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Buske M, Desch S, Heusch G, Rassaf T, Eitel I, Thiele H, Feistritzer HJ. Reperfusion Injury: How Can We Reduce It by Pre-, Per-, and Postconditioning. J Clin Med 2023; 13:159. [PMID: 38202166 PMCID: PMC10779793 DOI: 10.3390/jcm13010159] [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: 11/28/2023] [Revised: 12/20/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
While early coronary reperfusion via primary percutaneous coronary intervention (pPCI) is established as the most efficacious therapy for minimizing infarct size (IS) in acute ST-elevation myocardial infarction (STEMI), the restoration of blood flow also introduces myocardial ischemia-reperfusion injury (IRI), leading to cardiomyocyte death. Among diverse methods, ischemic conditioning (IC), achieved through repetitive cycles of ischemia and reperfusion, has emerged as the most promising method to mitigate IRI. IC can be performed by applying the protective stimulus directly to the affected myocardium or indirectly to non-affected tissue, which is known as remote ischemic conditioning (RIC). In clinical practice, RIC is often applied by serial inflations and deflations of a blood pressure cuff on a limb. Despite encouraging preclinical studies, as well as clinical studies demonstrating reductions in enzymatic IS and myocardial injury on imaging, the observed impact on clinical outcome has been disappointing so far. Nevertheless, previous studies indicate a potential benefit of IC in high-risk STEMI patients. Additional research is needed to evaluate the impact of IC in such high-risk cohorts. The objective of this review is to summarize the pathophysiological background and preclinical and clinical data of IRI reduction by IC.
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Affiliation(s)
- Maria Buske
- Department of Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, 04289 Leipzig, Germany; (M.B.); (S.D.)
| | - Steffen Desch
- Department of Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, 04289 Leipzig, Germany; (M.B.); (S.D.)
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, University of Essen Medical School, 45122 Essen, Germany;
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, 45147 Essen, Germany;
| | - Ingo Eitel
- Medical Clinic II, Clinic for Cardiology, Angiology and Intensive Care Medicine, University Heart Center Lübeck, 23538 Lübeck, Germany;
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, 23538 Lübeck, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, 04289 Leipzig, Germany; (M.B.); (S.D.)
| | - Hans-Josef Feistritzer
- Department of Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Science, 04289 Leipzig, Germany; (M.B.); (S.D.)
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Oliveros E, Saldarriaga Giraldo CI, Hall J, Tinuoye E, Rodriguez MJ, Gallego C, Contreras JP. Addressing Barriers for Women with Advanced Heart Failure. Curr Cardiol Rep 2023; 25:1257-1267. [PMID: 37698818 DOI: 10.1007/s11886-023-01946-y] [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] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE OF REVIEW Describe disparities in diagnosis and management between men and women with advanced heart failure (HF). Our goal is to identify barriers and suggest solutions. RECENT FINDINGS Women with advanced HF are less likely to undergo diagnostic testing and procedures (i.e., revascularization, implantable cardioverter defibrillators, cardiac resynchronization therapy, mechanical circulatory support, and orthotopic heart transplantation). Disparities related to gender create less favorable outcomes for women with advanced HF. The issues arise from access to care, paucity of knowledge, enrollment in clinical trials, and eligibility for advanced therapies. In this review, we propose a call to action to level the playing field in order to improve survival in women with advanced HF.
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Affiliation(s)
- Estefania Oliveros
- Heart and Vascular Institute, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA, 19444, USA.
| | | | - Jillian Hall
- Heart and Vascular Institute, Temple University Hospital, 3401 N Broad Street, Philadelphia, PA, 19444, USA
| | - Elizabeth Tinuoye
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA
| | | | - Catalina Gallego
- Pontificia Bolivariana, University of Antioquia, Cardiovid Clinic, Medellin, Colombia
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Epps KC, Tehrani BN, Rosner C, Bagchi P, Cotugno A, Damluji AA, deFilippi C, Desai S, Ibrahim N, Psotka M, Raja A, Sherwood MW, Singh R, Sinha SS, Tang D, Truesdell AG, O’Connor C, Batchelor W. Sex-Related Differences in Patient Characteristics, Hemodynamics, and Outcomes of Cardiogenic Shock: INOVA-SHOCK Registry. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:100978. [PMID: 38504778 PMCID: PMC10950300 DOI: 10.1016/j.jscai.2023.100978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Background Little is known about sex-related differences in outcomes of patients with cardiogenic shock (CS) treated within a standardized team-based approach (STBA). Methods We evaluated 520 consecutive patients (151 women and 369 men) with CS due to acute myocardial infarction (AMI) and heart failure (HF) in a single-center registry (January 2017-December 2019) and examined outcomes according to sex and CS phenotype. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiac events, 30-day mortality, major bleeding, vascular complications, and stroke. Results Women with AMI-CS had higher baseline acuity (CardShock score: female [F]: 5.5 vs male [M]: 4.0; P = .04). Women with HF-CS more often presented with cardiac arrest (F: 12.4% vs M: 2.4%; P< .01) and had higher rates of vasopressor use (F: 70.8% vs M: 58.0%; P = .04) and mechanical circulatory support (F: 46.1% vs M: 32.5%; P = .04). There were no sex-related differences in in-hospital mortality for AMI-CS (F: 45.2% vs M: 36.9%; P = .28) and HF-CS (F: 28.1% vs M: 24.5%; P = .56). Women with HF-CS experienced higher rates of major bleeding (F: 25.8% vs M: 13.7%; P = .02) and vascular complications (F: 15.7% vs M: 6.1%; P = .01). However, female sex was not an independent predictor of these complications. No sex differences in survival were noted at 1 year. Conclusions Within an STBA, although women with AMI-CS and HF-CS presented with higher acuity, they experienced similar in-hospital mortality, major adverse cardiac events, 30-day mortality, stroke, and 30-day readmissions as men. Further research is needed to better understand the extent to which historical differences in CS outcomes can be mitigated by an STBA.
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Affiliation(s)
- Kelly C. Epps
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Carolyn Rosner
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Pramita Bagchi
- Department of Statistics, George Mason University, Fairfax, Virginia
| | - Annunziata Cotugno
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Brescia, Italy
| | | | | | - Shashank Desai
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Anika Raja
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Ramesh Singh
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | - Daniel Tang
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Alexander G. Truesdell
- Inova Heart and Vascular Institute, Falls Church, Virginia
- Virginia Heart, Falls Church, Virginia
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Lozano-Jiménez S, Iranzo-Valero R, Segovia-Cubero J, Gómez-Bueno M, Rivas-Lasarte M, Mitroi C, Escudier-Villa JM, Oteo-Dominguez JF, Vieitez-Florez JM, Villar-García S, Hernández-Pérez FJ. Gender Differences in Cardiogenic Shock Patients: Clinical Features, Risk Prediction, and Outcomes in a Hub Center. Front Cardiovasc Med 2022; 9:912802. [PMID: 35911539 PMCID: PMC9326060 DOI: 10.3389/fcvm.2022.912802] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/22/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction There is scarce knowledge about gender differences in clinical presentation, management, use of risk stratification tools and prognosis in cardiogenic shock (CS) patients. Purpose The primary endpoint was to investigate the differences in characteristics, management, and in-hospital mortality according to gender in a cohort of CS patients admitted to a tertiary hub center. The secondary endpoint was to evaluate the prognostic performance of the Society of Cardiovascular Angiography and Interventions (SCAI) classification in predicting in-hospital mortality according to sex. Methods This is a retrospective single-Center cohort study of CS patients treated by a multidisciplinary shock team between September 2014 and December 2020. Baseline characteristics and clinical outcomes according to gender were registered. Discrimination of SCAI classification was assessed using the area under the receiver operating characteristic curve (AUC). Results Overall, 163 patients were included, 39 of them female (24%). Mean age of the overall cohort was 55 years (44–62), similar between groups. Compared with men, women were less likely to be smokers and the prevalence of COPD and diabetes mellitus was significantly lower in this group (p < 0.05). Postcardiotomy (44 vs. 31%) and fulminant myocarditis (13 vs. 2%) were more frequent etiologies in females than in males (p = 0.01), whereas acute myocardial infarction was less common among females (13 vs. 33%). Regarding management, the use of temporary mechanical circulatory support, mechanical ventilation, or renal replacement therapy was frequent and no different between the groups (88, 87, and 49%, respectively, in females vs. 42, 91, and 41% in males, p > 0.05). In-hospital survival in the overall cohort was 53%, without differences between groups (52% in females vs. 55% in males, p = 0.76). Most of the patients (60.7%) were in SCAIE at presentation without differences between sexes. The SCAI classification showed a moderate ability for predicting in-hospital mortality (overall, AUC: 0.653, 95% CI 0.582–0.725). The AUC was 0.636 for women (95% CI 0.491–0.780) and 0.658 for men (95% CI 0.575–0.740). Conclusions Only one in four of patients treated at a dedicated CS team were female. This may reflect differences in prevalence of severe heart disease at young (<65) ages, although a patient-selection bias cannot be ruled out. In this very high-risk CS population of multiple etiologies, overall, in-hospital survival was slightly above 50% and showed no differences between sexes. Treatment approaches, procedures, and SCAI risk stratification performance did not show gender disparities among treated patients.
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Affiliation(s)
- Sara Lozano-Jiménez
- Department of Cardiology, Hospital Puerta de Hierro, Madrid, Spain
- Centre of Biomedical Research in Cardiovascular Diseases (CIBERCV), Carlos III, Madrid, Spain
- *Correspondence: Sara Lozano-Jiménez
| | | | | | | | | | - Cristina Mitroi
- Department of Cardiology, Hospital Puerta de Hierro, Madrid, Spain
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Solomonchuk A, Rasputina L, Didenko D. PREVALENCE, CLINICAL AND FUNCTIONAL CHARACTERISTICS OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION COMPLICATED BY ACUTE HEART FAILURE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1741-1746. [PMID: 35962691 DOI: 10.36740/wlek202207124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim: The study was designed to establish the prevalence of acute heart failure in patients with acute myocardial infarction, to determine the sex-age characteristics of acute myocardial infarction course in case of complications by acute heart failure of high classes (Killip III and Killip IV). PATIENTS AND METHODS Materials and methods: We analyzed medical records of inpatients of the myocardial infarction department of the municipal non-profit enterprise Vinnytsia Regional Center for Cardiovascular Pathology in 2019. The survey covered 828 medical records of patients with acute myocardial infarction, average age (64.6 ± 0.38), including 569 (64.7%) males and 311 (35.3%) females. RESULTS Results: 129 (15.6%) patients with acute myocardial infarction were diagnosed high-class acute heart failure. Patients with high-class acute heart failure were statistically significantly elderly individuals of the average age (69.0 ± 1.3), (p <0.001), including 53.7% of males, and 46.3% (p <0.001) female patients. Patients with acute myocardial infarction complicated by acute heart failure were hospitalized within 2 hours of symptoms` onset with statistically significantly higher probability (p = 0.004). Patients with acute myocardial infarction complicated by acute high-class heart failure were statistically significantly more likely diagnosed with concomitant hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease than individuals with uncomplicated acute myocardial infarction. Acute myocardial infarction patients` mortality was 3.4%, while the one in patients with acute heart failure was 38% (p <0.001). CONCLUSION Conclusions: Patients with complicated myocardial infarction are characterized by statistically significantly higher comorbidity and increased lethality.
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Affiliation(s)
| | - Lesya Rasputina
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | - Daria Didenko
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
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Abstract
PURPOSE OF REVIEW The past decade has brought increased efforts to better understand causes for ACS readmissions and strategies to minimize them. This review seeks to provide a critical appraisal of this rapidly growing body of literature. RECENT FINDINGS Prior to 2010, readmission rates for patients suffering from ACS remained relatively constant. More recently, several strategies have been implemented to mitigate this including improved risk assessment models, transition care bundles, and development of targeted programs by federal organizations and professional societies. These strategies have been associated with a significant reduction in ACS readmission rates in more recent years. With this, improvements in 30-day post-discharge mortality rates are also being appreciated. As we continue to expand our knowledge on independent risk factors for ACS readmissions, further strategies targeting at-risk populations may further decrease the rate of readmissions. Efforts to understand and reduce 30-day ACS readmission rates have resulted in overall improved quality of care for patients.
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Rashidi A, Whitehead L, Glass C. Factors affecting hospital readmission rates following an acute coronary syndrome: A systematic review. J Clin Nurs 2021; 31:2377-2397. [PMID: 34811845 PMCID: PMC9546456 DOI: 10.1111/jocn.16122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 01/04/2023]
Abstract
Aim To synthesise quantitative evidence on factors that impact hospital readmission rates following ACS with comorbidities. Design Systematic review and narrative synthesis. Data sources A search of eight electronic databases, including Embase, Medline, PsycINFO, Web of Science, CINAHL, Cochrane Library, Scopus and the Joanna Briggs Institute (JBI). Review methods The search strategy included keywords and MeSH terms to identify English language studies published between 2001 and 2020. The quality of included studies was assessed by two independent reviewers, using Joanna Briggs Institute (JBI) critical appraisal tools. Results Twenty‐four articles were included in the review. All cause 30‐day readmission rate was most frequently reported and ranged from 4.2% to 81%. Reported factors that were associated with readmission varied across studies from socio‐demographic, behavioural factors, comorbidity factors and cardiac factors. Findings from some of the studies were limited by data source, study designs and small sample size. Conclusion Strategies that integrate comprehensive discharge planning and individualised care planning to enhance behavioural support are related to a reduction in readmission rates. It is recommended that nurses are supported to influence discharge planning and lead the development of nurse‐led interventions to ensure discharge planning is both coordinated and person‐centred.
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Affiliation(s)
- Amineh Rashidi
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
| | - Courtney Glass
- School of Nursing and Midwifery, Edith Cowan University, Perth, Australia
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Unplanned hospital readmissions after acute myocardial infarction: a nationwide analysis of rates, trends, predictors and causes in the United States between 2010 and 2014. Coron Artery Dis 2021; 31:354-364. [PMID: 31972608 DOI: 10.1097/mca.0000000000000844] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Unplanned hospital readmissions are an important quality metric for benchmarking, but there are limited data following an acute myocardial infarction (AMI). This study aims to examine the 30-day unplanned readmission rate, predictors, causes and outcomes after hospitalization for AMI. METHODS The USA Nationwide Readmission Database was utilized to analyze patients with a primary diagnosis of AMI between 2010 and 2014. Rates of readmissions, causes and costs were determined and multiple logistic regressions were used to identify predictors of readmissions. RESULTS Of 2 204 104 patients with AMI, the 30-day unplanned readmission rate was 12.3% (n = 270 510), which changed from 13.0 to 11.5% between 2010 and 2014. The estimated impact of readmissions in AMI was ~718 million USD and ~281000 additional bed days per year. Comorbidities such as diabetes [odds ratio (OR) 1.27, 95% confidence interval (CI) 1.25-1.29], chronic lung disease (OR 1.29, 95% CI 1.26-1.31), renal failure (OR 1.38, 95% CI 1.35-1.40) and cancer (OR 1.35, 95% CI 1.30-1.41) were independently associated with unplanned readmission. Discharge against medical advice was the variable most strongly associated with unplanned readmission (OR 2.40, 95% CI 2.27-2.54). Noncardiac causes for readmissions accounted for 52.9% of all readmissions. The most common cause of cardiac readmission was heart failure (14.3%) and for noncardiac readmissions was infections (8.8%). CONCLUSION Readmissions during the first month after AMI occur in more than one in 10 patients resulting in a healthcare cost of ~718 million USD per year and ~281000 additional bed days per year. These findings have important public health implications. Strategies to identify and reduce readmissions in AMI will dramatically reduce healthcare costs for society.
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Dayanand S, Martinez JM, Figueredo VM, Gupta S. Mechanical Circulatory Support in Women. J Cardiol 2020; 77:209-216. [PMID: 32868140 DOI: 10.1016/j.jjcc.2020.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 01/18/2023]
Abstract
A number of devices can now provide mechanical circulatory support (MCS) to patients with acute cardiogenic shock (CS) and chronic end-stage heart failure (HF). Women differ from men in pathophysiology and natural history of CS and HF, and are usually sicker at admission. Current evidence suggests that women benefit as much as men, if not more, from both temporary and durable MCS for appropriate indications. Yet, women have been under-represented in clinical trials of MCS devices. Limited evidence suggests that women benefit more from temporary MCS in CS associated with acute myocardial infarction. However, in patients with durable left ventricular assist devices (LVADs), women are more likely to experience thromboembolic events and right HF. This review aims to study available evidence and determine areas for further research on gender differences in (a) use of temporary MCS for CS and (b) use of durable LVADs. Use of MCS in conditions specific to, or more common in women (pregnancy, takotsubo cardiomyopathy, peripartum cardiomyopathy, and spontaneous coronary artery dissection) is also discussed.
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Affiliation(s)
- Sandeep Dayanand
- Department of Cardiovascular Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA.
| | - Jasmin M Martinez
- Department of Cardiovascular Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Vincent M Figueredo
- Department of Cardiovascular Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Shuchita Gupta
- Department of Cardiovascular Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
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Collado-Lledó E, Llaó I, Rivas-Lasarte M, González-Fernández V, Noriega FJ, Hernández-Perez FJ, Alegre O, Sionis A, Lidón RM, Viana-Tejedor A, Segovia-Cubero J, Ariza-Solé A. Clinical picture, management and risk stratification in patients with cardiogenic shock: does gender matter? BMC Cardiovasc Disord 2020; 20:189. [PMID: 32664921 PMCID: PMC7362401 DOI: 10.1186/s12872-020-01467-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/05/2020] [Indexed: 01/04/2023] Open
Abstract
Background Early recognition and risk stratification are crucial in cardiogenic shock (CS). A lower adherence to recommendations has been described in women with cardiovascular diseases. Little information exists about disparities in clinical picture, management and performance of risk stratification tools according to gender in patients with CS. Methods Data from the multicenter Red-Shock registry were used. All consecutive patients with CS were included. Both CardShock and IABP-SHOCK II risk scores were calculated. The primary end-point was in-hospital mortality. The discriminative ability of both scores according to gender was assessed by binary logistic regression, calculating Receiver operating characteristic (ROC) curves and the corresponding area under the curve (AUC). Results A total of 793 patients were included, of whom 222 (28%) were female. Women were significantly older and had a lower proportion of chronic obstructive pulmonary disease and prior myocardial infarction. CS was less often related to acute coronary syndromes (ACS) in women. The use of vasoactive drugs, renal replacement therapy, invasive ventilation, therapeutic hypothermia and mechanical circulatory support was similar between both groups. In-hospital mortality was 346/793 (43.6%). Mortality was not significantly different according to gender (p = 0.194). Cardshock risk score showed a good ability for predicting in-hospital mortality both in man (AUC 0.69) and women (AUC 0.735). Likewise, the IABP-II successfully predicted in-hospital mortality in both groups (man: AUC 0.693; women: AUC 0.722). Conclusions No significant differences were observed regarding management and in-hospital mortality according to gender. Both the CardShock and IABP-II risk scores depicted a good ability for predicting mortality also in women with CS.
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Affiliation(s)
- Elena Collado-Lledó
- Intensive Cardiac Care Unit. Cardiology Department, Hospital Universitari de Bellvitge -IDIBELL, Feixa Llarga s/n. 08907. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Isaac Llaó
- Intensive Cardiac Care Unit. Cardiology Department, Hospital Universitari de Bellvitge -IDIBELL, Feixa Llarga s/n. 08907. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mercedes Rivas-Lasarte
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, CIBER-CV, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Victor González-Fernández
- Cardiovascular Critical Care Unit, Cardiology Department, Vall d'Hebron Hospital, CIBER-CV Vall d'Hebron Hospital, Barcelona, Spain
| | - Francisco J Noriega
- Acute Cardiac Care Unit, Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Francisco José Hernández-Perez
- Advanced Heart Failure and Transplant Unit, Cardiology Department, Hospital Universitario Puerta de Hierro, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Oriol Alegre
- Intensive Cardiac Care Unit. Cardiology Department, Hospital Universitari de Bellvitge -IDIBELL, Feixa Llarga s/n. 08907. L'Hospitalet de Llobregat, Barcelona, Spain
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, IIB-SantPau, CIBER-CV, Universidad Autònoma de Barcelona, Barcelona, Spain
| | - Rosa M Lidón
- Cardiovascular Critical Care Unit, Cardiology Department, Vall d'Hebron Hospital, CIBER-CV Vall d'Hebron Hospital, Barcelona, Spain
| | - Ana Viana-Tejedor
- Acute Cardiac Care Unit, Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Segovia-Cubero
- Advanced Heart Failure and Transplant Unit, Cardiology Department, Hospital Universitario Puerta de Hierro, CIBER-CV, Universidad Autónoma de Madrid, Madrid, Spain
| | - Albert Ariza-Solé
- Intensive Cardiac Care Unit. Cardiology Department, Hospital Universitari de Bellvitge -IDIBELL, Feixa Llarga s/n. 08907. L'Hospitalet de Llobregat, Barcelona, Spain.
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Mahmoud AN, Elgendy IY, Mojadidi MK, Wayangankar SA, Bavry AA, Anderson RD, Jneid H, Pepine CJ. Prevalence, Causes, and Predictors of 30-Day Readmissions Following Hospitalization With Acute Myocardial Infarction Complicated By Cardiogenic Shock: Findings From the 2013-2014 National Readmissions Database. J Am Heart Assoc 2018; 7:JAHA.117.008235. [PMID: 29572325 PMCID: PMC5907572 DOI: 10.1161/jaha.117.008235] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Prior studies have shown that survivors of acute myocardial infarction (AMI) complicated by cardiogenic shock are likely to have increased risk of readmissions in the early post‐discharge period. However, the contemporary prevalence, reasons, and predictors of 30‐day readmissions are not well known. Methods and Results Hospitalizations for a primary diagnosis of AMI complicated by cardiogenic shock, and discharged alive, were identified in the 2013 and 2014 Nationwide Readmissions Databases. Prevalence and reasons for 30‐day unplanned readmissions were investigated. A hierarchical logistic regression model was used to identify independent predictors of 30‐day readmissions. Among 1 116 933 patient hospitalizations with AMI, 39 807 (3.6%) had cardiogenic shock and were discharged alive. Their 30‐day readmission rate was 18.6%, with a median time for readmission 10 days post discharge. Predictors of readmission included: non–ST‐segment elevation myocardial infarction, female sex, low‐income status, nonprivate insurance, chronic renal failure, long‐term ventricular assist device or intra‐aortic balloon placement, and tachyarrhythmia. The majority of readmissions were attributable to cardiac‐related causes (52%); heart failure being the most frequent cardiac cause (39% of all cardiac causes). Noncardiac‐related readmissions included infections (14.9%), bleeding (5.3%), and respiratory causes (4.9%). The median cost per readmission was $9473 US dollars ($5037–20 199). Conclusions Among survivors of AMI complicated by cardiogenic shock who were discharged from hospital, almost 1 in 5 are readmitted at 30 days, mainly because of cardiac reasons such as heart failure and new AMI. The risk of readmission was associated with certain baseline patient/hospital characteristics.
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Affiliation(s)
- Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL
| | - Mohammad K Mojadidi
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL
| | - Siddharth A Wayangankar
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL
| | - Anthony A Bavry
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL
| | - R David Anderson
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL
| | - Hani Jneid
- Division of Cardiovascular Medicine, Baylor College of Medicine, Houston, TX
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL
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