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Kwon JH, Bentley D, Cevasco M, Blumer V, Kanwar MK, Silvestry SC, Daneshmand MA, Abraham J, Shorbaji K, Kilic A. Patient Characteristics and Early Clinical Outcomes With Impella 5.5: A Systematic Review and Meta-Analysis. ASAIO J 2024; 70:557-564. [PMID: 38386980 DOI: 10.1097/mat.0000000000002169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Data regarding outcomes with Impella 5.5 are limited. The aim of this systematic review and meta-analysis was to summarize patient and treatment characteristics and early clinical outcomes among patients supported by Impella 5.5. A systematic literature search was conducted in PubMed, Scopus, and Cochrane databases from September 2019 to March 2023. Studies reporting outcomes in greater than or equal to 5 patients were included for review. Patient characteristics, treatment characteristics, and early clinical outcomes were extracted. Outcomes included adverse events, survival to hospital discharge, and 30 day survival. Random-effect models were used to estimate pooled effects for survival outcomes. Assessment for bias was performed using funnel plots and Egger's tests. Fifteen studies were included for qualitative review, representing 707 patients. Mean duration of support was 9.9 ± 8.2 days. On meta-analysis of 13 studies reporting survival outcomes, survival to hospital discharge was 68% (95% confidence interval [CI], 58-78%), and 30 day survival was 65% (95% CI, 56-74%) among patients with Impella devices predominantly supported by Impella 5.5 (>60%). There was significant study heterogeneity for these outcomes. Among 294 patients with Impella 5.5 only, survival to discharge was 78% (95% CI, 72-82%) with no significant study heterogeneity. This data present early benchmarks for outcomes with Impella 5.5 as clinical experience with these devices accrues.
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Affiliation(s)
- Jennie H Kwon
- From the Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Dana Bentley
- Principle Scientific Affairs, Abiomed, Danvers, Massachusetts
| | - Marisa Cevasco
- Division of Cardiovascular Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vanessa Blumer
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Manreet K Kanwar
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - Mani A Daneshmand
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Jacob Abraham
- Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence Research Network, Portland, Oregon
| | - Khaled Shorbaji
- From the Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Arman Kilic
- From the Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina
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2
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Leiva O, Cheng RK, Pauwaa S, Katz JN, Alvarez-Cardona J, Bernard S, Alviar C, Yang EH. Outcomes of Patients With Cancer With Myocardial Infarction-Associated Cardiogenic Shock Managed With Mechanical Circulatory Support. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:101208. [PMID: 39131775 PMCID: PMC11307771 DOI: 10.1016/j.jscai.2023.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 08/13/2024]
Abstract
Background Cardiogenic shock (CS) is the leading cause of death among patients with acute myocardial infarction (AMI) and is managed with temporary mechanical circulatory support (tMCS) in advanced cases. Patients with cancer are at high risk of AMI and CS. However, outcomes of patients with cancer and AMI-CS managed with tMCS have not been rigorously studied. Methods Adult patients with AMI-CS managed with tMCS from 2006 to 2018 with and without cancer were identified using the National Inpatient Sample. Propensity score matching (PSM) was performed for variables associated with cancer. Primary outcome was in-hospital death, and secondary outcomes were major bleeding and thrombotic complications. Results After PSM, 1287 patients with cancer were matched with 12,870 patients without cancer. There was an increasing temporal trend for prevalence of cancer among patients admitted with AMI-CS managed with tMCS (P trend < .001). After PSM, there was no difference in in-hospital death (odds ratio [OR], 1.00; 95% CI, 0.88-1.13) or thrombotic complications (OR, 1.10; 95% CI, 0.91-1.34) between patients with and without cancer. Patients with cancer had a higher risk of major bleeding (OR, 1.29; 95% CI, 1.15-1.46). Conclusions Among patients with AMI-CS managed with tMCS, cancer is becoming increasingly frequent and associated with increased risk of major bleeding, although there was no difference in in-hospital death. Further studies are needed to further characterize outcomes, and inclusion of patients with cancer in trials of tMCS is needed.
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Affiliation(s)
- Orly Leiva
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Richard K. Cheng
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Sunil Pauwaa
- Division of Cardiology, Advocate Christ Medical Center, Oak Lawn, Illinois
| | - Jason N. Katz
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Jose Alvarez-Cardona
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Samuel Bernard
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Carlos Alviar
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Eric H. Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California Los Angeles, Los Angeles, California
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3
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Campesi I, Franconi F, Serra PA. The Appropriateness of Medical Devices Is Strongly Influenced by Sex and Gender. Life (Basel) 2024; 14:234. [PMID: 38398743 PMCID: PMC10890141 DOI: 10.3390/life14020234] [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: 10/31/2023] [Revised: 01/22/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Until now, research has been performed mainly in men, with a low recruitment of women; consequentially, biological, physiological, and physio-pathological mechanisms are less understood in women. Obviously, without data obtained on women, it is impossible to apply the results of research appropriately to women. This issue also applies to medical devices (MDs), and numerous problems linked to scarce pre-market research and clinical trials on MDs were evidenced after their introduction to the market. Globally, some MDs are less efficient in women than in men and sometimes MDs are less safe for women than men, although recently there has been a small but significant decrease in the sex and gender gap. As an example, cardiac resynchronization defibrillators seem to produce more beneficial effects in women than in men. It is also important to remember that MDs can impact the health of healthcare providers and this could occur in a sex- and gender-dependent manner. Recently, MDs' complexity is rising, and to ensure their appropriate use they must have a sex-gender-sensitive approach. Unfortunately, the majority of physicians, healthcare providers, and developers of MDs still believe that the human population is only constituted by men. Therefore, to overcome the gender gap, a real collaboration between the inventors of MDs, health researchers, and health providers should be established to test MDs in female and male tissues, animals, and women.
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Affiliation(s)
- Ilaria Campesi
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100 Sassari, Italy
- Laboratorio Nazionale sulla Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100 Sassari, Italy;
| | - Flavia Franconi
- Laboratorio Nazionale sulla Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100 Sassari, Italy;
| | - Pier Andrea Serra
- Dipartimento di Medicina, Chirurgia e Farmacia, Università degli Studi di Sassari, 07100 Sassari, Italy;
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Ergui I, Salama J, Hooda U, Ebner B, Dangl M, Vincent L, Sancassani R, Colombo R. In-hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011-2019. Clin Cardiol 2024; 47:e24235. [PMID: 38366788 PMCID: PMC10873680 DOI: 10.1002/clc.24235] [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: 10/27/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Unhoused patients face significant barriers to receiving health care in both the inpatient and outpatient settings. For unhoused patients with heart failure who are in extremis, there is a lack of data regarding in-hospital outcomes and resource utilization in the setting of cardiogenic shock (CS). HYPOTHESIS Unhoused patients hospitalized with CS have increased mortality and decreased use of invasive therapies as compared to housed patients. METHODS The National Inpatient Sample (NIS) database was queried from 2011 to 2019 for relevant ICD-9 and ICD-10 codes to identify unhoused patients with an admission diagnosis of CS. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for prespecified and significantly different baseline characteristics (p < .05). RESULTS We identified a weighted sample of 1 202 583 adult CS hospitalizations, of whom 4510 were unhoused (0.38%). There was no significant difference in the comorbidity adjusted odds of mortality between groups. Unhoused patients had lower odds of receiving mechanical circulatory support, left heart catheterization, percutaneous coronary intervention, or pulmonary artery catheterization. Unhoused patients had higher adjusted odds of infectious complications, undergoing intubation, or requiring restraints. CONCLUSIONS These data suggest that, despite having fewer traditional comorbidities, unhoused patients have similar mortality and less access to more aggressive care than housed patients. Unhoused patients may experience under-diuresis, or more conservative care strategies, as evidenced by the higher intubation rate in this population. Further studies are needed to elucidate long-term outcomes and investigate systemic methods to ameliorate barriers to care in unhoused populations.
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Affiliation(s)
- Ian Ergui
- Division of Internal Medicine, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Joshua Salama
- Division of Internal Medicine, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Urvashi Hooda
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Bertrand Ebner
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Michael Dangl
- Division of Internal Medicine, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Louis Vincent
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Rhea Sancassani
- Department of CardiologyJackson Memorial HospitalMiamiFloridaUSA
| | - Rosario Colombo
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFloridaUSA
- Department of CardiologyJackson Memorial HospitalMiamiFloridaUSA
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Ryabov VV, Panteleev OO, Kercheva MA, Gorokhovsky AA, Syrkina AG, Margolis NY. SCAI Staging Application for Acute Myocardial Infarction-Related Cardiogenic Shock at a Single-Center Russian Registry. J Clin Med 2023; 12:7739. [PMID: 38137809 PMCID: PMC10743544 DOI: 10.3390/jcm12247739] [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: 10/24/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
AIM To access the features of the course of myocardial infarction (MI) in patients with different stages of MI complicated by cardiogenic shock (MI CS) according to the SCAI scale. METHODS We retrospectively described the portrait of CS MI (n = 117) at different stages of SCAI from the hospital MI registry (n = 1253). RESULTS Hospital mortality increased from stage to stage (p ≤ 0.001). Significant differences in biochemical parameters were found both for indicators characterizing intensive care measures, such as the presence of mechanical lung ventilation or an intra-aortic balloon pump, and for indicators of organ hypoperfusion such as lactate level, pHv (7.39 (7.36; 7.44) at stage A-B; 7.14 (7.06; 7.18) at stage E), creatinine, and glomerular filtration rate. Parameters related to MI characteristics, such as instrumental and laboratory data, anamnesis of ischemia, and performed treatment, did not differ between groups. Polynomial logistic regression showed that lactate level, mechanical ventilation, and monocyte count upon admission (1.15 (0.96; 1.23) at stage A-B; 0.78 (0.49; 0.94) at stage E, p = 0.005) correlated with CS severity. CONCLUSION The characteristics of MI at different stages of SCAI do not have differences and do not determine the severity of shock. We revealed a high discriminatory potential of the pH level in predicting refractory shock. The value of monocytes at admission may be a promising predictor of the severity of MI CS. The question of the causes of heterogeneity of MI CS, taking into account the homogeneity of MI characteristics, remains open and promising.
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Affiliation(s)
- Vyacheslav V. Ryabov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634012 Tomsk, Russia (O.O.P.); (A.G.S.)
- Cardiology Division, Siberian State Medical University, 2 Moscovsky Trakt, 634055 Tomsk, Russia
| | - Oleg O. Panteleev
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634012 Tomsk, Russia (O.O.P.); (A.G.S.)
- Cardiology Division, Siberian State Medical University, 2 Moscovsky Trakt, 634055 Tomsk, Russia
| | - Maria A. Kercheva
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634012 Tomsk, Russia (O.O.P.); (A.G.S.)
| | - Alexei A. Gorokhovsky
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634012 Tomsk, Russia (O.O.P.); (A.G.S.)
| | - Anna G. Syrkina
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634012 Tomsk, Russia (O.O.P.); (A.G.S.)
| | - Natalia Y. Margolis
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, 634012 Tomsk, Russia (O.O.P.); (A.G.S.)
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Ton VK, Kanwar MK, Li B, Blumer V, Li S, Zweck E, Sinha SS, Farr M, Hall S, Kataria R, Guglin M, Vorovich E, Hernandez-Montfort J, Garan AR, Pahuja M, Vallabhajosyula S, Nathan S, Abraham J, Harwani NM, Hickey GW, Wencker D, Schwartzman AD, Khalife W, Mahr C, Kim JH, Bhimaraj A, Sangal P, Zhang Y, Walec KD, Zazzali P, Burkhoff D, Kapur NK. Impact of Female Sex on Cardiogenic Shock Outcomes: A Cardiogenic Shock Working Group Report. JACC. HEART FAILURE 2023; 11:1742-1753. [PMID: 37930289 DOI: 10.1016/j.jchf.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Studies reporting cardiogenic shock (CS) outcomes in women are scarce. OBJECTIVES The authors compared survival at discharge among women vs men with CS complicating acute myocardial infarction (AMI-CS) and heart failure (HF-CS). METHODS The authors analyzed 5,083 CS patients in the Cardiogenic Shock Working Group. Propensity score matching (PSM) was performed with the use of baseline characteristics. Logistic regression was performed for log odds of survival. RESULTS Among 5,083 patients, 1,522 were women (30%), whose mean age was 61.8 ± 15.8 years. There were 30% women and 29.1% men with AMI-CS (P = 0.03). More women presented with de novo HF-CS compared with men (26.2% vs 19.3%; P < 0.001). Before PSM, differences in baseline characteristics and sex-specific outcomes were seen in the HF-CS cohort, with worse survival at discharge (69.9% vs 74.4%; P = 0.009) and a higher rate of maximum Society for Cardiac Angiography and Interventions stage E (26% vs 21%; P = 0.04) in women than in men. Women were less likely to receive pulmonary artery catheterization (52.9% vs 54.6%; P < 0.001), heart transplantation (6.5% vs 10.3%; P < 0.001), or left ventricular assist device implantation (7.8% vs 10%; P = 0.01). Regardless of CS etiology, women had more vascular complications (8.8% vs 5.7%; P < 0.001), bleeding (7.1% vs 5.2%; P = 0.01), and limb ischemia (6.8% vs 4.5%; P = 0.001). More vascular complications persisted in women after PSM (10.4% women vs 7.4% men; P = 0.06). CONCLUSIONS Women with HF-CS had worse outcomes and more vascular complications than men with HF-CS. More studies are needed to identify barriers to advanced therapies, decrease complications, and improve outcomes of women with CS.
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Affiliation(s)
- Van-Khue Ton
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Manreet K Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Borui Li
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Song Li
- University of Washington Medical Center, Seattle, Washington, USA
| | - Elric Zweck
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Shashank S Sinha
- Inova Heart and Vascular Institute, Inova Fairfax Medical Campus, Falls Church, Virginia, USA
| | - Maryjane Farr
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Shelley Hall
- Baylor University Medical Center, Dallas, Texas, USA
| | - Rachna Kataria
- Lifespan Cardiovascular Center, Brown University, Providence, Rhode Island, USA
| | - Maya Guglin
- Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Esther Vorovich
- Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois, USA
| | | | - A Reshad Garan
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mohit Pahuja
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | | | | | | | - Neil M Harwani
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gavin W Hickey
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | | | - Wissam Khalife
- University of Texas Medical Branch, Galveston, Texas, USA
| | - Claudius Mahr
- University of Washington Medical Center, Seattle, Washington, USA
| | - Ju H Kim
- Houston Methodist Research Institute, Houston, Texas, USA
| | | | - Paavni Sangal
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Yijing Zhang
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Karol D Walec
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | - Peter Zazzali
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA
| | | | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts, USA.
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7
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Rekhtman D, Iyengar A, Song C, Weingarten N, Shin M, Patel M, Herbst DA, Helmers M, Cevasco M, Atluri P. Emerging Racial Differences in Heart Transplant Waitlist Outcomes for Patients on Temporary Mechanical Circulatory Support. Am J Cardiol 2023; 204:234-241. [PMID: 37556892 DOI: 10.1016/j.amjcard.2023.07.086] [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: 04/07/2023] [Accepted: 07/10/2023] [Indexed: 08/11/2023]
Abstract
Temporary mechanical circulatory support (tMCS) is increasingly used for patients awaiting heart transplantation. Although examples of systemic inequity in cardiac care have been described, biases in tMCS use are not well characterized. This study explores the racial disparities in tMCS use and waitlist outcomes. The United Network for Organ Sharing database was used to identify adults listed for first-time heart transplantation from 2015 to 2021. White and non-White patients on extracorporeal membrane oxygenation, intra-aortic balloon pump, or temporary left ventricular assist device were identified. Waitlist outcomes of mortality, transplantation, and delisting were analyzed by race using competing risks regression. The effect of the new heart allocation system was also assessed. A total of 16,811 patients were included in this study, with 10,377 self-identifying as White and 6,434 as non-White. White patients were more often male, privately ensured, and had less co-morbidities (p <0.05). tMCS use was found to be significantly higher in non-White patients (p <0.001). Among those on tMCS, non-White patients were more likely to be delisted because of illness (subhazard ratio 1.34 [1.09 to 1.63]) and less likely to die while on the waitlist (subhazard ratio 0.76 [0.61 to 0.93]). This disparity was not present before the implementation of the new heart allocation system. tMCS use was proportional to the risk factors identified in the non-White cohort. After the implementation of the new heart allocation system, White patients were more likely to die, whereas non-White patients were more likely to be delisted. Further work is needed to determine the causes of and potential solutions for disparities in the waitlist outcomes.
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Affiliation(s)
- David Rekhtman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amit Iyengar
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cindy Song
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Noah Weingarten
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Max Shin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mrinal Patel
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David Alan Herbst
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark Helmers
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marisa Cevasco
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pavan Atluri
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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Moynihan KM, Dorste A, Alizadeh F, Phelps K, Barreto JA, Kolwaite AR, Merlocco A, Barbaro RP, Chan T, Thiagarajan RR. Health Disparities in Extracorporeal Membrane Oxygenation Utilization and Outcomes: A Scoping Review and Methodologic Critique of the Literature. Crit Care Med 2023; 51:843-860. [PMID: 36975216 DOI: 10.1097/ccm.0000000000005866] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
OBJECTIVES To map the scope, methodological rigor, quality, and direction of associations between social determinants of health (SDoH) and extracorporeal membrane oxygenation (ECMO) utilization or outcomes. DATA SOURCES PubMed, Web of Science, Embase, and Cochrane Library databases were systematically searched for citations from January 2000 to January 2023, examining socioeconomic status (SES), race, ethnicity, hospital and ECMO program characteristics, transport, and geographic location (context) with utilization and outcomes (concept) in ECMO patients (population). STUDY SELECTION Methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review extension. Two reviewers independently evaluated abstracts and full text of identified publications. Exclusion criteria included non-English, unavailable, less than 40 patients, and periprocedural or mixed mechanical support. DATA EXTRACTION Content analysis used a standardized data extraction tool and inductive thematic analysis for author-proposed mediators of disparities. Risk of bias was assessed using the Quality in Prognosis Studies tool. DATA SYNTHESIS Of 8,214 citations screened, 219 studies were identified. Primary analysis focuses on 148 (68%) including race/ethnicity/SES/payer variables including investigation of ECMO outcomes 114 (77%) and utilization 43 (29%). SDoH were the primary predictor in 15 (10%). Overall quality and methodologic rigor was poor with advanced statistics in 7%. Direction of associations between ECMO outcomes or utilization according to race, ethnicity, SES, or payer varied. In 38% adverse outcomes or lower use was reported in underrepresented, under-resourced or diverse populations, while improved outcomes or greater use were observed in these populations in 7%, and 55% had no statistically significant result. Only 26 studies (18%) discussed mechanistic drivers of disparities, primarily focusing on individual- and hospital-level rather than systemic/structural factors. CONCLUSIONS Associations between ECMO utilization and outcomes with SDoH are inconsistent, complicated by population heterogeneity and analytic shortcomings with limited consideration of systemic contributors. Findings and research gaps have implications for measuring, analyzing, and interpreting SDoH in ECMO research and healthcare.
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Affiliation(s)
- Katie M Moynihan
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Anna Dorste
- Medical Library, Boston Children's Hospital, Boston, MA
| | - Faraz Alizadeh
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Kayla Phelps
- Department of Pediatrics, Children's Hospital New Orleans, Louisiana State University, New Orleans, LA
| | - Jessica A Barreto
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Amy R Kolwaite
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Anthony Merlocco
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Ryan P Barbaro
- Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Titus Chan
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Ravi R Thiagarajan
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children's Hospital, Boston, MA
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9
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Gilani A, Maknojia A, Mufty M, Patel S, Grines CL, Ghatak A. Mechanical circulatory device utilization in cardiac arrest: Racial and gender disparities and impact on mortality. Int J Cardiol 2023; 371:460-464. [PMID: 36087630 DOI: 10.1016/j.ijcard.2022.09.004] [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: 07/03/2022] [Revised: 08/16/2022] [Accepted: 09/03/2022] [Indexed: 01/08/2023]
Abstract
The objectives of this retrospective study include identifying the utilization trend of mechanical circulatory devices (MCD) such as Intra-Aortic Balloon Pump (IABP), Impella and Extracorporeal Membrane Oxygenation (ECMO) in admissions with cardiac arrest, determining whether racial or gender disparities exist in their usage, and discerning if their use is associated with a reduction in mortality. By leveraging the National Inpatient Sample, we identified 229,180 weighted adult cardiac arrest admissions between October 1, 2015 and December 31, 2018. MCD were used in 6005 admissions (2.6%). IABP had the highest utilization, representing 77.8% of all MCDs, followed by Impella at 24.8%. The utilization of IABP decreased from 90.6% to 71.6%, while the use of Impella increased from 13.5% to 29.8% in this study period; both trends were statistically significant. MCD use was found to be lower in women compared to men (1.4% vs 3.6, P < 0.001) and in the Black population compared to White (1.5% vs 2.8%, P < 0.001). There was no difference in MCD utilization between Hispanic and the White cohorts. In-hospital mortality was lower in admissions associated with MCD (31.4% vs 45.9%, P < 0.001). ECMO was associated with the lowest mortality rate at 14.3%, followed by IABP at 28.1%. The use of Impella and combination therapy were not associated with a significant decrease in mortality. In conclusion, MCD use may decrease mortality in cardiac arrest, however their utilization appears to be lower in African Americans and in women.
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Affiliation(s)
- Aamir Gilani
- Internal Medicine Chief Resident; Northside Hospital Gwinnett, 1000 Medical Center Blvd, Lawrenceville, GA 30046, USA.
| | - Arish Maknojia
- Internal Medicine Resident; Northside Hospital Gwinnett, 1000 Medical Center Blvd, Lawrenceville, GA 30046, USA
| | - Muhammad Mufty
- Internal Medicine Resident; Northside Hospital Gwinnett, 1000 Medical Center Blvd, Lawrenceville, GA 30046, USA
| | - Shaan Patel
- Internal Medicine Resident; Northside Hospital Gwinnett, 1000 Medical Center Blvd, Lawrenceville, GA 30046, USA
| | - Cindy L Grines
- Northside Hospital Cardiovascular Institute, 575 Professional Dr #400, Lawrenceville, GA 30046, USA. Past president of the Society for Cardiovascular Angiography and Interventions
| | - Abhijit Ghatak
- Cardiovascular Clinic of North Georgia, 1475 Jesse Jewell Pkwy NE #300, Gainesville, GA 30501, USA
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10
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Richardson S, Verma A, Sanaiha Y, Chervu NL, Pan C, Williamson CG, Benharash P. Racial disparities in outcomes for extracorporeal membrane oxygenation in the United States. Am J Surg 2023; 225:113-117. [PMID: 36180299 DOI: 10.1016/j.amjsurg.2022.09.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/09/2022] [Accepted: 09/18/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Racial disparities in extracorporeal membrane oxygenation (ECMO) outcomes in patients with a broad set of indications are not well documented. METHODS Adults requiring ECMO were identified in the 2016-2019 National Inpatient Sample. Patient and hospital characteristics, including mortality, clinical outcomes, and resource utilization were analyzed using multivariable regressions. RESULTS Of 43,190 adult ECMO patients, 67.8% were classified as White, 18.1% Black, and 10.4% Hispanic. Although mortality for Whites declined from 47.5 to 41.0% (P = 0.002), it remained steady for others. Compared to White, Asian/Pacific Islander (PI) race was linked to increased odds of mortalty (AOR = 1.4, 95% CI = 1.1-2.0). Black race was associated with increased odds of acute kidney injury (AOR = 1.4, 95%-CI: 1.2-1.7), while Hispanic race was linked to neurologic complications (AOR 21.6; 95% CI 1.2-2.3). Black and Hispanic race were also associated with increased incremental costs. CONCLUSIONS Race-based disparities in ECMO outcomes persist in the United States. Further work should aim to understand and mitigate the underlying reasons for such findings.
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Affiliation(s)
- Shannon Richardson
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nikhil L Chervu
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Chelsea Pan
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Catherine G Williamson
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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11
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Jones-Ungerleider KC, Rose A, Knott K, Comstock S, Haft JW, Pagani FD, Tang PC. Sex-based considerations for implementation of ventricular assist device therapy. Front Cardiovasc Med 2022; 9:1011192. [DOI: 10.3389/fcvm.2022.1011192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Women with advanced heart failure receive advanced surgical therapies such as durable left ventricular assist device (LVAD) implantation or heart transplantation at a rate much lower compared to males. Reasons for this discrepancy remain largely unknown. Much of what is understood reflects outcomes of those patients who ultimately receive device implant or heart transplantation. Females have been shown to have a higher mortality following LVAD implantation and experience higher rates of bleeding and clotting phenomena and right ventricular failure. Beyond outcomes, the literature is limited in the identification of pre-operative factors that drive lower than expected LVAD implant rates in this population. More focused research is needed to define the disparities in advance heart failure therapy delivery in women and other underserved populations.
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12
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Ebong IA, DeFilippis EM, Hamad EA, Hsich EM, Randhawa VK, Billia F, Kassi M, Bhardwaj A, Byku M, Munagala MR, Rao RA, Hackmann AE, Gidea CG, DeMarco T, Hall SA. Special Considerations in the Care of Women With Advanced Heart Failure. Front Cardiovasc Med 2022; 9:890108. [PMID: 35898277 PMCID: PMC9309391 DOI: 10.3389/fcvm.2022.890108] [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] [Received: 03/05/2022] [Accepted: 06/22/2022] [Indexed: 01/17/2023] Open
Abstract
Advanced heart failure (AHF) is associated with increased morbidity and mortality, and greater healthcare utilization. Recognition requires a thorough clinical assessment and appropriate risk stratification. There are persisting inequities in the allocation of AHF therapies. Women are less likely to be referred for evaluation of candidacy for heart transplantation or left ventricular assist device despite facing a higher risk of AHF-related mortality. Sex-specific risk factors influence progression to advanced disease and should be considered when evaluating women for advanced therapies. The purpose of this review is to discuss the role of sex hormones on the pathophysiology of AHF, describe the clinical presentation, diagnostic evaluation and definitive therapies of AHF in women with special attention to pregnancy, lactation, contraception and menopause. Future studies are needed to address areas of equipoise in the care of women with AHF.
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Affiliation(s)
- Imo A. Ebong
- Division of Cardiovascular Medicine, University of California, Davis, Sacramento, CA, United States
- *Correspondence: Imo A. Ebong
| | - Ersilia M. DeFilippis
- Division of Cardiovascular Medicine, Columbia University Irving Medical Center, New York, NY, United States
| | - Eman A. Hamad
- Division of Cardiovascular Medicine, Temple University Hospital, Philadelphia, PA, United States
| | - Eileen M. Hsich
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH, United States
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Varinder K. Randhawa
- Department of Cardiovascular Medicine, Kaufman Center for Heart Failure and Recovery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Filio Billia
- Department of Cardiology, Toronto General Hospital, Toronto, ON, Canada
| | - Mahwash Kassi
- Houston Methodist Debakey Heart & Vascular Center, Houston, TX, United States
| | - Anju Bhardwaj
- Department of Advanced Cardiopulmonary Therapies and Transplantation, McGovern Medical School, University of Texas-Houston, Houston, TX, United States
| | - Mirnela Byku
- Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mrudala R. Munagala
- Department of Cardiology, Miami Transplant Institute, University of Miami Miller School of Medicine/Jackson Memorial Hospital, University of Miami, Miami, FL, United States
| | - Roopa A. Rao
- Division of Cardiology, Krannert Institute of Cardiology at Indiana University School of Medicine, Indianapolis, IN, United States
| | - Amy E. Hackmann
- Department of Cardiovascular and Thoracic Surgery, University of Texas SouthWestern Medical Center, Dallas, TX, United States
| | - Claudia G. Gidea
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Health, New York, NY, United States
| | - Teresa DeMarco
- Division of Cardiology, University of California, San Francisco, San Francisco, CA, United States
| | - Shelley A. Hall
- Division of Cardiology, Baylor University Medical Center, Dallas, TX, United States
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13
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Gallegos FN, Woo JL, Anderson BR, Lopez KN. Disparities in surgical outcomes of neonates with congenital heart disease across regions, centers, and populations. Semin Perinatol 2022; 46:151581. [PMID: 35396037 PMCID: PMC9177851 DOI: 10.1016/j.semperi.2022.151581] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To summarize existing literature on neonatal disparities in congenital heart disease surgical outcomes and identify potential policies to address these disparities. FINDING Disparities in outcomes for neonatal congenital heart surgery were largely published under four domains: race/ethnicity, insurance type, neighborhood/socioeconomic status, and cardiac center characteristics. While existing research identifies associations between these domains and mortality, more nuanced analyses are emerging to understand the mediators between these domains and other non-mortality outcomes, as well as potential interventions and policies to reduce disparities. A broader look into social determinants of health (SDOH), prenatal diagnosis, proximity of birth to a cardiac surgical center, and post-surgical outpatient and neurodevelopmental follow-up may accelerate interventions to mitigate disparities in outcomes. CONCLUSION Understanding the mechanisms of how SDOH relate to neonatal surgical outcomes is paramount, as disparities research in neonatal congenital heart surgery continues to shift from identification and description, to intervention and policy.
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Affiliation(s)
- Flora Nuñez Gallegos
- Stanford University School of Medicine, Lucile Packard Children’s Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Palo Alto, CA
| | - Joyce L. Woo
- Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children’s Hospital, Department of Pediatrics, Division of Pediatric Cardiology, Chicago, IL
| | - Brett R. Anderson
- Columbia University Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, Department of Pediatrics, Division of Pediatric Cardiology, New York, NY
| | - Keila N. Lopez
- Baylor College of Medicine Texas Children’s Hospital Department of Pediatrics, Division of Pediatric Cardiology, Houston TX,Corresponding Author:
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14
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Adelsheimer A, Wang J, Lu DY, Elbaum L, Krishnan U, Cheung JW, Feldman DN, Wong SC, Horn EM, Sobol I, Goyal P, Karas MG, Kim LK. Impact of Socioeconomic Status on Mechanical Circulatory Device Utilization and Outcomes in Cardiogenic Shock. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100027. [PMID: 39132559 PMCID: PMC11307802 DOI: 10.1016/j.jscai.2022.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 08/13/2024]
Abstract
Objectives This study evaluates the impact of socioeconomic status (SES) on utilization of mechanical circulatory support (MCS) devices and outcomes in cardiogenic shock (CS). Background CS is associated with significant mortality. There is increasing use of temporary MCS devices in CS, and its impact on outcomes is currently under investigation. There is a lack of data on the effect of SES on the utilization of MCS devices in CS. Methods CS hospitalizations were obtained from the State Inpatient Databases in 2016 from 9 states representing various regions in the United States. The study had exempt institutional review board status as the database includes deidentified data. Hospitalizations were separated into SES cohorts based on the median household income of the patient residence zip code. Utilization of MCS devices and revascularization procedures along with clinical outcomes with CS were compared across the quartiles. Results There were 38,520 hospitalizations identified with CS, 42.6% of which were secondary to acute myocardial infarction. Patients from higher SES areas were significantly older but had lower burden of comorbidities. Utilization of temporary MCS devices was higher for hospitalizations from higher SES regions (frequency from the lowest SES quartile to the highest SES quartile: 21.3%, 21.5%, 23.5, and 24.1%, P < .01), though revascularization rates were similar. However, there was no significant difference in overall mortality from CS among the 4 quartiles. Patients from regions of higher SES experienced increased hospital costs. Conclusions Higher SES regions had increased use of temporary MCS. There was no difference in mortality between SES cohorts.
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Affiliation(s)
- Andrew Adelsheimer
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Joseph Wang
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Daniel Y. Lu
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Lindsay Elbaum
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Udhay Krishnan
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York, New York
| | - Jim W. Cheung
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York, New York
| | - Dmitriy N. Feldman
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York, New York
| | - S. Chiu Wong
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Evelyn M. Horn
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Irina Sobol
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Parag Goyal
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York, New York
| | - Maria G. Karas
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Luke K. Kim
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
- Weill Cornell Cardiovascular Outcomes Research Group, Weill Cornell Medical College, New York, New York
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15
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DeFilippis EM, Beale A, Martin T, Agarwal A, Elkayam U, Lam CSP, Hsich E. Heart Failure Subtypes and Cardiomyopathies in Women. Circ Res 2022; 130:436-454. [PMID: 35175847 PMCID: PMC10361647 DOI: 10.1161/circresaha.121.319900] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure affects over 2.6 million women and 3.4 million men in the United States with known sex differences in epidemiology, management, response to treatment, and outcomes across a wide spectrum of cardiomyopathies that include peripartum cardiomyopathy, hypertrophic cardiomyopathy, stress cardiomyopathy, cardiac amyloidosis, and sarcoidosis. Some of these sex-specific considerations are driven by the cellular effects of sex hormones on the renin-angiotensin-aldosterone system, endothelial response to injury, vascular aging, and left ventricular remodeling. Other sex differences are perpetuated by implicit bias leading to undertreatment and underrepresentation in clinical trials. The goal of this narrative review is to comprehensively examine the existing literature over the last decade regarding sex differences in various heart failure syndromes from pathophysiological insights to clinical practice.
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Affiliation(s)
| | - Anna Beale
- Department of Cardiology, Alfred Hospital, Melbourne, Australia (A.B.)
| | - Trejeeve Martin
- Department of Cardiology, Cleveland Clinic, Ohio (T.M., E.H.)
| | - Anubha Agarwal
- Northwestern University Feinberg School of Medicine (A.A.)
| | - Uri Elkayam
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California (U.E.)
| | - Carolyn S P Lam
- National Heart Centre Singapore and Duke-National University of Singapore (C.S.P.L.)
| | - Eileen Hsich
- Department of Cardiology, Cleveland Clinic, Ohio (T.M., E.H.)
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16
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Rachoin JS, Olsen P, Gaughan J, Cerceo E. Racial differences in outcomes and utilization after cardiac arrest in the USA: A longitudinal study comparing different geographical regions in the USA from 2006-2018. Resuscitation 2021; 169:115-123. [PMID: 34757061 DOI: 10.1016/j.resuscitation.2021.10.038] [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: 07/19/2021] [Revised: 10/20/2021] [Accepted: 10/25/2021] [Indexed: 10/20/2022]
Abstract
AIM Healthcare disparities can affect access and quality of care among many in the United States (US). In addition to race, we sought to assess if geography affected rates of cardiac arrest, and the subsequent outcomes. METHODS Using the National Inpatient Sample database from 2006-2018, we assessed rates of cardiac arrest (out of hospital that survived to admission and in-hospital) and cardiac catheterization, and length of stay (LOS) in four regions: Northeast (NE), South (SO) West (W) and Midwest (MW). RESULTS Cardiac arrest increased from 27,611 (2006) to 43,333 (2018). The proportion of African American (AA) patients experiencing cardiac arrest significantly increased from 11.9% to 18.8%. The mortality decreased from 65.4% to 60.8% in all patients and 70.2% to 61.4% in AA. Mortality in AA remained higher than non-AA (OR, 1.09 [1.08-1.11], p < 0.001). When regions were compared for mortality, MW had a lower risk than NE 0.94[0.92-9.96]; SO 1.05[1.04-1.07] and W 1.11[1.09-1.13] were higher compared to NE. LOS decreased slightly from 9.0 days to 8.7 in all patients. LOS for AA was longer than non-AA (11.3 vs 8.6 days) with the NE having the longest LOS. AA were less likely to receive cardiac catheterization than non-AA (9.5% vs 15%) with the largest racial gap in the MW region. CONCLUSION The proportion of AA with cardiac arrests increased over the study period. Mortality and LOS improved significantly in AA from 2006 to 2018 but remain significantly higher than non-AA patients. Future research should identify contributors to these concerning trends.
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Affiliation(s)
- Jean-Sebastien Rachoin
- Department of Critical Care Medicine, Cooper Medical School of Rowan University, Cooper University Healthcare, United States.
| | - Phillip Olsen
- Department of Medicine, Cooper Medical School of Rowan University, Cooper University Healthcare, United States
| | - John Gaughan
- Department of Biostatistics, Cooper Medical School of Rowan University, Cooper University Healthcare, United States
| | - Elizabeth Cerceo
- Department of Hospital Medicine, Cooper Medical School of Rowan University, Cooper University Healthcare, United States
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17
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Grines CL, Klein AJ, Bauser-Heaton H, Alkhouli M, Katukuri N, Aggarwal V, Altin SE, Batchelor WB, Blankenship JC, Fakorede F, Hawkins B, Hernandez GA, Ijioma N, Keeshan B, Li J, Ligon RA, Pineda A, Sandoval Y, Young MN. Racial and ethnic disparities in coronary, vascular, structural, and congenital heart disease. Catheter Cardiovasc Interv 2021; 98:277-294. [PMID: 33909339 DOI: 10.1002/ccd.29745] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022]
Abstract
Cardiovascular disease (CVD) remains the leading cause of death in the United States. However, percutaneous interventional cardiovascular therapies are often underutilized in Blacks, Hispanics, and women and may contribute to excess morbidity and mortality in these vulnerable populations. The Society for Cardiovascular Angiography and Interventions (SCAI) is committed to reducing racial, ethnic, and sex-based treatment disparities in interventional cardiology patients. Accordingly, each of the SCAI Clinical Interest Councils (coronary, peripheral, structural, and congenital heart disease [CHD]) participated in the development of this whitepaper addressing disparities in diagnosis, treatment, and outcomes in underserved populations. The councils were charged with summarizing the available data on prevalence, treatment, and outcomes and elucidating potential reasons for any disparities. Given the huge changes in racial and ethnic composition by age in the United States (Figure 1), it was difficult to determine disparities in rates of diagnosis and we expected to find some racial differences in prevalence of disease. For example, since the average age of patients undergoing transcatheter aortic valve replacement (TAVR) is 80 years, one may expect 80% of TAVR patients to be non-Hispanic White. Conversely, only 50% of congenital heart interventions would be expected to be performed in non-Hispanic Whites. Finally, we identified opportunities for SCAI to advance clinical care and equity for our patients, regardless of sex, ethnicity, or race.
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Affiliation(s)
- Cindy L Grines
- Cardiology, Northside Hospital Cardiovascular Institute, Atlanta, Georgia, USA
| | - Andrew J Klein
- Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Holly Bauser-Heaton
- Pediatric Cardiology, Sibley Heart Center of Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | - Neelima Katukuri
- Cardiology, Orlando VA Medical Center, University of Central Florida, Orlando, Florida, USA
| | - Varun Aggarwal
- Pediatric Cardiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - S Elissa Altin
- Cardiovascular Disease, Yale University, New Haven, Connecticut, USA
| | - Wayne B Batchelor
- Interventional Cardiology, Inova Heart and Vascular Institute, Fairfax, Virginia, USA
| | - James C Blankenship
- Internal Medicine, Cardiology Division, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Foluso Fakorede
- Interventional Cardiology, Cardiovascular Solutions of Central Mississippi, Cleveland, Mississippi, USA
| | - Beau Hawkins
- Cardiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Gabriel A Hernandez
- Cardiology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Britton Keeshan
- Clinical Pediatrics, Yale New Haven Children's Hospital, New Haven, Connecticut, USA
| | - Jun Li
- Cardiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - R Allen Ligon
- Pediatric Cardiology, Joe DiMaggio Children's Hospital - Memorial Healthcare System, Hollywood, Florida, USA
| | - Andres Pineda
- Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | | | - Michael N Young
- Cardiology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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