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Jamal S, Mughal MS, Kichloo A, Edigin E, Khan MZ, Minhas AMK, Ali M, Kanjwal K. Left atrial appendage closure using WATCHMAN device in chronic kidney disease and end stage renal disease patients. Pacing Clin Electrophysiol 2022; 45:866-873. [PMID: 35633309 DOI: 10.1111/pace.14537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 04/20/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) and End Stage renal Disease are considered independent risk factors for developing atrial fibrillation (AF). Percutaneous occlusion of left atrial appendage (LAAC) using WATCHMAN device is a widely accepted alternative to anticoagulation therapy to prevent ischemic stroke in AF in patients who are not candidates for anticoagulation. There is limited data regarding the utilization and periprocedural safety of this intervention in patients with CKD/ESRD. METHODS We retrospectively reviewed all hospitalization from 2016 to 2017 with (ICD-10) procedure diagnosis code of LAA closure using WATCHMAN procedure with and without a secondary diagnosis of CKD/ESRD in acute-care hospitals across the United States using the national inpatient sample. Demographic variables (gender, race, income, hospital characteristics, medical comorbidities) were collected and compared. The primary outcomes were inpatient mortality, hospital length and cost of stay. RESULTS There were over 71 million discharges included in the combined 2016 and 2017 NIS database. 16,505 hospitalizations were for adult patients with a procedure code for LAA closure via watchman procedure. Of 16,505 patients 3,245 (19.66%) had CKD and ESRD. There was no statistically significant difference in mortality, length and cost of stay in patients with and without CKD/ESRD. There were no statistically significant differences in periprocedural cerebrovascular accidents in both groups. CONCLUSION Patients with and without ESRD/CKD who undergo LAA occlusion with Watchman have similar procedure related, in-hospital mortality and complications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Shakeel Jamal
- Department of Internal Medicine, Central Michigan University, College of Medicine, Mount Pleasant, Michigan, USA
| | - Mohsin Sheraz Mughal
- Department of Internal Medicine, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University, College of Medicine, Mount Pleasant, Michigan, USA
| | - Ehizogie Edigin
- Department of Internal Medicine, Cook County Health System, Chicago, Illinois, USA
| | - Muhammad Zia Khan
- Department of Internal Medicine, West Virginia University, Morgantown, West Virginia, USA
| | | | - Muzaffar Ali
- Department of Electrophysiology, Sheri Kashmir Institute of Medical Sciences, Srinagar, India
| | - Khalil Kanjwal
- Division of Cardiology, McLaren Greater Lansing, Lansing, Michigan, USA
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Chouairi F, Mercier MR, Alperovich M, Clune J, Prsic A. Preoperative Deficiency Anemia in Digital Replantation: A Marker of Disparities, Increased Length of Stay, and Hospital Cost. J Hand Microsurg 2022; 14:147-152. [PMID: 35983290 PMCID: PMC9381176 DOI: 10.1055/s-0040-1714152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Introduction The effects of preoperative anemia have been shown to be an independent risk factor associated with poor outcomes in both cardiac and noncardiac surgery. Socioeconomic status and race have also been linked to poor outcomes in a variety of conditions. This study was designed to study iron deficiency anemia as a marker of health disparities, length of stay and hospital cost in digital replantation. Materials and Methods Digit replantations performed between 2008 and 2014 were reviewed from the National Inpatient Sample (NIS) database using the ICD-9-CM procedure codes 84.21 and 84.22. Patients with more than one code or with an upper arm (83.24) or hand replantation (84.23) code were excluded. Extracted variables included age, race, comorbidities, hospital type, hospital region, insurance payer type, and median household income quartile. Digit replantations were separated into patients with and without deficiency anemia. Demographics, comorbidities, and access to care were compared between cohorts by chi-squared and t -tests. Multivariate regressions were utilized to assess the effects of anemia on total cost and length of stay. The regression controlled for demographics, region, income, insurance, hospital type, and comorbidities. Beta coefficient was calculated for length of stay and hospital cost. The regression controlled for significant age, race, region, and comorbidities in addition to the above variables. Results In the studied patient population of those without anemia, 59.5% were Caucasian, and in patients with anemia, 46.7% were Caucasian ( p < 0.001). Whereas in the in the studied patient population of those without anemia, 6.7% were Black, and in patients with anemia, 15.7% were Black ( p < 0.001). Median household income, payer information, length of stay and total cost of hospitalization had statistically significant differences. Using regression and β-coefficient, the effect of anemia on length of stay and cost was also significant ( p < 0.001). Regression controlled for age, race, region and comorbidities, with the β-coefficient for effect on cost 37327.18 and on length of stay 3.96. Conclusion These data show that deficiency anemias are associated with a significant increase in length and total cost of stay in patients undergoing digital replantation. Additionally, a larger percentage of patients undergoing digital replantations and who have deficiency anemia belong to the lowest income quartile. Our findings present an important finding for public health prevention and resource allocation. Future studies could focus on clinical intervention with iron supplementation at the time of digital replantation.
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Affiliation(s)
- Fouad Chouairi
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - Michael R. Mercier
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - Michael Alperovich
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - James Clune
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - Adnan Prsic
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
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Kichloo A, Jamal S, Albosta M, Khan MZ, Aljadah M, Edigin E, Amir R, Wani F, Ul-Haq E, Kanjwal K. Increased inpatient mortality in patients hospitalized for atrial fibrillation and atrial flutter with concomitant amyloidosis: Insight from National Inpatient Sample (NIS) 2016-2017. Indian Pacing Electrophysiol J 2021; 21:344-348. [PMID: 34153477 PMCID: PMC8577133 DOI: 10.1016/j.ipej.2021.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/31/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Using National Inpatient Database (NIS), comparison of clinical outcomes for patients primarily admitted for atrial fibrillation/flutter with and without a secondary diagnosis of amyloidosis was done. Inpatient mortality was the primary outcome and hospital length of stay (LOS), mean total hospital charges, odds of undergoing cardiac ablation, pharmacologic cardioversion, having a secondary discharge diagnosis of heart block, cardiogenic shock and cardiac arrest were secondary outcomes. Methods NIS database of 2016, 2017 was used for only adult hospitalizations with atrial fibrillation/flutter as principal diagnosis with and without amyloidosis as secondary diagnosis using ICD-10 codes. Multivariate logistic with linear regression analysis was used to adjust for confounders. Results 932,054 hospitalizations were for adult patients with a principal discharge diagnosis of atrial fibrillation/flutter. 830 (0.09%) of these hospitalizations had amyloidosis. Atrial fibrillation/flutter hospitalizations with co-existing amyloidosis have higher inpatient mortality (4.22% vs 0.88%, AOR: 3.92, 95% CI 1.81–8.51, p = 0.001) and likelihood of having a secondary discharge diagnosis of cardiac arrest (2.40% vs 0.51%, AOR: 4.80, 95% CI 1.89–12.20, p = 0.001) compared to those without amyloidosis. Conclusions Hospitalizations of atrial fibrillation/flutter with co-existing amyloidosis have higher inpatient mortality and odds of having a secondary discharge diagnosis of cardiac arrest compared to those without amyloidosis. However, LOS, total hospital charges, likelihood of undergoing cardiac ablation, pharmacologic cardioversion, having a secondary discharge diagnosis of heart block and cardiogenic shock were similar between both groups.
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Affiliation(s)
- Asim Kichloo
- Central Michigan University College of Medicine, Saginaw, MI, USA; Samaritan Medical Center, Watertown, NY, USA.
| | - Shakeel Jamal
- Central Michigan University College of Medicine, Saginaw, MI, USA.
| | - Michael Albosta
- Central Michigan University College of Medicine, Saginaw, MI, USA.
| | | | | | | | - Rawan Amir
- University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Farah Wani
- Samaritan Medical Center, Watertown, NY, USA.
| | - Ehtesham Ul-Haq
- University of Kentucky College of Medicine, Bowling Green, KY, USA.
| | - Khalil Kanjwal
- Michigan State University McLaren Greater Lansing Hospital, Lansing, MI, USA.
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Jamal S, Kichloo A, Bailey B, Singh J, Virk H, Soni R, Wani F, Ajmal M, Ananthaneni S, Edigin E, Sudhakar R, Kanjwal K. Clinical Outcomes and Disease Burden in Amyloidosis Patients with and Without Atrial Fibrillation-Insight from the National Inpatient Sample Database. J Innov Card Rhythm Manag 2021; 12:4542-4549. [PMID: 34234988 PMCID: PMC8225306 DOI: 10.19102/icrm.2021.120605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/05/2021] [Indexed: 01/09/2023] Open
Abstract
Amyloidosis is a systemic illness that affects multiple organ systems, including the cardiovascular, renal, gastrointestinal, and pulmonary systems. Common manifestations include restrictive cardiomyopathy, arrhythmias, nephrotic syndrome, and gastrointestinal hemorrhage. It is unknown whether coexisting atrial fibrillation (AF) worsens the disease burden and outcomes in patients with systemic amyloidosis. In this study, those with a diagnosis of amyloidosis with and without coexisting AF were identified by querying the Healthcare Cost and Utilization Project—specifically, the National Inpatient Sample for the year 2016—based on International Classification of Diseases, 10th Revision, Clinical Modification codes. During 2016, a total of 2,997 patients were admitted with a diagnosis of amyloidosis, including 918 with concurrent AF. Greater rates of mortality (7.4% vs. 5.6%); heart block (6.8% vs. 2.8%); cardiogenic shock (5% vs. 1.6%); placement of an implantable cardioverter-defibrillator, cardiac resynchronization therapy device, or permanent pacemaker (14.5% vs. 4.5%); renal failure (29% vs. 21%); heart failure (66% vs. 30%); and bleeding complications (5.7% vs. 2.8%) were observed in patients with a diagnosis of amyloidosis and coexisting AF when compared with in patients without AF. Interestingly, patients with amyloidosis without comorbid AF had greater odds of associated stroke relative to those with concurrent AF (7.9% vs. 3.4%).
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Affiliation(s)
- Shakeel Jamal
- Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI, USA
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI, USA
| | - Beth Bailey
- Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI, USA
| | - Jagmeet Singh
- Division of Nephrology, Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| | - Hafeez Virk
- Division of Cardiovascular Medicine, Albert Einstein College of Medicine, Philadelphia, PA, USA
| | - Ronak Soni
- Division of Cardiovascular Medicine, University of Toledo, College of Medicine, Toledo, OH, USA
| | - Farah Wani
- Department of Internal Medicine, Samaritan Medical Center, Watertown, NY, USA
| | - Muhammad Ajmal
- Division of Cardiovascular Medicine, University of Arizona, College of Medicine, Tucson, AZ, USA
| | - Sindhura Ananthaneni
- Department of Internal Medicine, Central Michigan University, College of Medicine, Saginaw, MI, USA
| | - Ehizogie Edigin
- Department of Internal Medicine, John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Rajeev Sudhakar
- Division of Cardiovascular Medicine, Ascension Medical Group, Central Michigan University, Saginaw, MI, USA
| | - Khalil Kanjwal
- Division of Electrophysiology, McLaren Greater Lansing Hospital, Michigan State University, Lansing, MI, USA
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