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Ng AP, Chervu N, Sanaiha Y, Vadlakonda A, Kronen E, Benharash P. Sociodemographic disparities in concomitant left atrial appendage occlusion during cardiac valve operations. PLoS One 2023; 18:e0286337. [PMID: 37228108 DOI: 10.1371/journal.pone.0286337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Sociodemographic disparities in atrial fibrillation (AF) management and thromboembolic prophylaxis have previously been reported, which may involve inequitable access to left atrial appendage occlusion (LAAO) during cardiac surgery. The present study aimed to evaluate the association of LAAO utilization with sex, race, and hospital region among patients with AF undergoing heart valve operations. METHODS Adults with AF undergoing valve replacement/repair in the 2012-2019 National Inpatient Sample were identified and stratified based on concurrent LAAO. Multivariable linear and logistic regressions were developed to identify factors associated with LAAO utilization. Mortality, complications including stroke and thromboembolism, hospitalization costs and length of stay (LOS) were secondarily assessed. RESULTS Of 382,580 patients undergoing valve operations, 18.7% underwent concomitant LAAO. Over the study period, the proportion of female patients receiving LAAO significantly decreased from 44.8% to 38.9% (p<0.001). Upon risk adjustment, female (AOR 0.93 [95% CI 0.89-0.97]) and Black patients (0.91 [0.83-0.99]) had significantly reduced odds of undergoing LAAO compared to males and Whites, respectively. Additionally, hospitals in the Midwest (1.38 [1.24-1.51]) and West (1.26 [1.15-1.36]) had increased likelihood of LAAO whereas Northeast hospitals (0.85 [0.77-0.94)] had decreased odds relative to the South. Furthermore, LAAO was associated with decreased stroke (0.71 [0.60-0.84]) and thromboembolism (0.68 [0.54-0.86]), $4,200 reduction in costs and 1-day decrement in LOS. CONCLUSIONS Female and Black patients had significantly lower odds while Midwest and Western hospitals had greater odds of LAAO utilization. Enhancing access to LAAO during valvular surgery is warranted to improve clinical and financial outcomes for patients with AF.
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Affiliation(s)
- Ayesha P Ng
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Yas Sanaiha
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Amulya Vadlakonda
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Elsa Kronen
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
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Li YP, Chen JY, Chen TW, Lu WD. Atrial high-rate episodes intensify R 2CHA 2DS 2-VASc score for prognostic stratification in pacemaker patients. Sci Rep 2023; 13:7640. [PMID: 37169860 PMCID: PMC10175262 DOI: 10.1038/s41598-023-34784-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023] Open
Abstract
Patients with device detected atrial high-rate episodes (AHRE) have an increased risk of MACE. The R2CHA2DS2-VASc, CHADS2, R2CHADS2 and CHA2DS2-VASc score have been investigated for predicting major adverse cardiovascular events (MACE) in different groups of patients. We aimed to evaluate the R2CHA2DS2-VASc score in combination with AHRE ≥ 6 min for predicting MACE in patients with dual-chamber PPM but no prior atrial fibrillation (AF). We retrospectively enrolled 376 consecutive patients undergoing dual-chamber PPM implantation and no prior AF. The primary endpoint was subsequent MACE. For all patients in the cohort, CHADS2, R2CHADS2, CHA2DS2-VASc, R2CHA2DS2-VASc scores and AHRE ≥ or < 6 min were determined. AHRE was recorded as a heart rate > 175 bpm (Medtronic) or > 200 bpm (Biotronik) lasting ≥ 30 s. Multivariate Cox regression analysis with time-dependent covariates was used to determine the independent predictors of MACE. ROC-AUC analysis was performed for CHADS2, R2CHADS2, CHA2DS2-VASc, and R2CHA2DS2-VASc scores and then adding AHRE ≥ 6 min to the four scores. The median age was 77 years, and 107 patients (28.5%) developed AHRE ≥ 6 min. After a median follow-up of 32 months, 46 (12.2%) MACE occurred. Multivariate Cox regression analysis showed that R2CHA2DS2-VASc score (HR, 1.485; 95% CI, 1.212-1.818; p < 0.001) and AHRE ≥ 6 min (HR, 2.125; 95% CI, 1.162-3.887; p = 0.014) were independent predictors for MACE. The optimal R2CHA2DS2-VASc score cutoff value was 4.5 (set at ≥ 5), with the highest Youden index (AUC, 0.770; 95% CI, 0.709-0.831; p < 0.001). ROC-AUC analysis of the four risk scores separately combined with AHRE ≥ 6 min all showed better discriminatory power than the four scores alone (All Z-statistic p < 0.05). In patients with PPM who develop AHRE ≥ 6 min, it is crucial to perform risk assessment with either four scores to further stratify risk for MACE.
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Affiliation(s)
- Yi-Pan Li
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Ju-Yi Chen
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan.
| | - Tse-Wei Chen
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
| | - Wei-Da Lu
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Road, Tainan, 704, Taiwan
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Abramov D, Kobo O, Gorodeski EZ, Rana JS, Walsh MN, Parwani P, Myint PK, Sauer AJ, Mamas MA. Incidence, Predictors, and Outcomes of Major Bleeding Among Patients Hospitalized With Acute Heart Failure. Am J Cardiol 2023; 191:59-65. [PMID: 36640601 DOI: 10.1016/j.amjcard.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 01/15/2023]
Abstract
Acute heart failure (AHF) is a common etiology of hospitalization and is associated with morbidity, including bleeding. In this study, the authors sought to assess the incidence, types, and associates of major bleeding in patients hospitalized with AHF. The National Inpatient Sample from October 2015 to December 2018 was used to identify patients with AHF. The incidence of common bleeding etiologies, and patient demographics, co-morbidities, associated acute cardiac diagnoses, and invasive procedures, were identified. The multivariable logistic regression was used to identify predictors of bleeding and the association of bleeding episodes with inpatient mortality. During the study period, 1,106,634 patients were admitted with a primary diagnosis of AHF, of whom 58,955 (5.3%) had an episode of bleeding. Common bleeding sources were gastrointestinal (25.7%), hematuria (24%), respiratory (23.6%), and procedure-related bleeding (2.5%). Major bleeding was more common in patients with AHF with preserved ejection fraction (odds ratio 1.14, confidence interval 1.12 to 1.16, p <0.001) versus AHF with reduced ejection fraction and in men (odds ratio 1.3, confidence interval 1.29 to 1.31, p <0.001). Major bleeding was associated with higher mortality (7.0% vs 2.4%, p <0.001), longer length of stay (7 vs 4 days, p <0.001), and higher inpatient costs ($49,658 vs $27,636, p <0.001). In conclusion, major bleeding occurs in 5.3% of patients hospitalized with AHF and is associated with higher inpatient mortality and costs and longer length of stay.
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Affiliation(s)
- Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Ofer Kobo
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Eiran Z Gorodeski
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio; Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jamal S Rana
- Department of Cardiology, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, California
| | | | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Phyo K Myint
- Aberdeen Diabetes and Cardiovascular Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom; Ageing Clinical and Experimental Research Team, University of Aberdeen, Aberdeen, United Kingdom
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom.
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Fang C, Chen Z, Zhang J, Jin X, Yang M. Association of CHA2DS2-VASC Score with in-Hospital Cardiovascular Adverse Events in Patients with Acute ST-Segment Elevation Myocardial Infarction. Int J Clin Pract 2022; 2022:3659381. [PMID: 36225534 PMCID: PMC9525758 DOI: 10.1155/2022/3659381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Acute ST-elevation myocardial infarction (STEMI) is a common clinical critical illness, and accurate, reliable, simple, and easy-to-remember tools are needed in clinical practice to quickly identify the risk of this condition in STEMI patients. This study investigates the predictive value of the admission CHA2DS2-VASc score for in-hospital MACE in STEMI patients. Methods A total of 210 STEMI patients who visited the Chest Pain Center of the Second People's Hospital of Hefei from December 2019 to December 2021 were retrospectively analyzed. They were divided into MACE and non-MACE groups. The receiver operating characteristic curve (ROC) was used to assess the predictive value of the CHA2DS2-VASc score for MACE events during hospitalization. Results The CHA2DS2-VASc score was higher in the MACE group than in the non-MACE group (P < 0.05), and multivariate logistic regression analysis showed that the CHA2DS2-VASc score was an independent risk factor for MACE events during hospitalization in STEMI patients (OR = 1.391, 95%CI 1.044-1.853, P=0.024); ROC curve analysis showed that the area under the curve (AUC) of the CHA2DS2-VASc score was 0.744, the sensitivity was 0.64, the specificity was 0.694, and the optimal cutoff value was 3.5 in predicting the risk of MACE events during hospitalization in STEMI patients. There were no significant differences between the GRACE score (0.744 VS.0.827) and TIMI score (0.744VS.0.745) (P > 0.05). Conclusion The CHA2DS2-VASc score can successfully predict the occurrence of in-hospital MACE events in STEMI patients.
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Affiliation(s)
- Caoyang Fang
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei 230011, Anhui, China
- Hefei Second People's Hospital Affiliated to Bengbu Medical College, Department of Cardiology, Hefei 230011, Anhui, China
| | - Zhenfei Chen
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei 230011, Anhui, China
| | - Jing Zhang
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei 230011, Anhui, China
| | - Xiaoqin Jin
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei 230011, Anhui, China
| | - Mengsi Yang
- Department of Cardiology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei 230011, Anhui, China
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5
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CHA2DS2-VASc score as an independent outcome predictor in patients hospitalized with acute ischemic stroke. PLoS One 2022; 17:e0270823. [PMID: 35830440 PMCID: PMC9278736 DOI: 10.1371/journal.pone.0270823] [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: 02/15/2022] [Accepted: 06/18/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose Atrial fibrillation (AF) is a significant independent risk factor for 1-year mortality in patients with first acute ischemic stroke (AIS). The CHA2DS2-VASc score was initially developed to assess the risk of stroke in patients with AF. Recently, this scoring system has been demonstrated to have clinical value for predicting long-term clinical outcomes in AIS but the evidence is insufficient. This large-scale prospective cohort study investigated the independent predictive value of the score in such patients. Methods We included patients with AIS from the Taiwan Stroke Registry (TSR) during 2006–2016 as the present study population. Patients were divided into those with high (≥2) and low (<2) CHA2DS2-VASc scores. We further analyzed and classified patients according to the presence of AF. The clinical endpoint was major adverse cardiac and cerebrovascular events (MACCEs) at 1 year after the index AIS. Results A total of 62,227 patients with AIS were enrolled. The median age was 70.3 years, and 59% of the patients were women. After confounding factors were controlled, patients with high CHA2DS2-VASc scores had significantly higher incidence of 1-year MACCEs (adjusted hazard ratio [HR] = 1.63; 95% confidence interval [CI] = 1.52, 1.76), re-stroke (adjusted HR = 1.28; 95% CI = 1.16, 1.42), and all-cause mortality (adjusted HR = 2.03; 95% CI = 1.83, 2.24) than those with low CHA2DS2-VASc scores did. In the comparison between AF and non-AF groups, the AF group had increased MACCEs (adjusted HR = 1.74; 95% CI = 1.60, 1.89), myocardial infarction (adjusted HR = 4.86; 95% CI = 2.07, 11.4), re-stroke (adjusted HR = 1.47; 95% CI = 1.26, 1.71), and all-cause mortality (adjusted HR = 1.90; 95% CI = 1.72, 2.10). The Kaplan–Meier curve revealed that both CHA2DS2-VASc scores and AF were independent risk predictors for 1-year MACCEs and mortality. Conclusions The CHA2DS2-VASc score and AF appeared to consistently predict 1-year MACCEs of AIS patients and provide more accurate risk stratification. Therefore, increased use of the CHA2DS2-VASc score may help improve the holistic clinical assessment of AIS patients with or without AF.
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Wu L, Narasimhan B, Bhatia K, Wu E, Li P, Ho KS, Shah AN, Kantharia BK. One Year Outcomes of Atrial Fibrillation Ablation: Contemporary Analysis of the United States Nationwide Readmission Database. Pacing Clin Electrophysiol 2022; 45:1151-1159. [PMID: 35656924 DOI: 10.1111/pace.14543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/06/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data on long-term outcomes of catheter ablation (CA) for atrial fibrillation (AF) in outside of clinical trials settings are sparse. OBJECTIVE We aimed to assess outcomes and readmissions at 1 year following admission for CA for AF. METHODS Utilizing the Nationwide Readmissions Database (2016-2018), we identified patients with CA among all patients with a primary admission diagnosis of AF, and a control group by propensity score match adjusted for age, sex, comorbidities, CHA₂DS₂-VASc scores, and the hospital characteristics. The primary outcome was a composite of unplanned heart failure (HF), AF and stroke-related readmissions and death at 1 year, and secondary outcomes were hospital outcomes and all-cause readmission rates. RESULTS The study cohort consisted of 29,771 patients undergoing CA and 63,988 controls. Patients undergoing CA were younger with lower CHA₂DS₂-VASc scores and less comorbidities. Over a follow-up of 170 ±1.1 days, the primary outcome occurred in 5.2% in CA group and 6.0% of controls (hazard ratio [HR] and 95% confidence interval [CI]: 0.86 [0.76-0.94], p = 0.002). CA affected AF and stroke related readmission, but showed no effect on HF and mortality outcome.Male sex (HR: 0.83 [0.74-0.94], p = 0.03), younger age (HR: 0.71 [0.61-0.83], p<0.001], and lower CHA₂DS₂-VASc scores (HR: 0.68 [0.55-0.84], p<0.001) were associated with lower risk of primary outcome with CA. CONCLUSION In this study, CA for AF was associated with significantly lower AF and stroke-related admissions, but not to HF or all cause readmission. Better outcomes were seen among males, younger patients and in patients with less comorbidities and low CHA₂DS₂-VASc scores. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lingling Wu
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mount Sinai-Morningside Hospital, New York, NY, USA.,University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bharat Narasimhan
- Mount Sinai-Morningside Hospital, New York, NY, USA.,Houston Methodist Hospital, Houston, TX, USA
| | - Kirtipal Bhatia
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mount Sinai-Morningside Hospital, New York, NY, USA
| | - Ellen Wu
- University of Alabama at Birmingham, Birmingham, AL, USA.,Immunowake Inc., Birmingham, AL, USA
| | - Pengyang Li
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kam S Ho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mount Sinai-Morningside Hospital, New York, NY, USA
| | - Arti N Shah
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,NYC Health and Hospitals, Elmhurst, Queens, NY, USA.,Cardiovascular and Heart Rhythm Consultants, New York, NY, USA
| | - Bharat K Kantharia
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Mount Sinai-Morningside Hospital, New York, NY, USA.,Cardiovascular and Heart Rhythm Consultants, New York, NY, USA
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Harb SC, Wang TKM, Nemer D, Wu Y, Cho L, Menon V, Wazni O, Cremer PC, Jaber W. CHA 2DS 2-VASc score stratifies mortality risk in patients with and without atrial fibrillation. Open Heart 2021; 8:openhrt-2021-001794. [PMID: 34815301 PMCID: PMC8611438 DOI: 10.1136/openhrt-2021-001794] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/25/2021] [Indexed: 12/14/2022] Open
Abstract
Objectives The CHA2DS2-VASc score is the preferred risk model for anticoagulation decision-making in atrial fibrillation (AF) patients. Recent studies have found this score to have prognostic value in other cardiovascular diseases. We assessed the relationships between CHA2DS2-VASc score and long-term mortality in adults referred for stress testing, Methods 165 184 consecutive patients from January 1991 to December 2014 from a prospective registry were studied, with CHA2DS2-VASc score calculated for all patients, and AF and anticoagulation status were recorded. The primary endpoint was all-cause mortality. Results In this cohort, 12 450 (7.5%) patients had AF and mean CHA2DS2-VASc score was 2.2±1.2. There were 22 152 (18.4%) deaths during mean follow-up of 6.1±4.8 years. In multivariable analysis, CHA2DS2-VASc score, presence of AF and anticoagulation use, along with end-stage renal failure and smoking were all independently associated with mortality with HRs (95% CIs) of 1.23 (1.21 to 1.25), 1.18 (1.10 to 1.27) and 1.50 (1.40 to 1.60), respectively. Higher CHA2DS2-VASc score was incrementally associated with worse survival both in patients with and without AF (log-rank p<0.001). Anticoagulation use was associated with reduced survival in non-AF patients with alternative anticoagulation indications at all CHA2DS2-VASc score categories, and AF patients with lower CHA2DS2-VASc score 0–2, but was protective in AF patients with higher CHA2DS2-VASc score 4–9. Conclusion Incrementally higher CHA2DS2-VASc score, a simple clinical tool, is associated with mortality in patients regardless of presence of AF and anticoagulation status. Anticoagulation use was associated with worse survival in non-AF patients and AF patients with low CHA2DS2-VASc scores, but was protective in AF patients with high CHA2DS2-VASc scores.
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Affiliation(s)
- Serge C Harb
- Cardiovascular Medicine (Cardiovascular Imaging Section), Cleveland Clinic, Cleveland, Ohio, USA
| | - Tom Kai Ming Wang
- Cardiovascular Medicine (Cardiovascular Imaging Section), Cleveland Clinic, Cleveland, Ohio, USA
| | - David Nemer
- Cardiovascular Medicine (Cardiac Electrophysiology and Pacing Section), Cleveland Clinic, Cleveland, Ohio, USA
| | - Yuping Wu
- Mathematics, Cleveland State University, Cleveland, Ohio, USA
| | - Leslie Cho
- Cardiovascular Medicine (Invasive & Interventional Cardiology Section), Cleveland Clinic, Cleveland, Ohio, USA
| | - Venu Menon
- Cardiovascular Medicine (Clinical Cardiology Section), Cleveland Clinic, Cleveland, Ohio, USA
| | - Osama Wazni
- Cardiovascular Medicine (Cardiac Electrophysiology and Pacing Section), Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C Cremer
- Cardiovascular Medicine (Cardiovascular Imaging Section), Cleveland Clinic, Cleveland, Ohio, USA
| | - Wael Jaber
- Cardiovascular Medicine (Cardiovascular Imaging Section), Cleveland Clinic, Cleveland, Ohio, USA
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The Hidden Value of a CHA 2DS 2-VASc Score. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 29:69-70. [PMID: 34140230 DOI: 10.1016/j.carrev.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/23/2022]
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9
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Sparrow R, Sanjoy S, Choi YH, Elgendy IY, Jneid H, Villablanca PA, Holmes DR, Pershad A, Alraies C, Sposato LA, Mamas MA, Bagur R. Racial, ethnic and socioeconomic disparities in patients undergoing left atrial appendage closure. Heart 2021; 107:1946-1955. [PMID: 33795381 DOI: 10.1136/heartjnl-2020-318650] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This manuscript aims to explore the impact of race/ethnicity and socioeconomic status on in-hospital complication rates after left atrial appendage closure (LAAC). METHODS The US National Inpatient Sample was used to identify hospitalisations for LAAC between 1 October 2015 to 31 December 2018. These patients were stratified by race/ethnicity and quartiles of median neighbourhood income. The primary outcome was the occurrence of in-hospital major adverse events, defined as a composite of postprocedural bleeding, cardiac and vascular complications, acute kidney injury and ischaemic stroke. RESULTS Of 6478 unweighted hospitalisations for LAAC, 58% were male and patients of black, Hispanic and 'other' race/ethnicity each comprised approximately 5% of the cohort. Adjusted by the older Americans population, the estimated number of LAAC procedures was 69.2/100 000 for white individuals, as compared with 29.5/100 000 for blacks, 47.2/100 000 for Hispanics and 40.7/100 000 for individuals of 'other' race/ethnicity. Black patients were ~5 years younger but had a higher comorbidity burden. The primary outcome occurred in 5% of patients and differed significantly between racial/ethnic groups (p<0.001) but not across neighbourhood income quartiles (p=0.88). After multilevel modelling, the overall rate of in-hospital major adverse events was higher in black patients as compared with whites (OR: 1.60, 95% CI 1.22 to 2.10, p<0.001); however, the incidence of acute kidney injury was higher in Hispanics (OR: 2.19, 95% CI 1.52 to 3.17, p<0.001). No significant differences were found in adjusted overall in-hospital complication rates between income quartiles. CONCLUSION In this study assessing racial/ethnic disparities in patients undergoing LAAC, minorities are under-represented, specifically patients of black race/ethnicity. Compared with whites, black patients had higher comorbidity burden and higher rates of in-hospital complications. Lower socioeconomic status was not associated with complication rates.
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Affiliation(s)
- Robbie Sparrow
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Shubrandu Sanjoy
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Yun-Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Islam Y Elgendy
- Division of Cardiology, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Hani Jneid
- Division of Cardiology, Baylor College of Medicine and Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Pedro A Villablanca
- Center for Structural Heart Disease, Henry Ford Health System, Detroit, Michigan, USA
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Ashish Pershad
- The University of Arizona College of Medicine - Phoenix, Phoenix, Arizona, USA
| | - Chadi Alraies
- Department of Interventional Cardiology, Wayne State University, Detroit, Michigan, USA
| | - Luciano A Sposato
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, London, Ontario, Canada.,London Health Sciences Centre, London, Ontario, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, Stoke, UK
| | - Rodrigo Bagur
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada .,London Health Sciences Centre, London, Ontario, Canada.,Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, Stoke, UK
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