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Gharbin J, Winful A, Alebna P, Grewal N, Brgdar A, Rhodd S, Taha M, Fatima U, Mehrotra P, Onwuanyi A. Trends in incidence and clinical outcome of non-ST elevation myocardial infarction in patients with amyloidosis in the United States, 2010-2020. Am Heart J Plus 2023; 35:100336. [PMID: 38511180 PMCID: PMC10945973 DOI: 10.1016/j.ahjo.2023.100336] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 10/18/2023] [Indexed: 03/22/2024]
Abstract
Study objective To assess temporal changes in clinical profile and in-hospital outcome of patients with amyloidosis presenting with non-ST elevation myocardial infarction, NSTEMI. Design/setting We conducted a retrospective observational study using the National Inpatient Sample (NIS) database from January 1, 2010, to December 31, 2020. Main outcomes Primary outcome of interest was trend in adjusted in-hospital mortality in patients with amyloidosis presenting with NSTEMI from 2010 to 2020. Our secondary outcomes were trend in rate of coronary revascularization, and trend in duration of hospitalization. Results We identified 272,896 hospitalizations for amyloidosis. There was a temporal increase in incidence of NSTEMI among patients aged 18-44 years from 15.5 % to 28.0 %, a reverse trend was observed in 45-64 years: 22.1 % to 17.7 %, p = 0.043. There was no statistically significant difference in rate of coronary revascularization from 2010 to 2020; 16.3 % to 14.2 %, p = 0.86. We observed an increased odds of all-cause in-hospital mortality in patients with NSTEMI compared to those without NSTEMI (aOR = 2.2, 95 % CI: 1.9-2.6, p < 0.001) but there was a decrease trend in mortality from 21.5 % to 11.3 %, p = 0.013 for trend. Hospitalization duration was also observed to decreased from 14.1 days to 10.9 days during the study period (p = 0.055 for trend). Conclusion In patients with amyloidosis presenting with NSTEMI, there was increased incidence of NSTEMI among young adults, a steady trend in coronary revascularization, and a decreasing trend of adjusted all-cause in-hospital mortality and length of hospitalization from 2010 to 2020 in the United States.
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Affiliation(s)
- John Gharbin
- Department of Internal Medicine, Howard University, Washington, DC, USA
| | - Adwoa Winful
- Medical University of South Carolina Health, Orangeburg, SC, USA
| | - Pamela Alebna
- Division of Cardiology, Virginia Commonwealth University, Virginia, USA
| | - Niyati Grewal
- Department of Internal Medicine, Howard University, Washington, DC, USA
| | - Ahmed Brgdar
- Division of Cardiology, Howard University, Washington, DC, USA
| | - Suchelis Rhodd
- Division of Cardiology, Howard University, Washington, DC, USA
| | - Mohammed Taha
- Division of Cardiology, Virginia Commonwealth University, Virginia, USA
| | - Urooj Fatima
- Division of Cardiology, Howard University, Washington, DC, USA
| | | | - Anekwe Onwuanyi
- Division of Cardiology, Morehouse School of Medicine, Atlanta, GA, USA
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Hassan MA, Gharbin J, Bajaj S, Brgdar A. Type I Non-ST Segment Elevation Myocardial Infarction (NSTEMI) Followed by Type II in a Young Patient With Fibromuscular Dysplasia (FMD) Presented With Hypertensive Emergency: A Case Report. Cureus 2023; 15:e40401. [PMID: 37456388 PMCID: PMC10347299 DOI: 10.7759/cureus.40401] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
This article presents a case report highlighting the association between fibromuscular dysplasia (FMD) and acute myocardial infarction in a 25-year-old female patient with multiple cardiovascular comorbidities. Initially presenting with a hypertensive emergency, the patient subsequently developed acute coronary syndrome. MRI revealed irregular narrowing of the bilateral renal arteries, consistent with a diagnosis of FMD. Further evaluation through cardiac catheterization confirmed 95% stenosis of the mid-circumflex artery, necessitating percutaneous coronary intervention (PCI). Fibromuscular dysplasia has been frequently reported in conjunction with coronary artery dissection leading to acute coronary syndrome, especially in young females. Here, we describe the case of FMD without any coronary artery dissection. The presence of FMD highlights the need for comprehensive evaluation and management in patients with multiple cardiovascular risk factors. The recognition of FMD as an underlying pathology in acute myocardial infarction is crucial for appropriate intervention strategies. In this particular case, PCI was successfully performed to address the significant stenosis of the mid-circumflex artery. These findings emphasize the importance of considering FMD as a potential contributing factor in young patients presenting with acute coronary syndrome, particularly in the context of renal artery involvement. Increased awareness among healthcare providers regarding the association between FMD and acute myocardial infarction can aid in prompt diagnosis, appropriate management, and improved patient outcomes.
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Affiliation(s)
- Mubariz A Hassan
- Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - John Gharbin
- Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - Siddharth Bajaj
- Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - Ahmed Brgdar
- Internal Medicine, Howard University Hospital, Washington, DC, USA
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Taha ME, Gharbin J, Nwancha AB, Munawar MM, Nepaul D, Balogun A, zaroig M, Alebna PA, Fatima U. PROTEIN-ENERGY MALNUTRITION AND OUTCOMES OF HOSPITALIZATIONS FOR ACUTE MYOCARDIAL INFARCTION IN THE USA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01684-4] [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: 03/06/2023]
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Gharbin J, Winful A, Hassan MA, Bajaj S, Batta Y, Alebna P, Rhodd S, Taha M, Fatima U, Mehrotra P. Differences in the Clinical Outcome of Ischemic and Nonischemic Cardiomyopathy in Heart Failure With Concomitant Opioid Use Disorder. Curr Probl Cardiol 2023; 48:101609. [PMID: 36690309 DOI: 10.1016/j.cpcardiol.2023.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Heart Failure (HF) and Opioid Use Disorder (OUD) independently have significant impact on patients and the United States (US) health system. In the setting of the opioid epidemic, research on the effects of OUD on cardiovascular diseases is rapidly evolving. However, no study exists on differential outcomes of ischemic cardiomyopathy (ICM) and nonischemic cardiomyopathy (NICM) in patients with HF with OUD. We performed a retrospective, observational cohort study using National Inpatient Sample (NIS) 2018-2020 databases. Patients aged 18 years and above with diagnoses of HF with concomitant OUD were included. Patients were further classified into ICM and NICM. Primary outcome of interest was differences in all- cause in-hospital mortality. Secondary outcome was incidence of cardiogenic shock. We identified 99,810 hospitalizations that met inclusion criteria, ICM accounted for 27%. Mean age for ICM was higher compared to NICM (63 years vs 56 years, P < 0.01). Compared to NICM, patients with ICM had higher cardiovascular disease risk factors and comorbidities; type 2 diabetes mellitus (46.3 % vs 30.1%, P < 0.01), atrial fibrillation/flutter (33.5% vs 29.9%, P < 0.01), hyperlipidemia (52.5% vs 28.9%, P < 0.01), and Charlson comorbidity index ≥5 was 46.7% versus 29.7%, P < 0.01. After controlling for covariates and potential confounders, we observed higher odds of all-cause in-hospital mortality in patients with NICM (aOR = 1.36; 95% CI:1.03-1.78, P = 0.02). There was no statistical significant difference in incidence of cardiogenic shock between ICM and NICM (aOR = 0.86;95% CI 0.70-1.07, P = 0.18). In patients with HF with concomitant OUD, we found a 36% increase in odds of all-cause in-hospital mortality in patients with NICM compared to ICM despite being younger in age with less comorbidities. There was no difference in odds of in-hospital cardiogenic shock in this study population. This study contributes to the discussion of OUD and cardiovascular diseases which is rapidly developing and requires further prospective studies.
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Affiliation(s)
- John Gharbin
- Department of Medicine, Howard University Hospital, Washington DC, USA.
| | - Adwoa Winful
- Department of Hospital Medicine, Doctors Hospital of Augusta, Augusta, GA, USA
| | | | - Siddharth Bajaj
- Department of Medicine, Howard University Hospital, Washington DC, USA
| | | | - Pamela Alebna
- Department of Medicine, RWJ Barnabas Health, Jersey City, NJ, USA
| | - Suchellis Rhodd
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
| | - Mohammed Taha
- Division of Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
| | - Urooj Fatima
- College of Medicine, Howard University, Washington, DC, USA; Division of Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
| | - Prafulla Mehrotra
- College of Medicine, Howard University, Washington, DC, USA; Division of Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
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Grewal N, Gharbin J, Mehrotra P. An Unusual Case of Lyme Carditis With Persistent Third-Degree Heart Block. J Investig Med High Impact Case Rep 2023; 11:23247096231206332. [PMID: 37902264 PMCID: PMC10617288 DOI: 10.1177/23247096231206332] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/06/2023] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Lyme's carditis and neuroborreliosis are common manifestation of disseminated Lyme disease. However, third-degree atrioventricular blocks with Lyme's carditis requiring permanent pacemaker with neuroborreliosis and Lyme's disease-associated immunodeficiency are uncommon. Here we present a case of 64-year-old female presenting with neurological symptoms and electrocardiogram changes suggestive of complete heart block with no improvement in the degree of heart block with intravenous antibiotics, requiring permanent pacemaker implantation and course complicated by fungemia.
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Brgdar A, Gharbin J, Awan A, Ogunti R, Khurshid Q, Hamad M, Mehrotra P. Atrial Fibrillation as a Prognostic Indicator in Patients With Orthostatic Hypotension: Nationwide Inpatient Sample Analysis. Cardiol Res 2022; 13:228-235. [PMID: 36128415 PMCID: PMC9451585 DOI: 10.14740/cr1405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/29/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Ahmed Brgdar
- Department of Medicine, Howard University Hospital, Washington, DC, USA
- Corresponding Author: Ahmed Brgdar, Department of Medicine, Howard University Hospital, Washington, DC, USA.
| | - John Gharbin
- Department of Medicine, Howard University Hospital, Washington, DC, USA
| | - Ahmad Awan
- Cardiovascular Disease, Montefiore Medical Center, Bronx, NY, USA
| | - Richard Ogunti
- Department of Medicine, Mayo Clinic Health System, Mankato, Minnesota, USA
| | - Qasim Khurshid
- Department of Medicine, Howard University Hospital, Washington, DC, USA
| | - Mayar Hamad
- Faculty of Science, University of Calgary, Calgary, AB, Canada
| | - Prafulla Mehrotra
- Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
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Brgdar A, Gharbin J, Elawad A, Yi J, Sanchez J, Bishaw A, Taha ME, Ameyaw EE, Allen N, Prafulla M. Effects of Substance Use Disorder on In-Hospital Outcomes of Young Patients Presenting With a Cardiovascular Event: A Nationwide Analysis. Cureus 2022; 14:e22737. [PMID: 35386479 PMCID: PMC8969757 DOI: 10.7759/cureus.22737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background Substance use is widely prevalent among young adults and is associated with increased cardiovascular morbidity and mortality such as sudden cardiac arrest, acute coronary syndrome, arrhythmias, and cardiomyopathy. However, they are limited studies analyzing the impact of substance use disorder on in-hospital outcomes among young patients with cardiovascular events. Methods All patients aged 18-39 years admitted primarily for major cardiovascular events including acute myocardial infarction (AMI), arrhythmia, cardiac arrest, acute ischemic stroke, and venous thromboembolic events in 2019 were identified in the National Inpatient Sample database. They were then categorized into those with and without concomitant substance use disorder (SUD). The primary outcome was in-hospital mortality. Unadjusted and adjusted analysis was performed on appropriate variables of interest. Results Of 57,985 hospitalizations with cardiac events, 12,115 (20%) of young adults had concomitant SUD. SUD was significantly associated with cardiac arrest (OR 3.3; CI 2.4-4.4), atrial fibrillation (OR 1.5; CI 1.3-1.7), AMI (OR 1.3; CI 1.2-1.6), heart failure (OR 2.6; CI 2.4-3.0) (all p<0.05) despite a lower prevalence of traditional cardiovascular risk factors than non-users. Logistic regression showed acute kidney injury (aOR 1.5; CI 1.3-1.8; p<0.001) and inpatient mortality (aOR 1.6; CI 1.2-2.2; p<0.001) were also significantly higher in young patients presenting with cardiac events and concomitant SUD. There was no difference in the length of stay or incidence of gastrointestinal bleed between the two groups. Conclusion In young patients presenting with a cardiovascular event, concurrent substance use disorder was associated with increased in-hospital mortality despite significantly lower comorbidities.
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Brgdar A, Gharbin J, Elawad A, Khalafalla S, Bishaw A, Balogun AF, Taha ME. The Effects of Body Mass Index on In-Hospital Mortality and Outcomes in Patients With Heart Failure: A Nationwide Analysis. Cureus 2022; 14:e22691. [PMID: 35386147 PMCID: PMC8967113 DOI: 10.7759/cureus.22691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 11/05/2022] Open
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Brgdar A, Yi J, Awan A, Taha M, Ogunti R, Gharbin J, Prafulla M, Opoku I. Impact of Obstructive Sleep Apnea On In-Hospital Outcomes in Patients With Atrial Fibrillation: A Retrospective Analysis of the National Inpatient Sample. Cureus 2021; 13:e20770. [PMID: 35111455 PMCID: PMC8793003 DOI: 10.7759/cureus.20770] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/05/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is frequently seen with atrial fibrillation (AF) and is associated with increased cardiovascular morbidity, including hypertension, congestive heart failure, ischemic heart disease, and stroke. However, the impact of OSA on in-hospital outcomes of patients with AF is unclear. Methodology All patients aged ≥18 admitted primarily for AF between January 2016 and December 2017 were identified in the National Inpatient Sample database. They were then categorized into those with OSA and those without OSA. The primary outcome was in-hospital mortality. Unadjusted and adjusted analysis was performed on appropriate variables of interest. Results Of 156,521 primary AF hospitalizations, 15% of the patients had OSA. Baseline characteristics revealed no race disparity between the two groups. However, compared to those without OSA, the OSA group was younger and had a significantly higher proportion of males, obesity, heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and hyperlipidemia. Long-term anticoagulation and inpatient cardioversion were also higher in the OSA group. Following propensity matching, inpatient mortality was similar between the two groups [0.54% in OSA vs. 0.51% in non-OSA; adjusted odds ratio = 1.06 (95% confidence interval = 0.82-1.35)]. Similarly, OSA was not significantly associated with acute kidney injury, cardiac arrest, gastrointestinal bleed, acute stroke, or length of stay. However, the OSA group was less anemic and required fewer in-hospital blood transfusions. Conclusions Although OSA is highly prevalent in AF patients, inpatient mortality and cardiovascular outcomes such as cardiac arrest, stroke, or major bleeding were similar in AF patients with or without concomitant OSA with no significant differences in length of stay.
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Affiliation(s)
- Ahmed Brgdar
- Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - Jin Yi
- Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - Ahmad Awan
- Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
| | - Mohamed Taha
- Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
| | - Richard Ogunti
- Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - John Gharbin
- Internal Medicine, Howard University Hospital, Washington, DC, USA
| | - Mehrotra Prafulla
- Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
| | - Isaac Opoku
- Cardiovascular Disease, Howard University Hospital, Washington, DC, USA
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Summers NA, Gharbin J, Friedman-Moraco R, Lyon GM, Lutgring J. Multi-drug-resistant Enterococcus faecium bacteraemia in a liver transplant recipient. JMM Case Rep 2018; 6:e005172. [PMID: 30863549 PMCID: PMC6412035 DOI: 10.1099/jmmcr.0.005172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/04/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Enterococcus faecium is a commensal organism commonly colonizing the human gastrointestinal tract. Although it is generally a non-virulent organism, E. faecium can cause significant morbidity and mortality due to its inherent and acquired resistances to commonly used antimicrobials. Patients who are immunosuppressed are particularly vulnerable. Case presentation A 65–75-year-old patient with a history of an orthotopic liver transplant for hepatitis C infection and diabetes was re-admitted to the hospital with abdominal pain and fever. The patient had several recent admissions related to the presentation reported here, which included treatment with a prolonged course of broad-spectrum antibiotics. The patient was found to have a recurrent liver abscess and blood cultures grew vancomycin-resistant E. faecium, non-susceptible to all tested agents: ampicillin, penicillin, vancomycin, daptomycin and linezolid. The patient was started initially on chloramphenicol intravenously while awaiting additional susceptibility testing, which ultimately revealed chloramphenicol non-susceptibility. Tigecycline was started but the patient ultimately decided to pursue hospice care. Conclusion Multi-drug-resistant organisms are increasingly being recognized and are associated with poorer outcomes, particularly in immunosuppressed patients. We describe a particularly resistant organism and discuss potential therapeutic options.
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Affiliation(s)
- Nathan A Summers
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - John Gharbin
- Department of Global Health, Emory University, Atlanta, GA, USA
| | - Rachel Friedman-Moraco
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - G Marshall Lyon
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Joseph Lutgring
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, USA
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