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Dennis M, Burrell A, Lal S, Ferguson C, French J, Bowcock E, Kruit N, Burns B, Jain P. Cardiogenic Shock Challenges and Priorities: A Clinician Survey. Heart Lung Circ 2024; 33:1227-1231. [PMID: 38744603 DOI: 10.1016/j.hlc.2024.04.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/04/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Cardiogenic shock (CS) is common and survival outcomes have not substantially improved. Australia's geography presents unique challenges in the management of CS. The challenges and research priorities for clinicians pertaining to CS identification and management have yet to be described. METHOD We used an exploratory sequential mixed methods design. Semi-structured interviews were conducted with 10 clinicians (medical and nursing) to identify themes for quantitative evaluation. A total of 143 clinicians undertook quantitative evaluation through online survey. The interviews and surveys addressed current understanding of CS, status of cardiogenic systems and future research priorities. RESULTS There were 143 respondents: 16 (11%) emergency, cardiology 22 (16%), 37 (26%) intensive care, 54 (38%) nursing. In total, 107 (75%) believe CS is under-recognised. Thirteen (13; 9%) of respondents indicated their hospital had existing CS teams, all from metropolitan hospitals, and 40% thought additional access to mechanical circulatory support devices was required. Five (5; 11%) non-tertiary hospital respondents had not experienced a delay in transfer of a patient in CS. All respondents felt additional research, particularly into the management of CS, was required. CONCLUSIONS Clinicians report that CS is under-recognised and further research into CS management is required. Access to specialised CS services is still an issue and CS protocolised pathways may be of value.
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Affiliation(s)
- Mark Dennis
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Aidan Burrell
- Australia and New Zealand Intensive Care Research Centre (ANZIC-RC), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia; Department of Intensive Care, Alfred Health, Melbourne, Vic, Australia
| | - Sean Lal
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Caleb Ferguson
- Centre for Chronic & Complex Care Research, Blacktown Hospital, Blacktown, Sydney, and Western Sydney Local Health, Sydney, NSW, Australia; School of Nursing, University of Wollongong, NSW, Australia
| | - John French
- University of New South Wales, Sydney, NSW, Australia; Department of Cardiology, Liverpool Hospital, Liverpool, Sydney, NSW, Australia
| | - Emma Bowcock
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Intensive Care Medicine, Nepean Hospital, Nepean, Sydney, NSW, Australia
| | - Natalie Kruit
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Aeromedical Operations, New South Wales Ambulance, Sydney, NSW, Australia; Department of Anaesthesia, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Brian Burns
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Anaesthesia, Westmead Hospital, Westmead, Sydney, NSW, Australia; Department of Emergency Medicine, Northern Beaches Hospital, Sydney, NSW, Australia
| | - Pankaj Jain
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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2
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Hemolytic Performance in Two Generations of the Sputnik Left Ventricular Assist Device: A Combined Numerical and Experimental Study. J Funct Biomater 2022; 13:jfb13010007. [PMID: 35076513 PMCID: PMC8788462 DOI: 10.3390/jfb13010007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 02/05/2023] Open
Abstract
Background: Currently, left ventricular assist devices (LVADs) are a successful surgical treatment for patients with end-stage heart failure on the waiting list or with contraindicated heart transplantation. In Russia, Sputnik 1 LVAD was also successfully introduced into clinical practice as a bridge-to-transplant and a destination therapy device. Development of Sputnik 2 LVAD was aimed at miniaturization to reduce invasiveness, optimize hemocompatibility, and improve versatility for patients of various sizes. Methods: We compared hemolysis level in flow path of the Sputnik LVADs and investigated design aspects influencing other types of blood damage, using predictions of computational fluid dynamics (CFD) and experimental assessment. The investigated operating point was a flow rate of 5 L/min and a pressure head of 100 mm Hg at an impeller rotational speed of 9100 min−1. Results: Mean hemolysis indices predicted with CFD were 0.0090% in the Sputnik 1 and 0.0023% in the Sputnik 2. Averaged values of normalized index of hemolysis obtained experimentally for the Sputnik 1 and the Sputnik 2 were 0.011 ± 0.003 g/100 L and 0.004 ± 0.002 g/100 L, respectively. Conclusions: Obtained results indicate obvious improvements in hemocompatibility and sufficiently satisfy the determined miniaturization aim for the Sputnik 2 LVAD development.
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Clendenen N, Ahlgren B, Robitaille MJ, Christensen E, Morabito J, Grae L, Lyman M, Weitzel N. Year in Review 2020: Noteworthy Literature in Cardiothoracic Anesthesiology. Semin Cardiothorac Vasc Anesth 2021; 25:94-106. [PMID: 33938302 PMCID: PMC10088871 DOI: 10.1177/10892532211013614] [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] [Indexed: 12/15/2022]
Abstract
The year 2020 was marred by the emergence of a deadly pandemic that disrupted every aspect of life. Despite the disruption, notable research accomplishments in the practice of cardiothoracic anesthesiology occurred in 2020 with an emphasis on optimizing care, improving outcomes, and expanding what is possible for patients undergoing cardiac surgery. This year's edition of Noteworthy Literature Review will focus on specific themes in cardiac anesthesiology that include preoperative anemia, predictors of acute kidney injury following cardiac surgery, pain management modalities, anticoagulation strategies after transcatheter aortic valve replacement, mechanical circulatory support, and future directions in research.
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Affiliation(s)
| | - Bryan Ahlgren
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Mark J Robitaille
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Joseph Morabito
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lyndsey Grae
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew Lyman
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nathaen Weitzel
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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4
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Fontenay S, Catarino L, Snoussi S, van den Brink H, Pineau J, Prognon P, Martelli N. Quality of economic evaluations of ventricular assist devices: A systematic review. Int J Technol Assess Health Care 2020; 36:1-8. [PMID: 32618521 DOI: 10.1017/s0266462320000409] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Because of a lack of suitable heart donors, alternatives to transplantation are required. These alternatives can have high costs. The aim of this study was to perform a systematic review of cost-effectiveness studies of ventricular assist devices (VADs) and to assess the level of evidence of relevant studies. The purpose was not to present economic findings. METHODS A systematic review was performed using four electronic databases to identify health economic evaluation studies dealing with VADs. The methodological quality and reporting quality of the studies was assessed using three different tools, the Drummond, Cooper, and CHEERS (Consolidated Health Economic Evaluation Reporting Standards) checklists. RESULTS Of the 1,258 publications identified, thirteen articles were included in this review. Twelve studies were cost-utility analyses and one was a cost-effectiveness analysis. According to the Cooper hierarchy scale, the quality of the data used was heterogeneous. The level of evidence used for clinical effect sizes, safety data, and baseline clinical data was of poor quality. In contrast, cost data were of high quality in most studies. Quality of reporting varied between studies, with an average score of 17.4 (range 15-19) according to the CHEERS checklist. CONCLUSION The current study shows that the quality of clinical data used in economic evaluations of VADs is rather poor in general. This is a concern that deserves greater attention in the process of health technology assessment of medical devices.
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Affiliation(s)
- Sarah Fontenay
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
| | - Lionel Catarino
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
| | - Soumeya Snoussi
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
| | | | - Judith Pineau
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
| | - Patrice Prognon
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
| | - Nicolas Martelli
- Pharmacy Department, Georges Pompidou European Hospital, AP-HP, 20 Rue Leblanc, 75015Paris, France
- Université Paris-Saclay GRADES, 92290Châtenay-Malabry, France
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5
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Prichard R, Kershaw L, Goodall S, Davidson P, Newton PJ, Saing S, Hayward C. Costs Before and After Left Ventricular Assist Device Implant and Preceding Heart Transplant: A Cohort Study. Heart Lung Circ 2020; 29:1338-1346. [PMID: 32371031 DOI: 10.1016/j.hlc.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 07/21/2019] [Accepted: 08/12/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Up to 50% of heart transplant candidates require bridging with left ventricular assist devices (VAD). This study describes hospital activity and cost 1 year preceding and 1 year following VAD implant (pre-VAD) and for the year before transplant (pre-HTX). The sample comprises an Australian cohort and is the first study to investigate costs using both institutional and linked administrative data. METHODS Institutional activity was established for 77 consecutive patients actively listed for transplant between 2009 and 2012. Costs were sourced from the institution or Australian refined diagnosis groups (arDRGs) and the National Efficient Price for admissions to other public and private institutions. Data from 25/77 VAD recipients were analysed and compared with data from 52/77 pre-transplant patients. Total and per day at risk costs were assessed, as well as totals per resource. RESULTS Fifty per cent (50%) of the hospital costs in the pre-VAD year occurred during admission of VAD implant. Sixty-four per cent (64%) of costs in the pre-HTX and 38% in the pre-VAD period occurred outside the implanting centre. Costs in the year prior to VAD, $97,565 (IQR $86,907-$153,916), were significantly higher than costs accrued in the year prior to transplant, $40,250 ($13,493-$81,260), p < 0.0001. Once discharged, costs per day at risk for post-VAD patients approximated those from the pre-admission period, p = 0.16 and in the more clinically stable pre-HTX cohort, p = 0.08. CONCLUSION Compared with the year prior, VAD implant stabilised hospital cost in patients discharged home. A high proportion of the hospital costs in the pre-implant year occur outside the implanting centre and should be considered in economic models assessing the impact of VAD implant.
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Affiliation(s)
- Roslyn Prichard
- Faculty of Health, University of Technology Sydney, NSW, Australia
| | | | - Stephen Goodall
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia
| | - Patricia Davidson
- Johns Hopkins University, Baltimore, MD, USA; Faculty of Health, University of Technology Sydney, NSW, Australia
| | - Phillip J Newton
- Faculty of Health, University of Technology Sydney, NSW, Australia
| | - Sopany Saing
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, NSW, Australia
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6
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Saing S, van der Linden N, Hayward C, Goodall S. Why is There Discordance between the Reimbursement of High-Cost 'Life-Extending' Pharmaceuticals and Medical Devices? The Funding of Ventricular Assist Devices in Australia. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:421-431. [PMID: 30906972 DOI: 10.1007/s40258-019-00470-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
New health technologies often yield health benefits, but often at a high cost. In Australia, the processes for public reimbursement of high-cost pharmaceuticals and medical devices are different, potentially resulting in inequity in support for new therapies. We explore how reimbursement is different for medical devices compared with pharmaceuticals, including whether higher cost-effectiveness thresholds are accepted for pharmaceuticals. A literature review identified the challenges of economic evaluations for medical devices compared with pharmaceuticals. We used the ventricular assist device as a case study to highlight specific features of medical device funding in Australia. We used existing guidelines to evaluate whether ventricular assist devices would fulfil the requirements for the "Life-Saving Drugs Program", which is usually reserved for expensive life-extending pharmaceutical treatments of serious and rare medical conditions. The challenges in conducting economic evaluations of medical devices include limited data to support effectiveness, device-operator interaction (surgical experience) and incremental innovations (miniaturisation). However, whilst high-cost pharmaceuticals may be funded by a single source (federal government), the funding of high-cost devices is complex and may be funded via a combination of federal, state and private health insurance. Based on the Life-Saving Drugs Program criteria, we found that ventricular assist devices could be funded by a similar mechanism to that which funds high-cost life-extending pharmaceuticals. This article highlights the complexities of medical device reimbursement. Whilst differences in available evidence affect the evaluation process, differences in funding methods contribute to inequitable reimbursement decisions between medical devices and pharmaceuticals.
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Affiliation(s)
- Sopany Saing
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Naomi van der Linden
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Christopher Hayward
- Heart Failure and Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia
- Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Stephen Goodall
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, PO Box 123, Sydney, NSW, 2007, Australia
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7
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Schmier JK, Patel JD, Leonhard MJ, Midha PA. A Systematic Review of Cost-Effectiveness Analyses of Left Ventricular Assist Devices: Issues and Challenges. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:35-46. [PMID: 30345458 DOI: 10.1007/s40258-018-0439-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Advanced heart failure (HF) can be treated conservatively or aggressively, with left ventricular assist devices (LVADs) and heart transplant (HT) being the most aggressive strategies. OBJECTIVE The goal of this review was to identify, describe, critique and summarize published cost-effectiveness analyses on LVADs for adults with HF. METHODS We conducted a literature search using PubMed and ProQuest DIALOG databases to identify English-language publications from 2006 to 2017 describing cost-effectiveness analyses of LVADs and reviewed them against inclusion criteria. Those that met criteria were obtained for full-text review and abstracted if they continued to meet study requirements. RESULTS A total of 12 cost-effectiveness studies (13 articles) were identified, all of which described models; they were almost evenly split between those examining LVADs as destination therapy (DT) or as bridge to transplant (BTT). Studies were Markov or semi-Markov models with one- or three-month cycles that followed patients until death. Inputs came from a variety of sources, with the REMATCH trial and INTERMACS registry common clinical data sources, although some publications also used data from studies at their own institutions. Costs were derived from standard sources in many studies but from individual hospital data in some. Inputs for health utilities, which were used in 11 of 12 studies, were generally derived from two studies. None of the studies reported a societal perspective, that is, included non-medical costs such as caregiving. CONCLUSIONS No study found LVADs to be cost effective for DT or BTT with base case assumptions, although incremental cost-effectiveness ratios met thresholds for cost effectiveness in some probabilistic analyses. With constant improvements in LVADs and expanding indications, understanding and re-evaluating the cost effectiveness of their use will be critical to making treatment decisions.
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Affiliation(s)
- Jordana K Schmier
- Exponent Inc, 1800 Diagonal Rd., Suite 500, Alexandria, VA, 22314, USA.
| | - Jasmine D Patel
- Exponent Inc, 3440 Market Street, Suite 600, Philadelphia, PA, 19104, USA
| | - Megan J Leonhard
- Exponent, Inc, 15375 SE 30th Place, Suite 250, Bellevue, WA, 98007, USA
| | - Prem A Midha
- Exponent Inc, 3440 Market Street, Suite 600, Philadelphia, PA, 19104, USA
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8
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COMBINING INSTITUTIONAL AND ADMINISTRATIVE DATA TO ASSESS HOSPITAL COSTS FOR PATIENTS RECEIVING VENTRICULAR ASSIST DEVICES. Int J Technol Assess Health Care 2019; 34:555-566. [PMID: 30595135 DOI: 10.1017/s0266462318003586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to describe patient level costing methods and develop a database of healthcare resource use and cost in patients with AHF receiving ventricular assist device (VAD) therapy. METHODS Patient level micro-costing was used to identify documented activity in the years preceding and following VAD implantation, and preceding heart transplant for a cohort of seventy-seven consecutive patients listed for heart transplantation (2009-12). Clinician interviews verified activity, established time resource required for each activity, and added additional undocumented activities. Costs were sourced from the general ledger, salary, stock price, pharmacy formulary data, and from national medical benefits and prostheses lists. Linked administrative data analyses of activity external to the implanting institution, used National Weighted Activity Units (NWAU), 2014 efficient price, and admission complexity cost weights and were compared with micro-costed data for the implanting admission. RESULTS The database produced includes patient level activity and costs associated with the seventy-seven patients across thirteen resource areas including hospital activity external to the implanting center. The median cost of the implanting admission using linked administrative data was $246,839 (interquartile range [IQR] $246,839-$271,743), versus $270,716 (IQR $211,740-$378,482) for the institutional micro-costing (p = .08). CONCLUSIONS Linked administrative data provides a useful alternative for imputing costs external to the implanting center, and combined with institutional data can illuminate both the pathways to transplant referral and the hospital activity generated by patients experiencing the terminal phases of heart failure in the year before transplant, cf-VAD implant, or death.
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9
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Cavarretta E, Marullo AGM, Sciarretta S, Benedetto U, Greco E, Roever L, Tonelli E, Peruzzi M, Iaccarino A, Biondi-Zoccai G, Frati G. A network meta-analysis of randomized trials and observational studies on left ventricular assist devices in adult patients with end-stage heart failure. Eur J Cardiothorac Surg 2018; 55:461-467. [PMID: 30137270 DOI: 10.1093/ejcts/ezy285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/10/2018] [Accepted: 07/17/2018] [Indexed: 02/05/2023] Open
Affiliation(s)
- Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Antonino G M Marullo
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Sebastiano Sciarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of Angio-Cardio-Neurology, IRCCS Neuromed, Pozzilli, Italy
| | - Umberto Benedetto
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Ernesto Greco
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological, and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Uberlândia, Brazil
| | - Euclide Tonelli
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Mariangela Peruzzi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Alessandra Iaccarino
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department “Paride Stefanini” General and Specialist Surgery, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of Angio-Cardio-Neurology, IRCCS Neuromed, Pozzilli, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of Angio-Cardio-Neurology, IRCCS Neuromed, Pozzilli, Italy
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10
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Left Ventricular Device Implantation Impacts on Hospitalisation Rates, Length of Stay and Out of Hospital Time. Heart Lung Circ 2018; 27:708-715. [DOI: 10.1016/j.hlc.2017.06.717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/15/2017] [Accepted: 06/02/2017] [Indexed: 11/23/2022]
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Shah M, Patil S, Patel B, Agarwal M, Davila CD, Garg L, Agrawal S, Kapur NK, Jorde UP. Causes and Predictors of 30-Day Readmission in Patients With Acute Myocardial Infarction and Cardiogenic Shock. Circ Heart Fail 2018; 11:e004310. [DOI: 10.1161/circheartfailure.117.004310] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background:
Acute myocardial infarction (AMI) occurs as a result of irreversible damage to cardiac myocytes secondary to lack of blood supply. Cardiogenic shock complicating AMI has significant associated morbidity and mortality, and data on postdischarge outcomes are limited.
Methods and Results:
We derived the study cohort of patients with AMI and cardiogenic shock from the 2013 to 2014 Healthcare Cost and Utilization Project National Readmission Database. Incidence, predictors, and causes of 30-day readmissions were analyzed. From 43 212 index admissions for AMI with cardiogenic shock, 26 016 (60.2%) survived to discharge and 5277 (20.2% of survivors) patients were readmitted within 30 days. More than 50% of these readmissions occurred within first 10 days. Cardiac causes accounted for 42% of 30-day readmissions (heart failure 20.6%; acute coronary syndrome 11.6%). Among noncardiac causes, respiratory (11.4%), infectious (9.4%), medical or surgical care complications (6.3%), gastrointestinal/hepatobiliary (6.5%), and renal causes (4.8%) were most common. Length of stay ≥8 days (odds ratio [OR], 2.04; 95% confidence interval [CI], 1.70–2.44;
P
<0.01), acute deep venous thrombosis (OR, 1.26; 95% CI, 1.08–1.48;
P
<0.01), liver disease (OR, 1.25; 95% CI, 1.03–1.50;
P
=0.02), systemic thromboembolism (OR, 1.21; 95% CI, 1.02–1.44;
P
=0.02), peripheral vascular disease (OR, 1.16; 95% CI, 1.07–1.27;
P
<0.01), diabetes mellitus (OR, 1.16; 95% CI, 1.08–1.24;
P
<0.01), long-term ventricular assist device implantation (OR, 1.77; 95% CI, 1.23–2.55;
P
<0.01), intraaortic balloon pump use (OR, 1.10; 95% CI, 1.02–1.18;
P
<0.01), performance of coronary artery bypass grafting (OR, 0.85; 95% CI, 0.77–0.93;
P
<0.01), private insurance (OR, 0.72; 95% CI, 0.64–0.80;
P
<0.01), and discharge to home (OR, 0.85; 95% CI, 0.73–0.98;
P
=0.03) were among the independent predictors of 30-day readmission.
Conclusions:
In-hospital mortality and 30-day readmission in cardiogenic shock complicating AMI are significantly elevated. Patients are readmitted mainly for noncardiac causes. Identification of high-risk factors may guide interventions to improve outcomes within this population.
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Affiliation(s)
- Mahek Shah
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA (M.S., B.P., L.G.). Department of Medicine, University of Pittsburgh Medical Center, PA (S.P.). Department of Medicine, University of Tennessee Health Science Center, Memphis (M.A.). The Cardiovascular Center, Tufts Medical Center, Boston, MA (C.D.D., N.K.K.). Department of Cardiology, St Luke’s University Health Network, Bethlehem, PA (S.A.). Department of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY (U.P.J.)
| | - Shantanu Patil
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA (M.S., B.P., L.G.). Department of Medicine, University of Pittsburgh Medical Center, PA (S.P.). Department of Medicine, University of Tennessee Health Science Center, Memphis (M.A.). The Cardiovascular Center, Tufts Medical Center, Boston, MA (C.D.D., N.K.K.). Department of Cardiology, St Luke’s University Health Network, Bethlehem, PA (S.A.). Department of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY (U.P.J.)
| | - Brijesh Patel
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA (M.S., B.P., L.G.). Department of Medicine, University of Pittsburgh Medical Center, PA (S.P.). Department of Medicine, University of Tennessee Health Science Center, Memphis (M.A.). The Cardiovascular Center, Tufts Medical Center, Boston, MA (C.D.D., N.K.K.). Department of Cardiology, St Luke’s University Health Network, Bethlehem, PA (S.A.). Department of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY (U.P.J.)
| | - Manyoo Agarwal
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA (M.S., B.P., L.G.). Department of Medicine, University of Pittsburgh Medical Center, PA (S.P.). Department of Medicine, University of Tennessee Health Science Center, Memphis (M.A.). The Cardiovascular Center, Tufts Medical Center, Boston, MA (C.D.D., N.K.K.). Department of Cardiology, St Luke’s University Health Network, Bethlehem, PA (S.A.). Department of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY (U.P.J.)
| | - Carlos D. Davila
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA (M.S., B.P., L.G.). Department of Medicine, University of Pittsburgh Medical Center, PA (S.P.). Department of Medicine, University of Tennessee Health Science Center, Memphis (M.A.). The Cardiovascular Center, Tufts Medical Center, Boston, MA (C.D.D., N.K.K.). Department of Cardiology, St Luke’s University Health Network, Bethlehem, PA (S.A.). Department of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY (U.P.J.)
| | - Lohit Garg
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA (M.S., B.P., L.G.). Department of Medicine, University of Pittsburgh Medical Center, PA (S.P.). Department of Medicine, University of Tennessee Health Science Center, Memphis (M.A.). The Cardiovascular Center, Tufts Medical Center, Boston, MA (C.D.D., N.K.K.). Department of Cardiology, St Luke’s University Health Network, Bethlehem, PA (S.A.). Department of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY (U.P.J.)
| | - Sahil Agrawal
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA (M.S., B.P., L.G.). Department of Medicine, University of Pittsburgh Medical Center, PA (S.P.). Department of Medicine, University of Tennessee Health Science Center, Memphis (M.A.). The Cardiovascular Center, Tufts Medical Center, Boston, MA (C.D.D., N.K.K.). Department of Cardiology, St Luke’s University Health Network, Bethlehem, PA (S.A.). Department of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY (U.P.J.)
| | - Navin K. Kapur
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA (M.S., B.P., L.G.). Department of Medicine, University of Pittsburgh Medical Center, PA (S.P.). Department of Medicine, University of Tennessee Health Science Center, Memphis (M.A.). The Cardiovascular Center, Tufts Medical Center, Boston, MA (C.D.D., N.K.K.). Department of Cardiology, St Luke’s University Health Network, Bethlehem, PA (S.A.). Department of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY (U.P.J.)
| | - Ulrich P. Jorde
- Department of Cardiology, Lehigh Valley Hospital, Allentown, PA (M.S., B.P., L.G.). Department of Medicine, University of Pittsburgh Medical Center, PA (S.P.). Department of Medicine, University of Tennessee Health Science Center, Memphis (M.A.). The Cardiovascular Center, Tufts Medical Center, Boston, MA (C.D.D., N.K.K.). Department of Cardiology, St Luke’s University Health Network, Bethlehem, PA (S.A.). Department of Cardiology, Montefiore-Einstein Heart Center, Bronx, NY (U.P.J.)
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Haft JW. What is the best tool for rescue? J Thorac Cardiovasc Surg 2018; 155:1069-1070. [PMID: 29452459 DOI: 10.1016/j.jtcvs.2017.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/04/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Jonathan W Haft
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
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McDonald MA, Ashley EA, Fedak PW, Hawkins N, Januzzi JL, McMurray JJ, Parikh VN, Rao V, Svystonyuk D, Teerlink JR, Virani S. Mind the Gap: Current Challenges and Future State of Heart Failure Care. Can J Cardiol 2017; 33:1434-1449. [DOI: 10.1016/j.cjca.2017.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 11/24/2022] Open
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Suarez-Barrientos A. Asistencia mecánica circulatoria como puente al trasplante. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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