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Olanipekun T, Ritchie C, Abe T, Effoe V, Chris-Olaiya A, Biney I, Erben YM, Guru P, Sanghavi D. Updated Trends in Inferior Vena Cava Filter Use by Indication in the United States After Food and Drug Administration Safety Warnings: A Decade Analysis From 2010 to 2019. J Endovasc Ther 2024; 31:873-881. [PMID: 36859812 DOI: 10.1177/15266028231156089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Overall inferior vena cava filter (IVCF) utilization has decreased in the United States since the 2010 US Food and Drug Administration (FDA) safety communication. The FDA renewed this safety warning in 2014 with additional mandates on reporting IVCF-related adverse events. We evaluated the impact of the FDA recommendations on IVCF placements for different indications from 2010 to 2019 and further assessed utilization trends by region and hospital teaching status. METHODS Inferior vena cava filter placements between 2010 and 2019 were identified in the Nationwide Inpatient Sample database using the associated International Classification of Diseases, Ninth Revision, Clinical Modification, and Tenth Revision codes. Inferior vena cava filter placements were categorized by indication for venous thromboembolism (VTE) "treatment" in patients with VTE diagnosis and contraindication to anticoagulation and "prophylaxis" in patients without VTE. Generalized linear regression was used to analyze utilization trends. RESULTS A total of 823 717 IVCFs were placed over the study period, of which 644 663 (78.3%) were for VTE treatment and 179 054 (21.7%) were for prophylaxis indications. The median age for both categories of patients was 68 years. The total number of IVCFs placed for all indications decreased from 129 616 in 2010 to 58 465 in 2019, with an aggregate decline rate of -8.4%. The decline rate was higher between 2014 and 2019 than between 2010 and 2014 (-11.6% vs -7.2%). From 2010 to 2019, IVCF placement for VTE treatment and prophylaxis trended downward at rates of -7.9% and -10.2%, respectively. Urban nonteaching hospitals saw the highest decline for both VTE treatment (-17.2%) and prophylactic indications (-18.0%). Hospitals located in the Northeast region had the highest decline rates for VTE treatment (-10.3%) and prophylactic indications (-12.5%). CONCLUSION The higher decline rate in IVCF placements between 2014 and 2019 compared with 2010 and 2014 suggests an additional impact of the renewed 2014 FDA safety indications on national IVCF utilization. Variations in IVCF use for VTE treatment and prophylactic indications existed across hospital teaching types, locations, and regions. CLINICAL IMPACT Inferior vena cava filters (IVCF) are associated with medical complications. The 2010 and 2014 FDA safety warnings appeared to have synergistically contributed to a significant decline in IVCF utilization rates from 2010 - 2019 in the US. IVC filter placements in patients without venous thromboembolism (VTE) declined at a higher rate than VTE. However, IVCF utilization varied across hospitals and geographical locations, likely due to the absence of universally accepted clinical guidelines on IVCF indications and use. Harmonization of IVCF placement guidelines is needed to standardize clinical practice, thereby reducing the observed regional and hospital variations and potential IVC filter overutilization.
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Affiliation(s)
- Titilope Olanipekun
- Department of Hospital Medicine, Covenant Health System, Knoxville, TN, USA
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
| | - Charles Ritchie
- Department of Interventional Radiology, Mayo Clinic, Jacksonville, FL, USA
| | - Temidayo Abe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Cardiovascular Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Valery Effoe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, USA
- Department of Interventional Cardiology, Aurora Health Care, Milwaukee, WI, USA
| | - Abimbola Chris-Olaiya
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Isaac Biney
- Department of Pulmonary and Critical Care Medicine, The University of Tennessee Medical Center, Knoxville, TN, USA
| | - Young M Erben
- Department of Vascular Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Pramod Guru
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Devang Sanghavi
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA
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Fereydooni S, Green A, Wei EX, Rossi-Meyer MK, Kandathil CK, Most SP. Surgical complications in combined rhinoplasty and endoscopic sinus surgery. Int Forum Allergy Rhinol 2024; 14:1638-1642. [PMID: 38894612 DOI: 10.1002/alr.23388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/04/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
KEY POINTS Complications in combined surgery are equivalent to ESS but are higher than rhinoplasty alone. The most common complications are pneumonia, stroke, and epistaxis. Rhinoplasty surgeries with graft use have a higher risk of complications.
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Affiliation(s)
- Soraya Fereydooni
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Allen Green
- Stanford University School of Medicine, Stanford, California, USA
| | - Eric X Wei
- Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Monica K Rossi-Meyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Cherian K Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California, USA
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Wei EX, Green A, Kandathil CK, Most SP. Does Recent COVID-19 Infection Impact Safety of Nasal Surgery? Facial Plast Surg Aesthet Med 2024. [PMID: 38530097 DOI: 10.1089/fpsam.2023.0352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Affiliation(s)
- Eric X Wei
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Allen Green
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Cherian K Kandathil
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
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McGinnis KA, Justice AC, Marconi VC, Rodriguez-Barradas MC, Hauser RG, Oursler KK, Brown ST, Bryant KJ, Tate JP. Combining Charlson comorbidity and VACS indices improves prognostic accuracy for all-cause mortality for patients with and without HIV in the Veterans Health Administration. Front Med (Lausanne) 2024; 10:1342466. [PMID: 38356736 PMCID: PMC10864663 DOI: 10.3389/fmed.2023.1342466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/31/2023] [Indexed: 02/16/2024] Open
Abstract
Introduction As people age with HIV (PWH), many comorbid diseases are more common than among age matched comparators without HIV (PWoH). While the Veterans Aging Cohort (VACS) Index 2.0 accurately predicts mortality in PWH using age and clinical biomarkers, the only included comorbidity is hepatitis C. We asked whether adding comorbid disease groupings from the Charlson Comorbidity Index (CCI) improves the accuracy of VACS Index. Methods To maximize our ability to model mortality among older age groups, we began with PWoH in Veterans Health Administration (VA) from 2007-2017, divided into development and validation samples. Baseline predictors included age, and components of CCI and VACS Index (excluding CD4 count and HIV RNA). Patients were followed until December 31, 2021. We used Cox models to develop the VACS-CCI score and estimated mortality using a parametric (gamma) survival model. We compared accuracy using C-statistics and calibration curves in validation overall and within subgroups (gender, age ≥65 years, race/ethnicity, and CCI score). We then applied VACS-CCI in PWH and compared its accuracy to age, VACS Index 2.0, CCI and VACS-CCI with CD4 and HIV RNA added. Results The analytic sample consisted of 6,588,688 PWoH and 30,539 PWH. Among PWoH/PWH, median age was 65/55 years; 6%/3% were women; 15%/48% were Black and 5%/7% Hispanic. VACS-CCI provided the best discrimination (C-statistic = 0.81) with excellent calibration (predicted and observed mortality largely overlapped) overall and within subgroups. When VACS-CCI was applied to PWH it demonstrated similar discrimination as VACS Index 2.0 (C-statistic = 0.77 for both) but superior calibration among those with CD4 < 200. Discrimination was improved when CD4 and HIV RNA were added VACS-CCI (C-statistic = 0.79). Liver and kidney disease, congestive heart failure, malignancy, and dementia were negatively associated with CD4 (p-trends all <0.0001). Discussion Among PWH and PWoH in VA care, age alone weakly discriminates risk of mortality. VACS Index 2.0, CCI, and VACS-CCI all provide better discrimination, but VACS-CCI is more consistently calibrated. The association of comorbid diseases with lower CD4 underscores the likely role of HIV in non-AIDS conditions. Future work will include adding CD4 and HIV RNA to VACS-CCI and validating it in independent data.
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Affiliation(s)
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, CT, United States
- Yale School of Medicine, New Haven, CT, United States
| | - Vincent C. Marconi
- The Atlanta Veterans Affairs Medical Center, Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA, United States
- VA Medical Center, Decatur, GA, United States
| | - Maria C. Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, United States
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Ronald G. Hauser
- VA Connecticut Healthcare System, West Haven, CT, United States
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, United States
| | - Krisann K. Oursler
- Department of Internal Medicine, Virginia Tech Carilion School of Medicine, Roanoke, VA, United States
- VA Salem Healthcare System, Salem, VA, United States
| | | | - Kendall J. Bryant
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Janet P. Tate
- VA Connecticut Healthcare System, West Haven, CT, United States
- Yale School of Medicine, New Haven, CT, United States
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Lee RY, Knaplund C, Withall J, Bokhari SM, Cato KD, Rossetti SC. Variability in Nursing Documentation Patterns across Patients' Hospital Stays. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:1037-1046. [PMID: 38222368 PMCID: PMC10785899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
This study explores the variability in nursing documentation patterns in acute care and ICU settings, focusing on vital signs and note documentation, and examines how these patterns vary across patients' hospital stays, documentation types, and comorbidities. In both acute care and critical care settings, there was significant variability in nursing documentation patterns across hospital stays, by documentation type, and by patients' comorbidities. The results suggest that nurses adapt their documentation practices in response to their patients' fluctuating needs and conditions, highlighting the need to facilitate more individualized care and tailored documentation practices. The implications of these findings can inform decisions on nursing workload management, clinical decision support tools, and EHR optimizations.
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Affiliation(s)
- Rachel Y Lee
- Columbia University, Department of Biomedical Informatics, New York, NY
| | | | | | | | - Kenrick D Cato
- Columbia University, Department of Biomedical Informatics, New York, NY
- Children's Hospital of Philadelphia, Philadelphia, PA
| | - Sarah C Rossetti
- Columbia University, Department of Biomedical Informatics, New York, NY
- Columbia University, School of Nursing, New York, NY
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Schapiro D, Juneja R, Huang A, Meeks A, Liu D, Gelsey FT, Perez-Nieves M. Real-World Patterns of Basal Insulin Use with Other Diabetes Medications Among People with Type 2 Diabetes Between 2014 and 2020. Diabetes Ther 2023; 14:1157-1174. [PMID: 37184630 PMCID: PMC10241716 DOI: 10.1007/s13300-023-01414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/18/2023] [Indexed: 05/16/2023] Open
Abstract
INTRODUCTION Basal insulin's position in the type 2 diabetes (T2D) treatment paradigm has undergone significant revisions since the advent of diabetes medications such as glucagon-like peptide 1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is), which offer cardiorenal protection for people with T2D (PwT2D). This study aimed to characterize the demographic, clinical, and diabetes medication utilization patterns of PwT2D initiating basal insulin between 2014 and 2020 over the time period when these revisions were occurring. METHODS A retrospective study was conducted using the IBM® MarketScan® databases and included adults with T2D who initiated basal insulin therapy (basal insulin initiators) in 2015, 2017, or 2019. Patient characteristics, medication utilization patterns, and time to add an additional diabetes drug class were compared across years. Characteristics of users of basal insulin-GLP-1RA combination therapy (GLP-1RA-basal insulin dual users) were also compared across years. RESULTS Between 2015 and 2019, initiation of basal insulin therapy remained steady, with 1.6-1.9% of PwT2D starting basal insulin in each year. GLP-1RA and SGLT-2i use increased pre- and post-basal insulin initiation (pre-basal: GLP-1RA, from 14.8% to 25.2%, p < 0.0001; SGLT-2i, from 11.4% to 20.5%, p < 0.0001; post-basal: GLP-1RA, from 16.7% to 30.5%, p < 0.0001; SGLT-2i, from 13.4% to 23.3%, p < 0.0001]). The proportion of PwT2D with underlying cardiovascular and renal diseases did not increase during this period. Among basal insulin initiators without prior GLP-1RA, SGLT-2i, or bolus insulin use, time to adding on these agents decreased, with 14.0-15.6% starting bolus insulin within the first year. Among GLP-1RA-basal insulin dual initiators, the proportion of those with underlying cardiovascular disease was not higher among GLP-1RA first users. CONCLUSIONS In this real-world study, insulin remained key in the T2D treatment paradigm. A growing proportion of PwT2D utilized GLP-1RAs and SGLT-2is before and after initiation of basal insulin therapy. At the same time, there was no increase in the proportion of those initiating basal insulin who had cardiorenal comorbidity profiles for which treatment guidelines have recommended the use of GLP-1RAs or SGLT-2is.
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Affiliation(s)
| | | | - Ahong Huang
- Tigermed-BDM, 100 Franklin Square Dr #305, Somerset, NJ, 08873, USA
| | | | - Dongju Liu
- Eli Lilly and Company, Indianapolis, IN, 46225, USA
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Baxter SN, Johnson AH, Brennan JC, Dolle SS, Turcotte JJ, King PJ. The Efficacy of Telemedicine Versus In-Person Education for High-Risk Patients Undergoing Primary Total Joint Arthroplasty. J Arthroplasty 2023:S0883-5403(23)00015-3. [PMID: 36690187 DOI: 10.1016/j.arth.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/27/2022] [Accepted: 01/15/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND While multiple studies have demonstrated the positive impact of preoperative education on total joint arthroplasty (TJA) outcomes, the traditional method of conducting in-person individualized counseling or group education may limit access to these resources for a subset of the population. This study aimed to evaluate the use of preoperative telemedicine and in-person educational programs for primary TJA patients to determine if the utilization of telemedicine is inferior to in-person education in high-risk populations. METHODS A retrospective chart review of all "high-risk" patients undergoing primary unilateral TKA or THA by 1 of 10 board-certified surgeons at a single institution over 1 year was performed. Patients were prospectively classified as high-risk based on race/ethnicity, comorbidities, and socioeconomic and psychosocial factors. Demographics, comorbidities, and hospital outcomes were compared between patients receiving preoperative nurse navigator education via telemedicine versus those receiving face-to-face education. RESULTS When comparing the interventions, telemedicine education was noninferior to face-to-face visits. No significant differences between postoperative length of stay, discharge home, 30-day emergency department return, or 30-day readmission rates were noted. Within the telemedicine group, patients who received video consultations were found to be 6 times more likely to be discharged home after surgery (odds ratio (OR): 5.95, 95% confidence interval (CI): 2.00 to 25.49; P = .004) and less likely to have a 30-day readmission than the phone consultations (OR: 0.36, 95% CI: 0.12 to 0.94: P = .050). CONCLUSION This study demonstrates that telemedicine is not inferior to in-person preoperative education for patients undergoing unilateral TJA, although video-based consultation may improve outcomes over phone-only education.
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Affiliation(s)
- Samantha N Baxter
- Orthopedic Research Fellow, Anne Arundel Medical Center, Annapolis, Maryland
| | | | | | | | - Justin J Turcotte
- Orthopedic and Surgery Research, Anne Arundel Medical Center, Annapolis, Maryland
| | - Paul J King
- Anne Arundel Medical Center, Annapolis, Maryland
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Smyth EN, Beyrer J, Saverno KR, Hadden E, Abedtash H, DeLuca A, Lawrence GW, Rybowski S. Real-World Patient Characteristics, Utilization Patterns, and Outcomes of US Patients with HR+, HER2- Metastatic Breast Cancer Treated with Abemaciclib. Drugs Real World Outcomes 2022; 9:681-693. [PMID: 36097254 DOI: 10.1007/s40801-022-00327-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Abemaciclib is the most recent oral cyclin-dependent kinase 4 and 6 inhibitor (CDK4 & 6i) to receive US Food and Drug Administration (FDA) approval to treat hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced or metastatic breast cancer (MBC). Administrative claims data were used to describe patient characteristics and select clinical and economic outcomes in US patients treated in routine clinical practice. Prior analyses from electronic health records data indicate approximately 25% of patients received either palbociclib or ribociclib for MBC before initiating abemaciclib treatment; this work further explored these findings and associated outcomes. METHODS This retrospective study analyzed medical and pharmacy claims from the IBM® MarketScan® Research Databases between 1 January 2007 to 31 January 2020. Patients with HR+, HER2- MBC newly initiating abemaciclib between 1 September 2017 and 31 October 2019 were included and grouped by concomitant therapy (+aromatase inhibitor (AI), +fulvestrant (F), 200 mg abemaciclib monotherapy (Mono), or +other), and outcomes were analyzed by prior CDK4 & 6i use. Patient and treatment characteristics were summarized with descriptive statistics. Kaplan-Meier methods assessed time-to-discontinuation (TTD; i.e., persistency) and time-to-chemotherapy (TTC). Adherence (defined by the medication possession ratio) and drug wastage were determined. RESULTS This analysis included 454 patients (mean age 57.7 years), with 35.0% (n = 159) in the +F group, 29.3% (n = 133) in the +AI group, 10.4% (n = 47) in the 200 mg Mono group, and 25.3% (n = 115) in the +other group. Prior chemotherapy and CDK 4 & 6i use were present in 23.8% and 49.8% of all patients, respectively. Visceral metastases were present at abemaciclib initiation in 50.4% in the +AI group; 49.7% in the +F group; and 55.3% in the 200 mg Mono group. Liver metastases were present in 33.7% of the overall population. Among patients without prior CDK4 & 6i use, the median TTD for patients receiving abemaciclib + AI was not reached [95% CI 430-not reached (NR) days], abemaciclib + F [531 days (95% CI 281-NR)], and abemaciclib mono [141 days (95% CI 80-NR)]. Median TTC for abemaciclib + AI and abemaciclib + F groups were not reached and the median TTC for abemaciclib mono was 535 days (95% CI 181-NR). Medication adherence was 88.7% and medication wastage costs among those with at least one dose modification were $808.12 and $452.2 per patient per month based on amount paid and wholesale acquisition cost (WAC), respectively. Mean length of follow-up for all patients was 350 days (SD 187). CONCLUSION These real-world data complement clinical trial results by examining abemaciclib use among patients treated in routine clinical practice. The sizeable number of patients treated with prior CDK4 & 6i, chemotherapy, and/or visceral metastases at abemaciclib initiation suggest that many patients had very advanced disease and/or were in later stages of their treatment. These data confirm a higher percentage of patients treated with previous CDK4 & 6i than reported previously, reinforcing the importance of the ongoing, prospective clinical trials evaluating outcomes following progression on CDK4 & 6i.
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Louis DW, Kennedy KF, Saad M, Salber G, Imran H, Wark T, Soares C, Ghosalkar D, Cherala R, Poppas A, Abbott JD, Aronow HD. Preadmission Oral Anticoagulation for Atrial Fibrillation/Flutter and Death or Thrombotic Events During COVID-19 Admission. Am J Cardiol 2022; 181:38-44. [PMID: 35970632 PMCID: PMC9374502 DOI: 10.1016/j.amjcard.2022.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation/flutter (AF) and COVID-19 are associated with an elevated risk of arterial and venous thrombosis. Whether preadmission oral anticoagulation (OAC) for AF reduces the incidence of in-hospital death or thrombotic events among patients with COVID-19 is unknown. We identified 630 patients with pre-existing AF and a hospitalization diagnosis of COVID-19 and stratified them according to preadmission OAC use. Multivariable logistic regression was employed to relate preadmission OAC to composite in-hospital mortality or thrombotic events. Unadjusted composite in-hospital mortality or thrombotic complications occurred less often in those on than not on preadmission OAC (27.1% vs 46.8%, p <0.001). After adjustment, the incidence of composite in-hospital all-cause mortality or thrombotic complications remained lower with preadmission OAC (odds ratio 0.37, confidence interval 0.25 to 0.53, p <0.0001). Secondary outcomes including all-cause mortality (16.3% vs 24.9%, p = 0.007), intensive care unit admission (14.7% vs 29.0%, p <0.001), intubation (6.4% vs 18.6%, p <0.001), and noninvasive ventilation (18.6% vs 27.5%, p = 0.007) occurred less frequently, and length of stay was shorter (6 vs 7 days, p <0.001) in patients on than those not on preadmission OAC. A higher CHA2DS2-VASc score was associated with an increased risk of thrombotic events. In conclusion, among patients with baseline AF who were hospitalized with COVID-19, those on preadmission OAC had lower rates of death, arterial and venous thrombotic events, and less severe COVID-19.
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Affiliation(s)
- David W Louis
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kevin F Kennedy
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Marwan Saad
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Greg Salber
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Hafiz Imran
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Tyler Wark
- Department of Cardiology, University of Vermont, Burlington, Vermont
| | - Cullen Soares
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Dhairyasheel Ghosalkar
- Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rasan Cherala
- Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Athena Poppas
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - J Dawn Abbott
- Lifespan Cardiovascular Institute, Providence, Rhode Island; Division of Cardiology, Department of Medicine,, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Herbert D Aronow
- Division of Cardiology, Henry Ford Heart & Vascular Institute, Detroit, Michigan.
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Adebiyi EO, Edigin E, Shaka H, Hunter J, Swaminathan S. Pediatric Heart Failure Inpatient Mortality: A Cross-Sectional Analysis. Cureus 2022; 14:e26721. [PMID: 35959177 PMCID: PMC9360623 DOI: 10.7759/cureus.26721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Heart failure constitutes significant morbidity and mortality among the pediatric population. Few data exist on the prevalence and mortality rate of pediatric heart failure (pHF) in the United States. Objectives This study aimed to determine the in-hospital mortality and the principal diagnoses in pediatric patients with heart failure who died while being hospitalized in the United States. Methods This is a retrospective cross-sectional study using data from the 2019 Kid Inpatient Database (KID). The KID contained data on hospitalized children below 21 years of age. Using Stata 17 software (StataCorp LLC, College Station, Texas), the data were searched for heart failure diagnoses using International Classification of Diseases 10th revision Clinical Modification (ICD-10-CM) codes. By using the “rank” command in Stata, the most common principal diagnoses were placed in descending order of frequency, and these were further divided into different ICD-10 code categories. Results There were 16,206 pHF admissions in 2019. Of these admissions, 1,023 (6.31%) patients died. The top five principal ICD 10 code categories among all pHF deaths in descending order were circulatory system (17.95%), congenital/chromosomal abnormalities (17.43%), respiratory system (10.28%), infectious diseases (9.24%, and perinatal diseases (7.90%). Among all pHF deaths, sepsis of unspecified organisms (5.14%), hypoplastic left heart syndrome (HLHS) (3.19%), and acute respiratory failure with hypoxia (3.14%) were the most common primary diagnoses. Conclusion and significance Pediatric heart failure in-hospital overall mortality is 6.31%, and sepsis of unspecified organisms, HLHS, and acute respiratory failure are the most common principal diagnoses among these children. Preventive measures and prompt treatment of infections are paramount to reducing pHF mortality.
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Guo Ie H, Tang CH, Sheu ML, Liu HY, Lu N, Tsai TY, Chen BL, Huang KC. Evaluation of risk adjustment performance of diagnosis-based and medication-based comorbidity indices in patients with chronic obstructive pulmonary disease. PLoS One 2022; 17:e0270468. [PMID: 35802678 PMCID: PMC9269939 DOI: 10.1371/journal.pone.0270468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/12/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives
This study assessed risk adjustment performance of six comorbidity indices in two categories of comorbidity measures: diagnosis-based comorbidity indices and medication-based ones in patients with chronic obstructive pulmonary disease (COPD).
Methods
This was a population–based retrospective cohort study. Data used in this study were sourced from the Taiwan National Health Insurance Research Database. The study population comprised all patients who were hospitalized due to COPD for the first time in the target year of 2012. Each qualified patient was individually followed for one year starting from the index date to assess two outcomes of interest, medical expenditures within one year after discharge and in-hospital mortality of patients. To assess how well the added comorbidity measures would improve the fitted model, we calculated the log-likelihood ratio statistic G2. Subsequently, we compared risk adjustment performance of the comorbidity indices by using the Harrell c-statistic measure derived from multiple logistic regression models.
Results
Analytical results demonstrated that that comorbidity measures were significant predictors of medical expenditures and mortality of COPD patients. Specifically, in the category of diagnosis-based comorbidity indices the Elixhauser index was superior to other indices, while the RxRisk-V index was a stronger predictor in the framework of medication-based codes, for gauging both medical expenditures and in-hospital mortality by utilizing information from the index hospitalization only as well as the index and prior hospitalizations.
Conclusions
In conclusion, this work has ascertained that comorbidity indices are significant predictors of medical expenditures and mortality of COPD patients. Based on the study findings, we propose that when designing the payment schemes for patients with chronic diseases, the health authority should make adjustments in accordance with the burden of health care caused by comorbid conditions.
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Affiliation(s)
- Huei Guo Ie
- Teaching Resource Center, Office of Academic Affairs, Taipei Medical University, Taipei City, Taiwan
| | - Chao-Hsiun Tang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
| | - Mei-Ling Sheu
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, Taipei Medical University, Taipei City, Taiwan
| | - Ning Lu
- Department of Health Administration, College of Health and Human Services, Governors State University, University Park, Illinois, United States of America
| | - Tuan-Ya Tsai
- Department of Pharmacy, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Bi-Li Chen
- Department of Pharmacy, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Kuo-Cherh Huang
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei City, Taiwan
- * E-mail:
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Beyrer J, Manjelievskaia J, Bonafede M, Lenhart G, Nolot S, Haldane D, Johnston J. Validation of an International Classification of Disease, 10th revision coding adaptation for the Charlson Comorbidity Index in United States healthcare claims data. Pharmacoepidemiol Drug Saf 2021; 30:582-593. [PMID: 33580525 PMCID: PMC8252530 DOI: 10.1002/pds.5204] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/08/2021] [Indexed: 01/12/2023]
Abstract
PURPOSE An International Classification of Disease (ICD-10) Charlson Comorbidity Index (CCI) adaptation had not been previously developed and validated for United States (US) healthcare claims data. Many researchers use the Canadian adaption by Quan et al (2005), not validated in US data. We sought to evaluate the predictive validity of a US ICD-10 CCI adaptation in US claims and compare it with the Canadian standard. METHODS Diverse patient cohorts (rheumatoid arthritis, hip/knee replacement, lumbar spine surgery, acute myocardial infarction [AMI], stroke, pneumonia) in the IBM® MarketScan® Research Databases were linked with the IBM MarketScan Mortality file. Predictive performance was measured using c-statistics for binary outcomes (1-year and postoperative mortality, in-hospital complications) and root mean square prediction error (RMSE) for continuous outcomes (1-year all-cause medical costs, index hospitalization costs, length of stay [LOS]), after adjusting for age and sex. C-statistics were compared by the method of DeLong and colleagues (1988); RMSEs, by resampling. RESULTS C-statistics were generally high (≥ ~ 0.8) for mortality but lower for in-hospital complications (~0.6-0.7). RMSEs for costs and hospitalization LOS were relatively large and comparable to standard deviations. Results were similar overall between the US and Canadian adaptations, with relative differences typically <1%. CONCLUSIONS This US-based coding adaptation and a previously published Canadian adaptation resulted in similar predictive ability for all outcomes evaluated but may have different construct validity (not evaluated in our study). We recommend using adaptations specific to the country of data origin based on good research practice.
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Affiliation(s)
- Julie Beyrer
- Global Patient Outcomes and Real World EvidenceEli Lilly and CompanyIndianapolisIndianaUSA
| | | | | | - Gregory Lenhart
- IBM's Life SciencesIBM Watson HealthCambridgeMassachusettsUSA
| | - Sandra Nolot
- Global Patient Outcomes and Real World EvidenceEli Lilly and CompanyIndianapolisIndianaUSA
| | - Diane Haldane
- Global Patient Outcomes and Real World EvidenceEli Lilly and CompanyIndianapolisIndianaUSA
| | - Joseph Johnston
- Global Patient Outcomes and Real World EvidenceEli Lilly and CompanyIndianapolisIndianaUSA
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