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Misra S, Swayampakala K, Rajwani A, Davenport E, Fedor J, Saxonhouse S, Holshouser J, Patel N, Thompson J, Beaty E, Jain M, Powell B, Mehta R. Outcomes of an expedited same-day discharge protocol following cardiac implantable electronic device (CIED) implantation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01734-w. [PMID: 38194120 DOI: 10.1007/s10840-024-01734-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/01/2024] [Indexed: 01/10/2024]
Abstract
BACKGROUND With increasing constraints on healthcare resources, greater attention is being focused on improved resource utilization. Prior studies have demonstrated safety of same-day discharge following CIED implantation but are limited by vague protocols with long observation periods. In this study, we evaluate the safety of an expedited 2 hour same-day discharge protocol following CIED implantation. METHODS Patients undergoing CIED implantation at three centers between 2015 and 2021 were included. Procedural, demographic, and adverse event data were abstracted from the electronic health record. Patients were divided into same-day discharge (SDD) and delayed discharge (DD) cohorts. The primary outcome was complications including lead malfunction requiring revision, pneumothorax, hemothorax, lead dislodgement, lead perforation with tamponade, and mortality within 30 days of procedure. Outcomes were compared between the two cohorts using the χ2 test. RESULTS A total of 4543 CIED implantation procedures were included with 1557 patients (34%) in the SDD cohort. SDD patients were comparatively younger, were more likely to be male, and had fewer comorbidities than DD patients. Among SDD patients, the mean time to post-operative chest X-ray was 2.6 h. SDD had lower rates of complications (1.3% vs 2.1%, p = 0.0487) and acute care utilization post-discharge (9.6% vs 14.0%, p < 0.0001). There was no difference in the 90-day infection rate between the cohorts. CONCLUSIONS An expedited 2 hour same-day discharge protocol is safe and effective with low rates of complications, infection, and post-operative acute care utilization.
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Affiliation(s)
- Satish Misra
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA.
| | - Kamala Swayampakala
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Aparna Rajwani
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Elizabeth Davenport
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - John Fedor
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Sherry Saxonhouse
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - John Holshouser
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Neel Patel
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Joseph Thompson
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Elijah Beaty
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Manish Jain
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Brian Powell
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
| | - Rohit Mehta
- Sanger Heart and Vascular Institute, 1237 Harding Place, Charlotte, NC, 28204, USA
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Piayda K, Sievert K, Della Rocca D, Adeola O, Alkhouli M, Yoo D, Benito-González T, Cruz-González I, Galea R, Skurk C, De Backer O, Nielsen-Kudsk J, Grygier M, Beaty E, Newton J, Pérez de Prado A, Räber L, Gibson D, Van Niekerk C, Ellis C, Horton R, Natale A, Grundwald I, Zeus T, Sievert H. Safety and feasibility of peri-device leakage closure after LAAO: an international, multicentre collaborative study. EUROINTERVENTION 2021; 17:e1033-e1040. [PMID: 34219662 PMCID: PMC9724933 DOI: 10.4244/eij-d-21-00286] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Residual peri-device leakage (PDL) is frequent after left atrial appendage occlusion (LAAO). Little is known about management strategies, procedural aspects and outcomes of interventional PDL closure. AIMS The aim of this study was to assess the safety and feasibility of PDL closure after LAAO. METHODS Fifteen centres contributed data on baseline characteristics, in-hospital and follow-up outcomes of patients who underwent PDL closure after LAAO. Outcomes of interest included acute success and complication rates and long-term efficacy of the procedure. RESULTS A total of 95 patients were included and a cumulative number of 104 leaks were closed. The majority of PDLs were detected within 90 days (range 41-231). Detachable coils were the most frequent approach (42.3%), followed by the use of the AMPLATZER Vascular Plug II (29.8%) and the AMPLATZER Duct Occluder II (17.3%). Technical success was 100% with 94.2% of devices placed successfully within the first attempt. There were no major complications requiring surgical or transcatheter interventions. During follow-up (96 days [range 49-526]), persistent leaks were found in 18 patients (18.9%), yielding a functional success rate of 82.7%, although PDLs were significantly reduced in size (pre-leak sizemax: 6.1±3.6 mm vs post-leak sizemax: 2.5±1.3 mm, p<0.001). None of the patients had a leak >5 mm. Major adverse events during follow-up occurred in 5 patients (2 ischaemic strokes, 2 intracranial haemorrhages, and 1 major gastrointestinal bleeding). CONCLUSIONS Several interventional techniques have become available to achieve PDL closure. They are associated with high technical and functional success and low complication rates.
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Affiliation(s)
- Kerstin Piayda
- Cardiovascular Center (CVC) Frankfurt, Frankfurt, Germany
| | - Kolja Sievert
- Cardiovascular Center (CVC) Frankfurt, Frankfurt, Germany
| | | | | | | | | | | | | | - Roberto Galea
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Marek Grygier
- Poznan University of Medical Sciences, Poznan, Poland
| | - Elijah Beaty
- Wake Forest Baptist Health, Winston-Salem, NC, USA
| | | | | | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA,Scripps Health, La Jolla, CA, USA
| | | | - Tobias Zeus
- University Hospital Düsseldorf, Düsseldorf, Germany
| | - Horst Sievert
- CardioVascular Center (CVC) Frankfurt, Seckbacker Landstraβe 65, 60389 Frankfurt, Germany. E-mail:
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Piayda K, Sievert K, Della Rocca D, Adeola O, Alkhouli M, Yoo D, Benito-González T, Cruz-Gonzalez I, Galea R, Skurk C, De Backer O, Nielsen-Kudsk JE, Grygier M, Beaty E, Newton J, Perez de Prado A, Raber L, Gibson D, Van Niekerk C, Ellis C, Horton R, Natale A, Grunwald I, Zeus T, Sievert H. TCT-310 Percutaneous Peridevice Leakage Closure After Insufficient Left Atrial Appendage Occlusion: Results From a Worldwide Collaborative Study. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.1163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Brock JR, Singleton MJ, Bhave PD, Beaty E, Patel NJ, Deshmukh AJ, Bradford N, Simmons TW, Whalen SP, Subash Shantha GP. B-PO03-106 ASSOCIATION BETWEEN ADENOSINE USE AND ATRIAL FIBRILLATION RECURRENCE AFTER PULMONARY VEIN ISOLATION USING HIGH POWER SHORT DURATION ABLATION IN PATIENTS WITH ATRIAL FIBRILLATION. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Singleton MJ, Soliman E, Hughes T, Shantha G, Bhave P, Beaty E, Whalen S, Yeboah J. ASSOCIATION OF RESTING HEART RATE WITH INCIDENT DEMENTIA AND MILD COGNITIVE IMPAIRMENT: SPRINT. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03013-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mangla A, Kane J, Beaty E, Richardson D, Powell LH, Calvin JE. Comparison of predictors of heart failure-related hospitalization or death in patients with versus without preserved left ventricular ejection fraction. Am J Cardiol 2013; 112:1907-12. [PMID: 24063842 DOI: 10.1016/j.amjcard.2013.08.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 08/14/2013] [Accepted: 08/14/2013] [Indexed: 11/19/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is recognized as a major cause of cardiovascular morbidity and mortality. An ability to identify patients with HFpEF who are at increased risk for adverse outcomes can facilitate their more careful management. We studied the patients having heart failure (HF) using data from the Heart Failure Adherence and Retention Trial (HART). HART enrolled 902 patients in the New York Heart Association (NYHA) class II or III who had been recently hospitalized for HF to study the impact of self-management counseling on the primary outcome of death or HF hospitalization. In HART, 208 patients had HFpEF and 692 had HF with reduced ejection fraction (HFrEF) and were followed for a median of 1,080 days. Two final multivariate models were developed. In patients having HFpEF, predictors of primary outcome were male gender (odds ratio [OR] 3.45, p = 0.004), NYHA class III (OR 3.05, p = 0.008), distance covered on a 6-minute walk test (6-MWT) of <620 feet (OR 2.81, p = 0.013), and <80% adherence to prescribed medications (OR 2.61, p = 0.018). In patients having HFrEF, the predictors were being on diuretics (OR 3.06, p = 0.001), having ≥3 co-morbidities (OR 2.11, p = 0.0001), distance covered on a 6-MWT of <620 feet (OR 1.94, p = 0.001), NYHA class III (OR 1.90, p = 0.001), and age >65 years (OR 1.63, p = 0.01). In conclusion, indicators of functional status (6-MWT and NYHA class) were common to both patients with HFpEF and those with HFrEF, whereas gender and adherence to prescribed therapy were unique to patients having HFpEF in predicting death or HF hospitalization.
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Affiliation(s)
- Ashvarya Mangla
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, Illinois; Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois.
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