of CardiologyDrexel University College of MedicinePhiladelphiaPAUSA
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21
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Narasimhan B, Aedma SK, Bhatia K, Garg J, Kanuri SH, Turagam MK, Lakkireddy D. Current practice and future prospects in left atrial appendage occlusion. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1236-1252. [PMID: 34085712 DOI: 10.1111/pace.14284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/30/2021] [Accepted: 05/30/2021] [Indexed: 01/31/2023]
Abstract
The thromboembolic complications of Atrial fibrillation (AF) remain a major problem in contemporary clinical practice. Despite advances and developments in anticoagulation strategies, therapy is complicated by the high risk of bleeding complications and need for meticulous medication compliance. Over the past few decades, the left atrial appendage has emerged as a promising therapeutic target to prevent thromboembolic events while mitigating bleeding complications and compliance issues. Emerging data indicates that it is a safe, effective and feasible alternative to systemic anticoagulation in patients with non-valvular AF. A number of devices have been developed for endocardial or epicardial based isolation of the left atrial appendage. Increasing experience has improved overall procedural safety and ease while simultaneously reducing device related complication rates. Furthermore, increasing recognition of the non-mechanical advantages of this procedure has led to further interest in its utility for further indications beyond the prevention of thromboembolic complications. In this review, we present a comprehensive overview of the evolution of left atrial appendage occlusion, commercially available devices and the role of this modality in the current management of AF. We also provide a brief outline of the landmark trials supporting this approach as well as the ongoing research and future prospects of left atrial appendage occlusion.
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Affiliation(s)
- Bharat Narasimhan
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,St. Luke's-Roosevelt -Mount Sinai, New York, New York, USA
| | | | - Kirtipal Bhatia
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,St. Luke's-Roosevelt -Mount Sinai, New York, New York, USA
| | - Jalaj Garg
- Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | | | - Mohit K Turagam
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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22
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Khan MZ, Patel K, Patel KA, Doshi R, Shah V, Adalja D, Waqar Z, Franklin S, Gupta N, Gul MH, Jesani S, Kutalek S, Figueredo V. Burden of atrial fibrillation in patients with rheumatic diseases. World J Clin Cases 2021; 9:3252-3264. [PMID: 34002134 PMCID: PMC8107898 DOI: 10.12998/wjcc.v9.i14.3252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/06/2021] [Accepted: 03/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Studies have suggested that atrial fibrillation (AF) in patients with rheumatic diseases (RD) may be due to inflammation.
AIM To determine the highest association of AF among hospitalized RD patients and to determine morbidity and mortality associated with AF in hospitalized patients with RD.
METHODS The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF. A subgroup analysis was performed comparing outcomes of AF among different RD.
RESULTS The prevalence of AF was 23.9% among all patients with RD (n = 3949203). Among the RD subgroup, the prevalence of AF was highest in polymyalgia rheumatica (33.2%), gout (30.2%), and pseudogout (27.1%). After adjusting for comorbidities, the odds of having AF were increased with gout (1.25), vasculitis (1.19), polymyalgia rheumatica (1.15), dermatopolymyositis (1.14), psoriatic arthropathy (1.12), lupus (1.09), rheumatoid arthritis (1.05) and pseudogout (1.04). In contrast, enteropathic arthropathy (0.44), scleroderma (0.96), ankylosing spondylitis (0.96), and Sjorgen’s syndrome (0.94) had a decreased association of AF. The mortality, length of stay, and hospitalization costs were higher in patients with RD having AF vs without AF. Among the RD subgroup, the highest mortality was found with scleroderma (4.8%), followed by vasculitis (4%) and dermatopolymyositis (3.5%).
CONCLUSION A highest association of AF was found with gout followed by vasculitis, and polymyalgia rheumatica when compared to other RD. Mortality was two-fold higher in patients with RD with AF.
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Affiliation(s)
- Muhammad Zubair Khan
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Kirtenkumar Patel
- Division of Cardiology, North Shore University Hospital, Manhasset, NY 11030, United States
| | - Krunalkumar A Patel
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89502, United States
| | - Vraj Shah
- Division of Cardiology, Medical College of Baroda, Baroda 390001, India
| | - Devina Adalja
- Department of Internal Medicine, GMERS Gotri Medical College, Vadodara 390021, India
| | - Zainulabedin Waqar
- Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH 43608, United States
| | - Sona Franklin
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Neelesh Gupta
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA 19115, United States
| | - Muhammad Hamdan Gul
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL 60657, United States
| | - Shruti Jesani
- Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ 07202, United States
| | - Steven Kutalek
- Department of Cardiology, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Vincent Figueredo
- Department of Cardiology, St. Mary Medical Center, Langhorne, PA 19047, United States
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23
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Parcha V, Booker KS, Kalra R, Kuranz S, Berra L, Arora G, Arora P. A retrospective cohort study of 12,306 pediatric COVID-19 patients in the United States. Sci Rep 2021; 11:10231. [PMID: 33986390 PMCID: PMC8119690 DOI: 10.1038/s41598-021-89553-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/19/2021] [Indexed: 12/19/2022] Open
Abstract
Children and adolescents account for ~ 13% of total COVID-19 cases in the United States. However, little is known about the nature of the illness in children. The reopening of schools underlines the importance of understanding the epidemiology of pediatric COVID-19 infections. We sought to assess the clinical characteristics and outcomes in pediatric COVID-19 patients. We conducted a retrospective cross-sectional analysis of pediatric patients diagnosed with COVID-19 from healthcare organizations in the United States. The study outcomes (hospitalization, mechanical ventilation, critical care) were assessed using logistic regression. The subgroups of sex and race were compared after propensity score matching. Among 12,306 children with lab-confirmed COVID-19, 16.5% presented with respiratory symptoms (cough, dyspnea), 13.9% had gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain), 8.1% had dermatological symptoms (rash), 4.8% had neurological (headache), and 18.8% had other non-specific symptoms (fever, malaise, myalgia, arthralgia and disturbances of smell or taste). In the study cohort, the hospitalization frequency was 5.3%, with 17.6% needing critical care services and 4.1% requiring mechanical ventilation. Following propensity score matching, the risk of all outcomes was similar between males and females. Following propensity score matching, the risk of hospitalization was greater in non-Hispanic Black (RR 1.97 [95% CI 1.49–2.61]) and Hispanic children (RR 1.31 [95% CI 1.03–1.78]) compared with non-Hispanic Whites. In the pediatric population infected with COVID-19, a substantial proportion were hospitalized due to the illness and developed adverse clinical outcomes.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL, 35294-0019, USA
| | - Katherine S Booker
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, MN, USA.,Division of Hospital Medicine, Children's Minnesota, Minneapolis, MN, USA
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | | | - Lorenzo Berra
- Anesthesia & Critical Care, Pulmonary Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL, 35294-0019, USA
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, 1670 University Boulevard, Volker Hall B140, Birmingham, AL, 35294-0019, USA. .,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
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24
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Parcha V, Kalra R, Glenn AM, Davies JE, Kuranz S, Arora G, Arora P. Coronary artery bypass graft surgery outcomes in the United States: Impact of the coronavirus disease 2019 (COVID-19) pandemic. ACTA ACUST UNITED AC 2021; 6:132-143. [PMID: 33870234 PMCID: PMC8007527 DOI: 10.1016/j.xjon.2021.03.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/29/2022]
Abstract
Objective There has been a substantial decline in patients presenting for emergent and routine cardiovascular care in the United States after the onset of the coronavirus disease 2019 (COVID-19) pandemic. We sought to assess the risk of adverse clinical outcomes among patients undergoing coronary artery bypass graft (CABG) surgery during the 2020 COVID-19 pandemic period and compare the risks with those undergoing CABG before the pandemic in the year 2019. Methods A retrospective cross-sectional analysis of the TriNetX Research Network database was performed. Patients undergoing CABG between January 20, 2019, and September 15, 2019, contributed to the 2019 cohort, and those undergoing CABG between January 20, 2020, and September 15, 2020, contributed to the 2020 cohort. Propensity-score matching was performed, and the odds of mortality, acute kidney injury, stroke, acute respiratory distress syndrome, and mechanical ventilation occurring by 30 days were evaluated. Results The number of patients undergoing CABG in 2020 declined by 35.5% from 5534 patients in 2019 to 3569 patients in 2020. After propensity-score matching, 3569 patient pairs were identified in the 2019 and the 2020 cohorts. Compared with those undergoing CABG in 2019, the odds of mortality by 30 days were 0.96 (95% confidence interval [CI], 0.69-1.33; P = .80) in those undergoing CABG in 2020. The odds for stroke (odds ratio [OR], 1.201; 95% CI, 0.96-1.39), acute kidney injury (OR, 0.76; 95% CI, 0.59-1.08), acute respiratory distress syndrome (OR, 1.01; 95% CI, 0.60-2.42), and mechanical ventilation (OR, 1.11; 95% CI, 0.94-1.30) were similar between the 2 cohorts. Conclusions The number of patients undergoing CABG in 2020 has substantially declined compared with 2019. Similar odds of adverse clinical outcomes were seen among patients undergoing CABG in the setting of COVID-19 compared with those in 2019.
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Affiliation(s)
- Vibhu Parcha
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala
| | - Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis, Minn
| | - Austin M Glenn
- School of Medicine, University of Alabama at Birmingham, Birmingham, Ala
| | - James E Davies
- Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Ala
| | | | - Garima Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Ala.,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, Ala
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25
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Bencivenga L, Sepe I, Palaia ME, Komici K, Corbi G, Puzone B, Arcopinto M, Cittadini A, Ferrara N, Femminella GD, Rengo G. Antithrombotic therapy in patients undergoing transcatheter aortic valve replacement: the complexity of the elderly. Eur J Prev Cardiol 2021; 28:87-97. [PMID: 33624104 PMCID: PMC7665487 DOI: 10.1093/eurjpc/zwaa053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/03/2020] [Accepted: 08/12/2020] [Indexed: 12/13/2022]
Abstract
Along with epidemiologic transitions of the global population, the burden of aortic stenosis (AS) is rapidly increasing and transcatheter aortic valve replacement (TAVR) has quickly spread; indeed, it is nowadays also employed in treating patients with AS at intermediate operative risk. Nonetheless, the less invasive interventional strategy still carries relevant issues concerning post-procedural optimal antithrombotic strategy, given the current indications provided by guidelines are not completely supported by evidence-based data. Geriatric patients suffer from high bleeding and thromboembolic risks, whose balance is particularly subtle due to the presence of concomitant conditions, such as atrial fibrillation and chronic kidney disease, that make the post-TAVR antithrombotic management particularly insidious. This scenario is further complicated by the lack of specific evidence regarding the 'real-life' complex conditions typical of the geriatric syndromes, thus, the management of such a heterogeneous population, ranging from healthy ageing to frailty, is far from being defined. The aim of the present review is to summarize the critical points and the most updated evidence regarding the post-TAVR antithrombotic approach in the geriatric population, with a specific focus on the most frequent clinical settings.
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Affiliation(s)
| | - Immacolata Sepe
- Department of Translational Medical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, Naples 80131, Italy
| | - Maria Emiliana Palaia
- Department of Translational Medical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, Naples 80131, Italy
| | - Klara Komici
- Department of Medicine and Health Sciences, University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, Italy
| | - Graziamaria Corbi
- Department of Medicine and Health Sciences, University of Molise, Via Francesco De Sanctis 1, Campobasso 86100, Italy
| | - Brunella Puzone
- Department of Translational Medical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, Naples 80131, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, Naples 80131, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, Naples 80131, Italy
| | - Nicola Ferrara
- Department of Translational Medical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, Naples 80131, Italy
- Istituti Clinici Scientifici Maugeri SPA, Società Benefit, IRCCS, Istituto Scientifico di Telese, Via Bagni Vecchi 1, Telese Terme 82037 (BN), Italy
| | - Grazia Daniela Femminella
- Department of Translational Medical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, Naples 80131, Italy
- Department of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples “Federico II”, Via Sergio Pansini 5, Naples 80131, Italy
- Istituti Clinici Scientifici Maugeri SPA, Società Benefit, IRCCS, Istituto Scientifico di Telese, Via Bagni Vecchi 1, Telese Terme 82037 (BN), Italy
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26
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Anantha-Narayanan M, Doshi RP, Patel K, Sheikh AB, Llanos-Chea F, Abbott JD, Shishehbor MH, Guzman RJ, Hiatt WR, Duval S, Mena-Hurtado C, Smolderen KG. Contemporary Trends in Hospital Admissions and Outcomes in Patients With Critical Limb Ischemia: An Analysis From the National Inpatient Sample Database. Circ Cardiovasc Qual Outcomes 2021; 14:e007539. [PMID: 33541110 DOI: 10.1161/circoutcomes.120.007539] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Critical limb ischemia (CLI) morbidity and mortality rates have historically been disproportionately higher than for other atherosclerotic diseases, however, recent trends have not been reported. In patients admitted with CLI, we aimed to examine trends in in-hospital mortality, major amputations, length of stay, and cost of hospitalizations overall and stratified by type of revascularization procedures. METHODS Using 2011 to 2017 National Inpatient Sample data, we identified CLI-related admissions based on International Classification of Diseases, Ninth and Tenth Edition, Clinical Modification codes. Primary outcomes of interest were in-hospital mortality and major amputations. Secondary outcomes were the length of stay and cost of hospitalization. We stratified outcomes based on endovascular or open surgical interventions. We also performed hierarchical multivariable regression analyses of outcomes based on age, sex, race, hospital size, type, and location. RESULTS We identified 2 643 087 CLI-related admissions between 2011 and 2017. CLI admissions increased from 0.9% to 1.4% Ptrend<0.0001 as well as overall peripheral artery disease admissions (4.5%-8.9%, Ptrend<0.0001). In-hospital mortality for the entire CLI cohort decreased from 3.3% to 2.7%, Ptrend<0.0001, and major amputations decreased from 10.9% to 7%, Ptrend<0.0001. A decline was also noted for the length of stay from 5.7 (3.1-10.1) to 5.4 (3.0-9.2) days (Ptrend<0.0001), whereas admission costs increased from USD $11 791 ($6676-$21 712) to $12 597 ($7248-$22 748; Ptrend<0.0001). Endovascular interventions increased (Ptrend<0.0001) against a decline in surgical interventions (Ptrend<0.0001). Black race, female sex, and age ≥60 years were associated with higher in-hospital mortality, whereas Black race, male sex, and age<60 years were associated with higher major amputations. CONCLUSIONS A relatively small decrease in absolute numbers for mortality and major amputations were observed against a backdrop of increasing CLI admissions over recent years. Patients with CLI received more endovascular interventions than surgical interventions over time. However, admissions for endovascular interventions were characterized by higher risk patient profiles and a higher risk of major amputations as compared with surgical interventions.
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Affiliation(s)
- Mahesh Anantha-Narayanan
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Yale University, New Haven, CT (M.A.-N., A.B.S., F.L.-C., C.M.-H., K.G.S.)
| | - Rajkumar P Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno (R.P.D.)
| | - Krunalkumar Patel
- Department of Internal Medicine, St Mary Medical Center, Langhorne, PA (K.P.)
| | - Azfar Bilal Sheikh
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Yale University, New Haven, CT (M.A.-N., A.B.S., F.L.-C., C.M.-H., K.G.S.)
| | - Fiorella Llanos-Chea
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Yale University, New Haven, CT (M.A.-N., A.B.S., F.L.-C., C.M.-H., K.G.S.)
| | | | - Mehdi H Shishehbor
- Case Western Reserve University School of Medicine and University Hospital, Cleveland, OH (M.H.S.)
| | - Raul J Guzman
- Division of Vascular Surgery, Yale-New Haven Hospital, CT (R.J.G.)
| | - William R Hiatt
- Division of Cardiology, University of Colorado School of Medicine and CPC Clinical Research, Aurora (W.R.H.)
| | - Sue Duval
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.D.)
| | - Carlos Mena-Hurtado
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Yale University, New Haven, CT (M.A.-N., A.B.S., F.L.-C., C.M.-H., K.G.S.)
| | - Kim G Smolderen
- Vascular Medicine Outcomes (VAMOS) Program, Section of Cardiovascular Medicine, Yale University, New Haven, CT (M.A.-N., A.B.S., F.L.-C., C.M.-H., K.G.S.)
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27
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Wang QC, Wang ZY. Big Data and Atrial Fibrillation: Current Understanding and New Opportunities. J Cardiovasc Transl Res 2020; 13:944-952. [PMID: 32378163 DOI: 10.1007/s12265-020-10008-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia with diverse etiology that remarkably relates to high morbidity and mortality. With the advancements in intensive clinical and basic research, the understanding of electrophysiological and pathophysiological mechanism, as well as treatment of AF have made huge progress. However, many unresolved issues remain, including the core mechanisms and key intervention targets. Big data approach has produced new insights into the improvement of the situation. A large amount of data have been accumulated in the field of AF research, thus using the big data to achieve prevention and precise treatment of AF may be the direction of future development. In this review, we will discuss the current understanding of big data and explore the potential applications of big data in AF research, including predictive models of disease processes, disease heterogeneity, drug safety and development, precision medicine, and the potential source for big data acquisition. Grapical abstract.
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Affiliation(s)
- Qian-Chen Wang
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, China
| | - Zhen-Yu Wang
- Department of Cardiovascular Medicine, the Second Xiangya Hospital, Central South University, No.139 Renmin Road, Changsha, Hunan, China.
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28
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Zeng Q, Cheng Z, Xia Y, Cheng R, Ou A, Li X, Xu X, Huang Y, Xu D. Optimal antithrombotic therapy after transcatheter aortic valve replacement in patients with atrial fibrillation. Ther Adv Chronic Dis 2020; 11:2040622320949068. [PMID: 33133475 PMCID: PMC7576914 DOI: 10.1177/2040622320949068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/20/2020] [Indexed: 11/16/2022] Open
Abstract
Atrial fibrillation (AF) is prevalent in patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Depending on the timing of AF detection, it is usually categorized as pre-existing AF or new-onset AF. Antiplatelet therapy, rather than a vitamin K antagonist, may be considered as the primary treatment for patients without an indication for oral anticoagulants who undergo TAVR. However, the optimal postprocedural antithrombotic regimen for patients with AF undergoing TAVR remains unknown. In this review, we briefly introduce the management strategies of antithrombotic therapy and list the evidence from related studies to elucidate the optimal antithrombotic management for patients with AF undergoing TAVR.
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Affiliation(s)
- Qingchun Zeng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou , China
| | - Zhendong Cheng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yi Xia
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rui Cheng
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ailian Ou
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xinrui Li
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xingbo Xu
- Department of Cardiology and Pneumology, University Medical Center of Göttingen, Georg-August-University, Göttingen, Germany
| | - Yuli Huang
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Dingli Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, 1838 Northern Guangzhou Ave, Guangzhou 510515, China
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29
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New-onset arrhythmia associated with patients hospitalized for thyroid dysfunction. Heart Lung 2020; 49:758-762. [PMID: 32979641 DOI: 10.1016/j.hrtlng.2020.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Thyroid dysfunction has been associated with cardiovascular dysfunction in the literature. However, the frequency of new-onset arrhythmias associated with thyroid disease hospitalization is unknown. Hence, we analyzed frequency, in-hospital outcomes, and resource utilization of new-onset arrhythmias associated with thyroid dysfunction hospitalizations. METHODS The patients who were admitted with the primary reason of thyroid dysfunction were included using appropriate international classification of disease, ninth revision, clinical modification (ICD-9-CM) codes. We then identified new-onset arrhythmias using appropriate ICD-9-CM codes. We utilized the "present on admission" variable to exclude arrhythmias that were present on admission. RESULTS Among the eligible patients with thyroid dysfunction, only 3% (n=12,111) developed a new-onset arrhythmia. Atrioventricular block (1.49%) is the most frequent followed by atrial fibrillation (0.92%), ventricular tachycardia (0.47%), atrial flutter (0.23%), supraventricular tachycardia (0.1%) and ventricular fibrillation (0.07%). Patients with new-onset arrhythmias were older (mean age 76.7±12.5 years), more predominantly white (n=9008, 74.4%), higher females (n= 7632, 63%), and had a higher frequency of comorbidities. In-hospital mortality occurred in 827 (6.8%) patients with new-onset arrhythmias and 8632 (2.2%) patients without new-onset arrhythmias (P-value <0.001). The medical length of stay and cost of hospitalization was also higher in these patients. CONCLUSION Thyroid dysfunction is not associated with significantly higher rates of new-onset arrhythmias while inpatient. However, when developed, these arrhythmias are associated with higher mortality and resource utilization. The patients admitted to the hospital should have thyroid function checked when found to have an arrhythmia.
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Mirsadraee S, Sellers S, Duncan A, Hamadanchi A, Gorog DA. Bioprosthetic valve thrombosis and degeneration following transcatheter aortic valve implantation (TAVI). Clin Radiol 2020; 76:73.e39-73.e47. [PMID: 32919757 DOI: 10.1016/j.crad.2020.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 08/20/2020] [Indexed: 11/30/2022]
Abstract
Bioprosthetic valve thrombosis (BPVT) is a recognised complication of prosthetic aortic valves and can be found in up to 13% of patients after transcatheter implantation. The mechanism of BPVT is not well known, abnormal flow conditions in the new and native sinuses and lack of functional endothelialisation are suspected causes. BPVT may result in valve dysfunction, possibly related to degeneration, and recurrence of patient symptoms, or remain subclinical. BPVT is best diagnosed at multiphase gated computed tomography (CT) angiography as the presence of reduced leaflet motion (RELM) and hypoattenuating aortic leaflet thickening (HALT). Although CT is used to exclude BPVT in symptomatic patients and those with increased valve gradients, the value of screening and prophylactic anticoagulation is debatable.
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Affiliation(s)
- S Mirsadraee
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart & Lung Institute, Imperial College, London, UK.
| | - S Sellers
- Department of Radiology & Centre for Heart Lung Innovation, University of British Columbia & St Paul's Hospital, Vancouver, Canada
| | - A Duncan
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - A Hamadanchi
- Department of Cardiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - D A Gorog
- National Heart & Lung Institute, Imperial College, London, UK; Department of Postgraduate Medicine, University of Hertfordshire, Hertfordshire, UK
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Deharo P, Bisson A, Herbert J, Lacour T, Etienne CS, Porto A, Theron A, Collart F, Bourguignon T, Cuisset T, Fauchier L. Transcatheter Valve-in-Valve Aortic Valve Replacement as an Alternative to Surgical Re-Replacement. J Am Coll Cardiol 2020; 76:489-499. [DOI: 10.1016/j.jacc.2020.06.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/02/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
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Antwi‐Amoabeng D, Doshi R, Adalja D, Kumar A, Desai R, Islam R, Gullapalli N. Burden of arrythmias in transgender patients hospitalized for gender-affirming surgeries. J Arrhythm 2020; 36:797-800. [PMID: 32782660 PMCID: PMC7411199 DOI: 10.1002/joa3.12360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/15/2020] [Accepted: 05/03/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND We sought to describe the burden of arrhythmias and their impact on in-hospital outcomes in transgender patients who underwent gender re-assignment surgery. METHODS The study utilized data from the National Inpatient Sample from January 2012 to September 2015. RESULTS 16 555 adult transgender patients were included in this study. A total of 610 adults developed arrhythmia out of which atrial fibrillation (N = 475, 2.87%) was the most frequent arrhythmia. In-hospital mortality increased substantially with arrhythmias. CONCLUSIONS New-onset arrythmias, while infrequent in the inpatient setting is associated with significantly higher in-hospital mortality and resource utilization.
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Affiliation(s)
- Daniel Antwi‐Amoabeng
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
| | - Rajkumar Doshi
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
| | - Devina Adalja
- Department of MedicineGMERS Gotri Medical CollegeVadodaraGujaratIndia
| | - Ashish Kumar
- Department of Critical CareSt John’s Medical College HospitalBengaluruIndia
| | - Rupak Desai
- Division of CardiologyAtlanta Veterans Affairs Medical CenterDecaturGAUSA
| | - Raheel Islam
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
| | - Nageshwara Gullapalli
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
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Prevalence of cardiovascular risk factors and financial burden in younger adults hospitalized with atrial fibrillation. Heart Lung 2020; 49:393-397. [DOI: 10.1016/j.hrtlng.2020.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/25/2020] [Accepted: 02/03/2020] [Indexed: 12/17/2022]
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Kalra R, Parcha V, Patel N, Bhargava A, Li P, Arora G, Arora P. Implications of Atrial Fibrillation Among Patients With Atherosclerotic Cardiovascular Disease Undergoing Noncardiac Surgery. Am J Cardiol 2020; 125:1836-1844. [PMID: 32331712 DOI: 10.1016/j.amjcard.2020.03.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/08/2020] [Accepted: 03/10/2020] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation (AF) is a common perioperative arrhythmia. However, its occurrence and implications remain poorly defined in the setting of noncardiac procedures. We sought to define the incidence, prevalence, and prognostic implications of AF among patients with atherosclerotic cardiovascular disease (ASCVD) undergoing noncardiac surgery. Using a previously validated approach that employed unique patient-linked variables in the New York State Inpatient Database from January 1, 2012, to December 31, 2014, the frequency of new-onset and pre-existing AF was determined in adults with ASCVD aged ≥18 years undergoing noncardiac surgery. The secondary outcomes were stroke within 1 month and all-cause mortality. Using multivariable logistic regression models, the factors and outcomes associated with new-onset AF after noncardiac surgery were assessed. Nine surgical subgroups of major noncardiac surgery served as exposure. A total of 184,775 patients were identified during the study period. Age ≥65, anemia, history of heart failure, valvular heart disease, and thoracic surgery were predictors of new-onset AF after noncardiac surgery. Among 3,806 patients (2.5%) developed new-onset AF and 31,603 (17.5%) patient had pre-existing AF. After multivariable-adjusted modeling, new-onset AF was associated with increased odds of stroke within 1 month (odds ratio: 1.31, 95% confidence interval: 1.12 to 1.53; p < 0.001)], mortality (odds ratio: 3.74; 95% confidence interval: 3.30 to 4.24; p < 0.001) and longer length of stay in the hospital (10 days; interquartile range: 6 to 16 days; p < 0.001). New-onset AF portends a poor prognosis in patients with ASCVD undergoing noncardiac surgeries. The risk profile of patients that develop new-onset AF differs across patient phenotypes and by surgical procedure.
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Indja B, Woldendorp K, Vallely MP, Grieve SM. New Onset Atrial Fibrillation Following Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis. Heart Lung Circ 2020; 29:1542-1553. [PMID: 32327310 DOI: 10.1016/j.hlc.2020.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/20/2020] [Accepted: 03/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND New-onset atrial fibrillation (NOAF) is a well-recognised, although variably reported complication following surgical aortic valve replacement (SAVR). Rates of NOAF following transcatheter aortic valve implantation (TAVI) seem to be notably less than SAVR, even though this population is typically older and of higher risk. The aim of this study was to determine the prevalence of NOAF in both these populations and associated postoperative outcomes. METHODS We conducted a systematic review and meta-analysis of studies reporting rates of NOAF post SAVR or TAVI, along with early postoperative outcomes. Twenty-five (25) studies with a total of 13,010 patients were included in the final analysis. RESULTS The prevalence of NOAF post SAVR was 0.4 (95% CI 0.36-0.44) and post TAVI 0.15 (95% CI 0.11-0.18). NOAF was associated with an increased risk of postoperative cerebrovascular accident (CVA) for SAVR and TAVI (RR 1.44 95% CI 1.01-2.06 and RR 2.24 95% CI 1.46-3.45 respectively). NOAF was associated with increased mortality in the TAVI group (RR 3.02 95% CI 1.55-5.9) but not the SAVR group (RR 1.00, 95% CI 0.54-1.84). Hospital length of stay was increased for both TAVI and SAVR patients with NOAF (MD 2.54 days, 95% CI 2.0-3.00) and (MD 1.64 days, 95% CI 0.04-3.24 respectively). CONCLUSIONS The prevalence of NOAF is significantly less following TAVI, as compared to SAVR. While NOAF is associated with increased risk of postoperative stroke for both groups, for TAVI alone NOAF confers increased risk of early mortality.
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Affiliation(s)
- Ben Indja
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kei Woldendorp
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Michael P Vallely
- Division of Cardiac Surgery, The Ohio State University, Columbus, OH, USA
| | - Stuart M Grieve
- Sydney Translational Imaging Laboratory, Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Radiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Doshi R, Dhawan T, Rendon C, Rodriguez MA, Al-Khafaji JF, Taha M, Win TT, Gullapalli N. Incidence and implications of acute kidney injury in patients hospitalized with acute decompensated heart failure. Intern Emerg Med 2020; 15:421-428. [PMID: 31686359 DOI: 10.1007/s11739-019-02188-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/29/2019] [Indexed: 12/26/2022]
Abstract
Acute kidney injury (AKI) is a common complication in patients hospitalized with heart failure (HF). There is a paucity of research on the incidence and consequences of AKI among patients hospitalized with HF who do not have evidence of chronic kidney disease (CKD). The National Inpatient Sample database was used to identify index hospitalizations for acute HF from January 2012 through September 2015. The incidence of new-onset AKI was determined, and the study population was divided into two groups: HF with AKI (HFwAKI) and HF without AKI (HFwoAKI). These groups were further divided into the subgroups HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF). A total of 2,010,095 index hospitalizations for HF were identified. The incidence of new-onset AKI was found to be ~ 20% for this population. In a fully adjusted model, in-hospital mortality was higher in the HFwAKI group (adjusted OR 3.63, P ≤ 0.001) and higher among patients with HFrEF (adjusted OR 3.85), as opposed to patients with HFpEF (adjusted OR 3.21). Similarly, length of stay and cost of care for the HFwAKI group were significantly higher as well. New-onset AKI among hospitalizations for HF poses a significant health problem, especially considering the increasing prevalence of HF. Further research into the causes of AKI among HF hospitalizations is, therefore, important as it will enable the development of treatment strategies to prevent AKI in HF hospitalizations and, consequently, benefit both the patients and health care system of the United States.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA.
| | - Tania Dhawan
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Casey Rendon
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Marines Acevedo Rodriguez
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Jaafar F Al-Khafaji
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Mohamed Taha
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Thi Thi Win
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV, 89502, USA
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Comparison of Management and Outcomes of Acute Heart Failure Hospitalization in Medicaid Beneficiaries Versus Privately Insured Individuals. Am J Cardiol 2020; 125:1063-1068. [PMID: 32146925 DOI: 10.1016/j.amjcard.2019.12.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 11/19/2022]
Abstract
Medicaid expansion in terms of its eligibility and federal funding has led to improved healthcare access in previously uninsured individuals. However, proposed lower Medicaid rates have unintentionally led to lower utilization of substantial life-saving therapies and poor outcomes compared with private insurance. We examined heart failure (HF) management, in-hospital mortality, and resource utilization in Medicaid and privately insured individuals hospitalized with HF. The authors screened the National Inpatient Sample from January 2012 to September 2015 for HF hospitalizations with Medicaid or private insurance as the primary payer. The authors identified a total of 226,265 and 292,070 patients with HF hospitalizations with Medicaid and private insurance, respectively. In propensity-matched cohort of 155,790 hospitalizations in each group, Medicaid beneficiaries with HF hospitalization had lower rates of intra-aortic balloon pump/left ventricular assist device/extracorporeal membrane oxygenation utilization (0.6 vs 0.9%; odds ratio [OR] 0.64; 95% confidence interval [CI] 0.59 to 0.69), heart transplantation (0.15 vs 0.44%; OR 0.35; 95% CI 0.30 to 0.40), implantable cardioverter-defibrillator/cardiac resynchronization therapy/permanent pacemaker (3.3 vs 3.9%; OR 0.84; 95% CI 0.81 to 0.87), and had higher rates of in-hospital mortality (1.9 vs 1.7%; OR 1.12; 95% CI 1.07 to 1.19) compared with privately insured individuals (p <0.001 for both). In conclusion, Medicaid recipients with HF hospitalizations had a lower rate of device utilization, heart transplantation, and a higher rate of in-hospital mortality compared with the privately insured sector. Further studies are needed to explore and understand the variation in the outcomes of HF hospitalizations stratified by insurance status.
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Caracciolo A, Mazzone P, Laterra G, Garcia-Ruiz V, Polimeni A, Galasso S, Saporito F, Carerj S, D’Ascenzo F, Marquis-Gravel G, Giustino G, Costa F. Antithrombotic Therapy for Percutaneous Cardiovascular Interventions: From Coronary Artery Disease to Structural Heart Interventions. J Clin Med 2019; 8:jcm8112016. [PMID: 31752292 PMCID: PMC6912795 DOI: 10.3390/jcm8112016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/05/2019] [Accepted: 11/15/2019] [Indexed: 02/02/2023] Open
Abstract
Percutaneous cardiovascular interventions have changed dramatically in recent years, and the impetus given by the rapid implementation of novel techniques and devices have been mirrored by a refinement of antithrombotic strategies for secondary prevention, which have been supported by a significant burden of evidence from clinical studies. In the current manuscript, we aim to provide a comprehensive, yet pragmatic, revision of the current available evidence regarding antithrombotic strategies in the domain of percutaneous cardiovascular interventions. We revise the evidence regarding antithrombotic therapy for secondary prevention in coronary artery disease and stent implantation, the complex interrelation between antiplatelet and anticoagulant therapy in patients undergoing percutaneous coronary intervention with concomitant atrial fibrillation, and finally focus on the novel developments in the secondary prevention after structural heart disease intervention. A special focus on treatment individualization is included to emphasize risk and benefits of each therapeutic strategy.
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Affiliation(s)
- Alessandro Caracciolo
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Paolo Mazzone
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Giulia Laterra
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Victoria Garcia-Ruiz
- UGC del Corazón, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, 29010 Málaga, Spain;
| | - Alberto Polimeni
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Salvatore Galasso
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Francesco Saporito
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Scipione Carerj
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy;
| | - Guillaume Marquis-Gravel
- Duke Clinical Research Institute, Durham, NC 27708, USA;
- Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA;
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029-6574, USA
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Policlinic “G. Martino”, University of Messina, 98100 Messina, Italy; (A.C.); (P.M.); (G.L.); (S.G.); (F.S.); (S.C.)
- Correspondence: ; Tel.: +39-090-221-23-41; Fax: +39-090-221-23-81
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Doshi R, Majmundar M, Kansara T, Desai R, Shah J, Kumar A, Patel K. Frequency of Cardiovascular Events and In-hospital Mortality With Opioid Overdose Hospitalizations. Am J Cardiol 2019; 124:1528-1533. [PMID: 31521260 DOI: 10.1016/j.amjcard.2019.07.068] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 01/12/2023]
Abstract
The United States is in the kernel of cataclysmic opioid misuse epidemic with over 33,000 deaths per year from both prescription and illegal opioids use. One of the most common pernicious effects of opioids is on the cardiovascular system. The purpose of this analysis was to determine the incidence of opioid overdose associated cardiovascular events and its impact on short-term outcomes. This was a retrospective, observational study which utilized data from the National Inpatient Sample from January 2005 to September 2015 using International Classifications of Disease, Ninth Revision, Clinical Modification diagnosis codes to identify patients with opioid overdose and associated cardiovascular outcomes. Cardiovascular events were mainly divided into the following 3 parts: Ischemic Events (ischemic stroke and myocardial infarction), acute heart failure, and arrhythmias. The primary outcome of this study was incidence of any cardiovascular event. This study analyzed a total of 430,459 patients hospitalized with opioid overdose, out of which 36,837 (8.6%) had at least 1 cardiovascular event. In all the opioid overdose hospitalizations, 13,979 (3.2%) developed ischemic events, 3,074 (0.7%) developed acute heart failure, and 22,444 (5.2%) developed arrhythmia. Opioid overdose patients with new-onset cardiovascular events had higher odds for in-hospital mortality (odds ratio 4.55; 95% confidence interval 4.11 to 5.04, p <0.001) as compared to patients without cardiovascular events in the multivariable-adjusted model. This study group also demonstrated longer length of stay and higher cost of hospitalization associated with opioid overdose and associated cardiovascular outcome. In conclusion, opioid overdose is associated with higher rates of cardiovascular events, particularly ischemic events and cardiac arrhythmias. These adverse events eventually lead to higher mortality rates and more resource utilization.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, Nevada.
| | - Monil Majmundar
- Department of Internal Medicine, Metropolitan Hospital Center, New York Medical College, New York, New York
| | - Tikal Kansara
- Department of Internal Medicine, Metropolitan Hospital Center, New York Medical College, New York, New York
| | - Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, Georgia
| | - Jay Shah
- Department of Internal Medicine, Mercy St Vincent Medical Center, Toledo, Ohio
| | - Ashish Kumar
- Department of Critical Care Medicine, St John's Medical College Hospital, Bangalore, India
| | - Krunalkumar Patel
- Department of Cardiology, North Shore University Hospital, Manhasset, New York
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Doshi R, Pisipati S, Taha M, Dave M, Shah J, Adalja D, Gullapalli N. Incidence, 30-day readmission rates and predictors of readmission after new onset atrial fibrillation who underwent transcatheter aortic valve replacement. Heart Lung 2019; 49:186-192. [PMID: 31690493 DOI: 10.1016/j.hrtlng.2019.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/27/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION New onset Atrial Fibrillation (NOAF) is frequently seen post transcatheter aortic valve replacement (TAVR). NOAF in the setting of TAVR has also been recognized as predictor of worse outcomes, including higher readmission rates. Data assessing the effect and predictors of NOAF on 30-day readmission rates post TAVR is limited. OBJECTIVE To assess the incidence, 30-day readmission rate and predictors of NOAF in patients who underwent TAVR. METHODS Nationwide Readmissions Database was used to identify patients who developed NOAF post-TAVR between 2012 and 2015. RESULTS A total of 24,076 patients were included in this study, of which 54% were males, and the mean age was 82.4 ± 7.2. NOAF was developed in 10,847 (45%) patients. Overall readmission rates with NOAF was 19.7% and trend in the readmissions reduced during the course of the study (21.9% to 18.7%, Ptrend < 0.001). Thirty-day readmission rate in patients who developed NOAF post-TAVR was significantly higher compared to TAVR patients without NOAF (OR 1.39; 95% CI, 1.28-1.51; p < 0.001). Similarly, rate of ischemic stroke was significantly higher among patients who developed NOAF (OR 1.22; 95% CI, 1.07-1.4; p = 0.004). Predictors of readmissions in NOAF group were mostly non-cardiac, and included age, and comorbidities with chronic liver disease, renal failure and chronic lung disease been the most common comorbidities, in that order. CONCLUSIONS Incidence of NOAF is associated with increased risk of readmissions and ischemic stroke. Future research should focus on interventions to prevent avoidable readmissions and associated morbidity and mortality.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States.
| | - Sailaja Pisipati
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States
| | - Mohamed Taha
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States
| | - Mihir Dave
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States; Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Jay Shah
- Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH, USA
| | - Devina Adalja
- Department of General Medicine, Gotri Medical Education and Research Center, Vadodara, Gujarat, India
| | - Nageshwara Gullapalli
- Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St, W-11, Reno, NV 89502, United States
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Malik AH, Yandrapalli S, Tang GHL. Reevaluating the Use of the Nationwide Inpatient Sample to Identify Incident Cases of Atrial Fibrillation After Aortic Valve Replacement. JAMA Intern Med 2019; 179:1597-1598. [PMID: 31682689 DOI: 10.1001/jamainternmed.2019.4409] [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: 11/14/2022]
Affiliation(s)
- Aaqib H Malik
- Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla
| | - Srikanth Yandrapalli
- Division of Cardiology, Department of Medicine, New York Medical College, Westchester Medical Center, Valhalla
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York
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Kalra R, Patel N, Arora P. Reevaluating the Use of the Nationwide Inpatient Sample to Identify Incident Cases of Atrial Fibrillation After Aortic Valve Replacement-Reply. JAMA Intern Med 2019; 179:1598. [PMID: 31682698 DOI: 10.1001/jamainternmed.2019.4412] [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: 11/14/2022]
Affiliation(s)
- Rajat Kalra
- Cardiovascular Division, University of Minnesota, Minneapolis
| | - Nirav Patel
- Division of Cardiovascular Disease, University of Alabama at Birmingham
| | - Pankaj Arora
- Division of Cardiovascular Disease, University of Alabama at Birmingham.,Section of Cardiology, Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
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Goldsweig A, Aronow HD. Identifying patients likely to be readmitted after transcatheter aortic valve replacement. Heart 2019; 106:256-260. [PMID: 31649048 DOI: 10.1136/heartjnl-2019-315381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/06/2019] [Accepted: 10/08/2019] [Indexed: 11/03/2022] Open
Abstract
Hospital readmission following transcatheter aortic valve replacement (TAVR) contributes considerably to the costs of care. Readmission rates following TAVR have been reported to be as high as 17.4% at 30 days and 53.2% at 1 year. Patient and procedural factors predict an increased likelihood of readmission including non-transfemoral access, acute and chronic kidney impairment, chronic lung disease, left ventricular systolic dysfunction, atrial fibrillation, major bleeding and prolonged index hospitalisation. Recent studies have also found the requirement for new pacemaker implantation and the severity of paravalvular aortic regurgitation and tricuspid regurgitation to be novel predictors of readmission. Post-TAVR readmission within 30 days of discharge is more likely to occur for non-cardiac than cardiac pathology, although readmission for cardiac causes, especially heart failure, predicts higher mortality than readmission for non-cardiac causes. To combat the risk of readmission and associated mortality, the routine practice of calculating and considering readmission risk should be adopted by the heart team. Furthermore, because most readmissions following TAVR occur for non-cardiac reasons, more holistic approaches to readmission prevention are necessary. Familiarity with the most common predictors and causes of readmission should guide the development of initiatives to address these conditions proactively.
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Affiliation(s)
- Andrew Goldsweig
- Department of Cardiovascular Medicine, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
| | - Herbert David Aronow
- Department of Cardiovascular Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA.,Cardiovascular Institute, Lifespan Health System, Providence, Rhode Island, USA
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Huynh K. Incidence of new-onset AF after TAVI and AVR. Nat Rev Cardiol 2019; 16:454. [DOI: 10.1038/s41569-019-0229-7] [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: 11/09/2022]
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