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Scott M, Baykaner T, Bunch TJ, Piccini JP, Russo AM, Tzou WS, Zeitler EP, Steinberg BA. Contemporary trends in cardiac electrophysiology procedures in the United States, and impact of a global pandemic. Heart Rhythm O2 2023; 4:193-199. [PMID: 36569386 PMCID: PMC9767878 DOI: 10.1016/j.hroo.2022.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background There are limited data on trends in nationwide cardiac electrophysiology (EP) procedures in the United States before and during the global COVID-19 pandemic. Objective We aimed to understand contemporary EP procedural trends and how the COVID-19 pandemic impacted them. Methods Trends were obtained from publicly reported Centers for Medicare and Medicaid Services data from 2013 to 2020 (latest available). Rates of catheter-based EP procedures (EP studies and ablations) and cardiac implantable electronic device (CIED) procedures were analyzed. All procedural rates were calculated per 100,000 Medicare beneficiaries (year specific). Procedure physician subspecialty was also reported. Results From 2013 to 2019, annual rate of all cardiac EP procedures increased from 817.91 to 1089.68 per 100,000 beneficiaries. Catheter-based EP procedures increased from 323.73 to 675.01, while CIED rates decreased from 494.18 to 414.67. While all ablation procedures increased over time, relative proportion of ablation procedures being pulmonary vein isolation (PVI) increased (9.9% of ablations in 2013, to 18.2% in 2019). In 2020, rates of both catheter-based EP procedures and CIED procedures decreased; however, PVI share of ablation continued to increase in 2020 comprising 25.2% of ablation procedures. Conclusion Rates of EP procedures have increased among Medicare beneficiaries, with catheter-based procedures now eclipsing CIEDs. Additionally, a greater proportion of catheter-based EP procedures are PVI, but they still represent a minority of all ablations. In 2020, rates of EP procedures were attenuated, yet the proportion of PVI ablations increased to over one-fourth of ablation procedures. These data have important implications for the EP workforce.
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Affiliation(s)
- Monte Scott
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Tina Baykaner
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - T. Jared Bunch
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
| | - Jonathan P. Piccini
- Department of Medicine, Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| | - Andrea M. Russo
- Cooper Medical School of Rowan University, Camden, New Jersey
| | - Wendy S. Tzou
- Department of Medicine, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Emily P. Zeitler
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Benjamin A. Steinberg
- Department of Medicine, University of Utah Health Sciences Center, Salt Lake City, Utah
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Anetta K, Horak A, Wojakowski W, Wita K, Jadczyk T. Deep Learning Analysis of Polish Electronic Health Records for Diagnosis Prediction in Patients with Cardiovascular Diseases. J Pers Med 2022; 12:jpm12060869. [PMID: 35743653 PMCID: PMC9225281 DOI: 10.3390/jpm12060869] [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: 04/17/2022] [Revised: 05/12/2022] [Accepted: 05/23/2022] [Indexed: 02/05/2023] Open
Abstract
Electronic health records naturally contain most of the medical information in the form of doctor’s notes as unstructured or semi-structured texts. Current deep learning text analysis approaches allow researchers to reveal the inner semantics of text information and even identify hidden consequences that can offer extra decision support to doctors. In the presented article, we offer a new automated analysis of Polish summary texts of patient hospitalizations. The presented models were found to be able to predict the final diagnosis with almost 70% accuracy based just on the patient’s medical history (only 132 words on average), with possible accuracy increases when adding further sentences from hospitalization results; even one sentence was found to improve the results by 4%, and the best accuracy of 78% was achieved with five extra sentences. In addition to detailed descriptions of the data and methodology, we present an evaluation of the analysis using more than 50,000 Polish cardiology patient texts and dive into a detailed error analysis of the approach. The results indicate that the deep analysis of just the medical history summary can suggest the direction of diagnosis with a high probability that can be further increased just by supplementing the records with further examination results.
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Affiliation(s)
- Kristof Anetta
- Natural Language Processing Centre, Faculty of Informatics, Masaryk University, 602 00 Brno, Czech Republic;
| | - Ales Horak
- Natural Language Processing Centre, Faculty of Informatics, Masaryk University, 602 00 Brno, Czech Republic;
- Correspondence: (A.H.); (T.J.)
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Krystian Wita
- First Department of Cardiology, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Tomasz Jadczyk
- Department of Cardiology and Structural Heart Diseases, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland;
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne’s University Hospital Brno, 656 91 Brno, Czech Republic
- Correspondence: (A.H.); (T.J.)
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Myrda K, Buchta P, Błachut A, Skrzypek M, Gąsior M. Temporary Trends Concerning the Extent and Efficacy of Atrial Fibrillation Ablation Using Radiofrequency Energy in a Polish Single-Center Experience. Medicina (B Aires) 2022; 58:medicina58020187. [PMID: 35208512 PMCID: PMC8878639 DOI: 10.3390/medicina58020187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Atrial fibrillation (AF) is the most common supraventricular arrhythmia. Currently, catheter ablation is a preferred treatment strategy. The main objective of our study was a temporary trends analysis of patients’ data undergoing a single AF ablation procedure using radiofrequency energy (RF). The efficacy of the procedure underwent assessment during a 12-month follow-up. Materials and Methods: We analyzed 585 consecutive patients with symptomatic, recurrent, and drug-refractory AF hospitalized in our department between 2013 and 2018 who underwent RF ablation supported by a 3D electroanatomical system. The baseline characteristics, periprocedural parameters, and efficacy of the procedure at 6-, 9- and 12-month follow-ups were analyzed over the years. Results: The number of patients undergoing ablation increased. Patients with paroxysmal AF predominated (71.5%). However, the number of patients with the persistent type of arrhythmia increased over the years. The percentage of patients with chronic heart failure (CHF) increased to 27.5% in 2018, and patients presented with increasingly larger left atria (LA). In all patients, circumferential pulmonary vein isolation was performed. The percentage of patients who underwent arrhythmogenic substrate modification and cavotricuspid isthmus ablation increased. Over the years, the efficacy of a single procedure at the 12-month follow-up remained without significant differences between the years (72.0%, 69.6%, 75.5%, 74.8%, 71.7%, 71.7%). Conclusions: The rate of patients with CHF and advanced LA disease undergoing more extensive ablation increased over the years. The efficacy of a single procedure remained without significant differences between the years.
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Affiliation(s)
- Krzysztof Myrda
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland; (A.B.); (M.G.)
- Correspondence: ; Tel.: +48-506-603-277
| | - Piotr Buchta
- Silesian Center for Heart Diseases, 41-800 Zabrze, Poland;
| | - Aleksandra Błachut
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland; (A.B.); (M.G.)
| | - Michał Skrzypek
- Department of Biostatistics, School of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland; (A.B.); (M.G.)
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
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Doshi R, Kumar A, Shariff M, Adalja D, Patel K, Patel K, Desai R, Gullapalli N, Vallabhajosyula S. Comparison of procedural outcomes in patients undergoing catheter vs surgical ablation for atrial fibrillation and heart failure with reduced ejection fraction. J Arrhythm 2021; 37:60-69. [PMID: 33664887 PMCID: PMC7896461 DOI: 10.1002/joa3.12451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/22/2020] [Accepted: 10/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a lack of research comparing procedural outcomes of surgical ablation (SA) and catheter ablation (CA) among patients with heart failure with reduced ejection fraction (HFrEF) and atrial fibrillation (AF). The main objective was to compare the short-term procedural outcomes of SA and CA in patients with HFrEF. METHODS We used the national inpatient sample to identify hospitalizations over 18 years with HFrEF hospitalization and AF, and undergoing SA and CA from 2016 to 2017. Furthermore, the clinical outcomes of SA vs CA in AF stratified as nonparoxysmal and paroxysmal were analyzed. RESULTS A total of 1,770 HFrEF hospitalizations with AF who underwent SA and 1,620 HFrEF hospitalizations with AF who underwent CA were included in the analysis. Hospitalizations with CA had higher baseline comorbidities. The in-hospital mortality among HFrEF with AF undergoing SA as compared with CA was similar (2.8% vs 1.9%, respectively, adjusted P-value 0.09). Hospitalizations with SA had a significantly longer length of hospital stay, a higher percentage of postprocedural, and cardiac complications. In HFrEF hospitalizations with nonparoxysmal AF, SA as compared with CA was associated with a higher percentage of in-hospital mortality (2.4% vs 1%, adjusted P-value <.05), a longer length of stay, a higher cost of treatment, and a higher percentage of cardiac complications. CONCLUSION CA is associated with lower in-hospital adverse procedural outcomes as compared with SA among HFrEF hospitalizations with AF. Further research with freedom from AF as one of the outcome is needed between two groups for HFrEF.
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Affiliation(s)
- Rajkumar Doshi
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
| | - Ashish Kumar
- Department of Critical Care MedicineSt John’s Medical College HospitalBengaluruIndia
| | - Mariam Shariff
- Department of Critical Care MedicineSt John’s Medical College HospitalBengaluruIndia
| | - Devina Adalja
- Department of MedicineGMERS Gotri Medical CollegeVadodaraIndia
| | | | - Kirtenkumar Patel
- Department of CardiologyNorth Shore University HospitalManhassetNYUSA
| | - Rupak Desai
- Department of CardiologyAtlanta VA Medical CenterDecaturGAUSA
| | - Nageshwara Gullapalli
- Department of Internal MedicineUniversity of Nevada Reno School of MedicineRenoNVUSA
| | - Saraschandra Vallabhajosyula
- Section of Interventional CardiologyDivision of Cardiovascular MedicineDepartment of MedicineEmory University School of MedicineAtlantaGAUSA
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Gasior P, Desperak A, Gierlotka M, Milewski K, Wita K, Kalarus Z, Fluder J, Kazmierski M, Buszman PE, Gasior M, Wojakowski W. Clinical Characteristics, Treatments, and Outcomes of Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Results from a Multicenter National Registry. J Clin Med 2020; 9:E2779. [PMID: 32867273 PMCID: PMC7564426 DOI: 10.3390/jcm9092779] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) requires both clinical evidence of acute myocardial infarction (AMI) and demonstration of non-obstructive coronary arteries using angiography. We compared the clinical features, treatments, and three-year outcomes in patients with MINOCA and myocardial infarction with obstructive coronary artery disease (MI-CAD). METHODS We retrospectively analyzed data for 205,606 hospitalized patients with AMI. MINOCA was indicated as a working diagnosis in 6063 patients (2.94% of all AMI patients). For the control group we included 160,886 patients with MI-CAD. We evaluated the baseline characteristics, medication management options, outcomes, and readmission causes at 36 months follow-up. RESULTS Patients in the MINOCA group were younger. Females constituted a greater proportion of patients in the MINOCA group when compared to MI-CAD patients. STEMI during admission was diagnosed less frequently in the MINOCA group when compared to the MI-CAD group. All-cause mortality at 12 months was higher in the MINOCA group (10.94% vs. 9.54%, p < 0.001). At 36 months, there was no difference in the all-cause mortality rates (MINOCA 16.18% vs. MI-CAD 14.93%, p = 0.081). All-cause readmission rates were lower in the MINOCA group when compared to the MI-CAD group at both 12 months (45.19% vs. 54.33%, p < 0.001) and 36 months follow-up (56.42% vs. 66.66%, p < 0.001). CONCLUSIONS This is the first description of the clinical features, treatments, and three-year outcomes in a large population of Polish patients. The main finding of this study was a relatively low rate of MINOCA, with high rates of adverse events both at 12 and 36 months follow-up.
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Affiliation(s)
- Pawel Gasior
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland; (J.F.); (M.K.); (W.W.)
| | - Aneta Desperak
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland; (A.D.); (M.G.)
| | - Marek Gierlotka
- Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, 45-401 Opole, Poland;
| | - Krzysztof Milewski
- Centre for Cardiovascular Research and Development, American Heart of Poland, 43-450 Ustron, Poland;
| | - Krystian Wita
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland;
| | - Joanna Fluder
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland; (J.F.); (M.K.); (W.W.)
| | - Maciej Kazmierski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland; (J.F.); (M.K.); (W.W.)
| | - Paweł E. Buszman
- Department of Epidemiology and Statistics, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Mariusz Gasior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland; (A.D.); (M.G.)
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland; (J.F.); (M.K.); (W.W.)
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