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Nazir S. Re/Ir@Os-doping induced insulator-to-metal transition in Mott-insulator Ca 2FeOsO 6: octahedral distortion effects. Phys Chem Chem Phys 2024. [PMID: 38712613 DOI: 10.1039/d4cp00746h] [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] [Indexed: 05/08/2024]
Abstract
Regardless of several investigations to elucidate the ground state of the strongly correlated electron systems in doped Mott-insulators (MIs), the origin of the doping-induced insulator-to-metal transition (IMT) remains a crucial and debatable subject in solid-state physics. Herein, we explore the consequences of Re/Ir-doping at the Os-site (Re/Ir@Os), on the physical properties of the MI ferrimagnetic (FiM) Ca2FeOsO6 double perovskite oxides using density functional theory calculations. The doped structures' solidity is analyzed by computing the defect formation energies in terms of the dopant-rich situation, which confirms their growth credibility at ambient conditions along with mechanical and dynamical stabilities. Various FiM spin-ordering is taken into account in the doped structures to analyze the magnetic ground state, which is FiM-I/FiM-II in the Re/Ir@Os-doped system. Remarkably, an IMT is predicted in the Re/Ir@Os-doped structures, which is due to the admixture of the partially occupied 5d orbitals of these ions. The calculated partial spin magnetic moments (ms) of +4.12, -1.58, -0.75 and +0.88μB on the Fe, Os, Re, and Ir ions, endorse the +3, +5, +5, and +4 states having electronic configurations of t32g↑t02g↓e2g↑e0g↓, t32g↑t02g↓e0g↑e0g↓, t22g↑t02g↓e0g↑e0g↓, t32g↑t22g↓e0g↑e0g↓, respectively. The "+" and "-" signs on the ions ms values, lead the systems into various FiM magnetic ordering. Moreover, the estimated Curie temperature (TC) using the Heisenberg model in the pristine structure is 334 K, which is close to the experimentally observed value of 320 K along with a colossal uniaxial magneto crystalline anisotropy energy constant (K) of 2.95 × 107 erg cm-3 having the easy magnetic axis of the ac-plane ([101]). It is established that TC/K reduces and enhances to 298 K/1.33 × 107 erg cm-3 and 365 K/4.71 × 107 erg cm-3 for the Re@Os and Ir@Os-doped motif due to an increase and decrease in the octahedral distortions compared to that of the pristine system, respectively.
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Affiliation(s)
- S Nazir
- Department of Physics, University of Sargodha, 40100 Sargodha, Pakistan.
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Nazir S. Insulator-to-metal transition, magnetic anisotropy, and improved TC in a ferrimagnetic La 2CoIrO 6: strain influence. Phys Chem Chem Phys 2024; 26:5002-5009. [PMID: 38258460 DOI: 10.1039/d3cp04755e] [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] [Indexed: 01/24/2024]
Abstract
The elegant interactions between Coulomb repulsion and spin-orbit coupling in Ir-based double perovskite oxides (DPO) normally induce peculiar magnetic behavior. Herein, we investigate the effect of the development of biaxial [110] strain on the formation energetics, and electronic and magnetic properties of the La2CoIrO6 DPO employing density functional theory calculations. Our results reveal that the unstrained motif is a Mott-insulator achieving an energy band gap of 0.35 eV with a ferrimagnetic (FiM) ground state, which essentially arises due to anti-ferromagnetic (AFM) coupling between the half-occupied Co t2g and partially occupied Ir t2g/empty eg orbitals via oxygen 2p states. Along with this, it is found that [001] (c-axis) is the easy magnetic axis, which results in 12.5 meV total energy per u.c., obtaining a large anisotropy constant of 0.8 × 108 erg cm-3. The computed partial spin-magnetic moments on the Co/Ir ion are 2.64/-0.46 μB, where the negative sign on the Ir ion moment confirms the AFM interactions between them. Additionally, the t2g/eg and t2g orbital characteristics of Co2+ and Ir4+ ions are visible in the spin-magnetization density isosurfaces plot, respectively. Likewise, the estimated Curie temperature (TC) using the Heisenberg model is 104 K, which is in agreement with the experimentally observed value of 94/97 K. Interestingly, an insulator-to-metal transition is achieved at a critical compressive strain of -6% with a robust FiM state, where the Co 3dxy and Ir 5dx2-y2 orbitals are mainly responsible for metallicity. Simultaneously, the magnetocrystalline anisotropy energy and TC can be sufficiently enhanced by applying compressive strain due to enhancement in the structural distortions. So this work suggested that the strain strategy is an efficient approach to tuning the properties of the compounds for their feasible realization in spintronics.
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Affiliation(s)
- S Nazir
- Department of Physics, University of Sargodha, 40100 Sargodha, Pakistan.
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Khan MT, Mehmood S, Arslan M, Azhar M, Asad T, Raziq F, Liaqat S, Gondal MA, Rauf M, Nazir S, Faran G, Abbasi F, Farooq Z, Iqbal ZM, Qumar M, Wadood F, Raja IH, Ali H, Abbas G, Bughio E, Magsi AS, Younas U, Arshad MA, Rehman MF. Organoleptic characteristics and compositional profile of meat of growing Japanese quail fed different levels of poultry byproducts compost. BRAZ J BIOL 2023; 83:e274040. [PMID: 37937627 DOI: 10.1590/1519-6984.274040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/28/2023] [Indexed: 11/09/2023] Open
Abstract
The poultry industry generates a lot of waste, including dead birds, manure, and poultry litter. Poultry waste should never be disposed of improperly because it can seriously harm the environment. The waste can be recycled as a feedstock for use in poultry feed by composting the litter and deceased birds. The compositional profile and organoleptic properties of the meat of growing Japanese quail were examined over the course of a 4-week trial to ascertain the effect of adding compost to the diet. In a completely randomized design (CRD), 1200 newly hatched quail chicks (Coturnix coturnix japonica) were divided into five treatment groups (diets with 0, 2.5, 5, 7.5, and 10% compost), each consisting of 40 birds with six replicates. The addition of compost to the diet had no noticeable effects on the organoleptic qualities of appearance, color, aroma, taste, texture, juiciness, tenderness, and acceptability (P>0.05). The compositional profile characteristics for chicks given compost at any level compared to chicks fed the control diet showed no differences (P>0.05). These findings suggest that the sensory characteristics and compositional profile of growing meat quails can be maintained when fed diets including up to 10% compost.
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Affiliation(s)
- M T Khan
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Poultry Science, Bahawalpur, Pakistan
| | - S Mehmood
- University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Poultry Production, Lahore, Pakistan
| | - M Arslan
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Poultry Science, Bahawalpur, Pakistan
| | - M Azhar
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Poultry Science, Bahawalpur, Pakistan
| | - T Asad
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Poultry Science, Bahawalpur, Pakistan
| | - F Raziq
- Livestock and Dairy Development Department (Extension), Khyber Pakhtunkhwa, Pakistan
| | - S Liaqat
- The Islamia University of Bahawalpur, Faculty of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - M A Gondal
- Cholistan University of Veterinary and Animal Sciences, Institute of Continuing Education and Extension, Bahawalpur, Pakistan
| | - M Rauf
- Cholistan University of Veterinary and Animal Sciences, Faculty of Veterinary Science, Department of Pathology, Bahawalpur, Pakistan
| | - S Nazir
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Meat Technology, Bahawalpur, Pakistan
| | - G Faran
- The Islamia University of Bahawalpur, Institute of Biochemistry, Biotechnology and Bioinformatics, Department of Biochemistry, Bahawalpur, Pakistan
| | - F Abbasi
- The Islamia University of Bahawalpur, Department of Zoology, Faculty of Chemical and Biological Sciences, Bahawalpur, Pakistan
| | - Z Farooq
- Cholistan University of Veterinary and Animal Sciences, Department of Zoology, Faculty of Biosciences, Bahawalpur, Pakistan
| | - Z M Iqbal
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Livestock Management, Bahawalpur, Pakistan
| | - M Qumar
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Animal Nutrition, Bahawalpur, Pakistan
| | - F Wadood
- Cholistan University of Veterinary and Animal Sciences, Department of Theriogenology, Faculty of Veterinary Science, Bahawalpur, Pakistan
| | - I H Raja
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Animal Nutrition, Bahawalpur, Pakistan
| | - H Ali
- Office of Human and Animal Food Operation , Food Safety Officer, Springfield, IL, USA
| | - G Abbas
- Riphah College of Veterinary Sciences, Department of Animal Production, Lahore, Pakistan
| | - E Bughio
- Shaheed Benazir Bhutto University of Veterinary and Animal Sciences, Department of Poultry Production, Sakrand, Pakistan
| | - A S Magsi
- Shaheed Benazir Bhutto University of Veterinary and Animal Sciences, Department of Dairy Technology, Sakrand, Pakistan
| | - U Younas
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Livestock Management, Bahawalpur, Pakistan
| | - M A Arshad
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Poultry Science, Bahawalpur, Pakistan
| | - M F Rehman
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Poultry Science, Bahawalpur, Pakistan
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Khan MT, Mehmood S, Asad T, Azhar M, Arslan M, Raziq F, Liaqat S, Raja IH, Gondal MA, Rauf M, Nazir S, Faran G, Nisa Q, Abbasi F, Farooq Z, Iqbal ZM, Qumar M, Wadood F, Abbas G, Bughio E, Magsi AS, Younas U, Arshad MA. Assessing effect of feeding poultry byproducts compost on organoleptic characteristics and compositional profile of meat of broiler chickens. BRAZ J BIOL 2023; 83:e275633. [PMID: 37937630 DOI: 10.1590/1519-6984.275633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/07/2023] [Indexed: 11/09/2023] Open
Abstract
Large amounts of waste, including dead birds, manure, and poultry litter, are produced by the poultry industry. Poultry waste should be disposed of properly to avoid major pollution and health risks. Composting litter and dead birds could be an option to recycle the waste and use in poultry feed. A study was conducted to investigate the effects of feeding composted poultry waste on the organoleptic qualities and compositional profile of the meat of broiler chickens. A total of 300 day-old broiler chicks (500-Cobb) were randomly allocated to five treatment groups replicated six times with 10 birds each, under a completely randomized design (CRD). Five iso-caloric and iso-nitrogenous diets including composted poultry byproducts at concentrations of 0, 2.5, 5, 7.5, and 10% were fed ad libitum to the birds from day 0 to day 35. The sensory grading and meat composition profile of 500 Cobb broiler chickens were tested at 35 days of age. The findings showed that there were no variations in the sensory profiles of the meat from birds given various diets (P>0.05). Although the results were somewhat lower for the chicks fed compost-containing diets than for the control group, this difference was deemed to be insignificant (P>0.05). Similarly, there were no variations in the compositional profile values of the meat between meat from birds fed various diets (P>0.05). These findings imply that broiler chickens may be raised on diets containing up to 10% poultry byproduct compost without any negative impacts on the meat's sensory quality or composition. Additionally, using compost into broiler diets may help to lower the cost of feed.
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Affiliation(s)
- M T Khan
- Cholistan University of Veterinary and Animal Sciences, Department of Poultry Science, Faculty of Animal Production and Technology, Bahawalpur, Pakistan
| | - S Mehmood
- University of Veterinary and Animal Sciences, Department of Poultry Production, Faculty of Animal Production and Technology, Lahore, Pakistan
| | - T Asad
- Cholistan University of Veterinary and Animal Sciences, Department of Poultry Science, Faculty of Animal Production and Technology, Bahawalpur, Pakistan
| | - M Azhar
- Cholistan University of Veterinary and Animal Sciences, Department of Poultry Science, Faculty of Animal Production and Technology, Bahawalpur, Pakistan
| | - M Arslan
- Cholistan University of Veterinary and Animal Sciences, Department of Poultry Science, Faculty of Animal Production and Technology, Bahawalpur, Pakistan
| | - F Raziq
- Livestock and Dairy Development Department (Extension), Khyber Pakhtunkhwa, Pakistan
| | - S Liaqat
- The Islamia University of Bahawalpur, Faculty of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - I H Raja
- Cholistan University of Veterinary and Animal Sciences, Department of Animal Nutrition, Faculty of Animal Production and Technology, Bahawalpur, Pakistan
| | - M A Gondal
- Cholistan University of Veterinary and Animal Sciences, Institute of Continuing Education and Extension, Bahawalpur, Pakistan
| | - M Rauf
- Cholistan University of Veterinary and Animal Sciences, Faculty of Veterinary Science, Department of Pathology, Bahawalpur, Pakistan
| | - S Nazir
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Meat Technology, Bahawalpur, Pakistan
| | - G Faran
- The Islamia University of Bahawalpur, Department of Biochemistry, Institute of Biochemistry, Biotechnology and Bioinformatics, Bahawalpur, Pakistan
| | - Q Nisa
- University of Veterinary and Animal Sciences, Department of Pathology, Lahore, Pakistan
| | - F Abbasi
- The Islamia University of Bahawalpur, Faculty of Chemical and Biological Sciences, Department of Zoology, Bahawalpur, Pakistan
| | - Z Farooq
- Cholistan University of Veterinary and Animal Sciences, Faculty of Biosciences, Department of Zoology, Bahawalpur, Pakistan
| | - Z M Iqbal
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Livestock Management, Bahawalpur, Pakistan
| | - M Qumar
- Cholistan University of Veterinary and Animal Sciences, Department of Animal Nutrition, Faculty of Animal Production and Technology, Bahawalpur, Pakistan
| | - F Wadood
- Cholistan University of Veterinary and Animal Sciences, Faculty of Veterinary Science, Department of Theriogenology, Bahawalpur, Pakistan
| | - G Abbas
- Riphah College of Veterinary Sciences, Department of Animal Production, Lahore, Pakistan
| | - E Bughio
- Shaheed Benazir Bhutto University of Veterinary and Animal Sciences, Department of Poultry Production, Sakrand, Pakistan
| | - A S Magsi
- Shaheed Benazir Bhutto University of Veterinary and Animal Sciences, Department of Dairy Technology, Sakrand, Pakistan
| | - U Younas
- Cholistan University of Veterinary and Animal Sciences, Faculty of Animal Production and Technology, Department of Livestock Management, Bahawalpur, Pakistan
| | - M A Arshad
- Cholistan University of Veterinary and Animal Sciences, Department of Poultry Science, Faculty of Animal Production and Technology, Bahawalpur, Pakistan
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Sagheer S, Minhas AMK, Zaidi SH, Shah I, Ahuja KR, Ahuja SK, Nazir S, Talha KM, Dani SS, Fudim M, Abramov D, Virani SS, Wasty N. Association of Hospital Procedural Volume With Outcomes of Left Ventricular Assist Device Placement. J Card Fail 2023; 29:1531-1538. [PMID: 37419409 DOI: 10.1016/j.cardfail.2023.06.017] [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: 02/06/2023] [Revised: 05/19/2023] [Accepted: 06/11/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND With the advancement in device technology, the use of durable left ventricular assist devices (LVADs) has increased significantly in recent years. However, there is a dearth of evidence to conclude whether patients who undergo LVAD implantation at high-volume centers have better clinical outcomes than those receiving care at low- or medium-volume centers. METHODS We analyzed the hospitalizations using the Nationwide Readmission Database for the year 2019 for new LVAD implantation. Baseline comorbidities and hospital characteristics were compared among low- (1-5 procedures/year), medium- (6-16 procedures/year) and high-volume (17-72 procedures/year) hospitals. The volume/outcome relationship was analyzed using the annualized hospital volume as a categorical variable (tertiles) as well as a continuous variable. Multilevel mixed-effect logistic regression and negative binomial regression models were used to determine the association of hospital volume and outcomes, with tertile 1 (low-volume hospitals) as the reference category. RESULTS A total of 1533 new LVAD procedures were included in the analysis. The inpatient mortality rate was lower in the high-volume centers compared with the low-volume centers (9.04% vs 18.49%, aOR 0.41, CI0.21-0.80; P = 0.009). There was a trend toward lower mortality rates in medium-volume centers compared with low-volume centers; however, it did not reach statistical significance (13.27% vs 18.49%, aOR 0.57, CI0.27-1.23; P = 0.153). Similar results were seen for major adverse events (composite of stroke/transient ischemic attack and in-hospital mortality). There was no significant difference in bleeding/transfusion, acute kidney injury, vascular complications, pericardial effusion/hemopericardium/tamponade, length of stay, cost, or 30-day readmission rates between medium- and high-volume centers compared to low-volume centers. CONCLUSION Our findings indicate lower inpatient mortality rates in high-volume LVAD implantation centers and a trend toward lower mortality rates in medium-volume LVAD implantation centers compared to lower-volume centers.
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Affiliation(s)
- Shazib Sagheer
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM; Division of Interventional Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA.
| | | | | | - Ishan Shah
- Division of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, NM; Division of Interventional Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Keerat Rai Ahuja
- Department of Cardiology, Reading Hospital-Tower Health, Reading, PA, USA
| | - Satish Kumar Ahuja
- Department of Internal Medicine, Reading Hospital-Tower Health, Reading, PA, USA
| | - Salik Nazir
- The Aga Khan University, Karachi, Pakistan, and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Khawaja M Talha
- Division of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - Dmitry Abramov
- Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Salim S Virani
- The Aga Khan University, Karachi, Pakistan, and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Najam Wasty
- Division of Interventional Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
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Bhuta S, Ariss RW, Ding L, Nazir S, Magee GA, Garg PK, Gupta R. Oral factor Xa inhibitor underutilization following lower extremity peripheral vascular intervention. J Vasc Surg 2023; 78:498-505.e1. [PMID: 37100234 PMCID: PMC10524143 DOI: 10.1016/j.jvs.2023.04.026] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVE Patients undergoing peripheral vascular intervention (PVI) (ie, endovascular revascularization) for symptomatic lower extremity peripheral artery disease remain at high risk for major adverse limb and cardiovascular events. High-quality evidence demonstrates the addition of a low-dose oral factor Xa inhibitor to single antiplatelet therapy, termed dual pathway inhibition (DPI), reduces the incidence of major adverse events in this population. This study aims to describe the longitudinal trends in factor Xa inhibitor initiation after PVI, identify patient and procedural characteristics associated with factor Xa inhibitor use, and describe temporal trends in antithrombic therapy post-PVI before vs after VOYAGER PAD. METHODS This retrospective cross-sectional study was performed using data from the Vascular Quality Initiative PVI registry from January 2018 through June 2022. Multivariate logistic regression was utilized to determine predictors of factor Xa inhibitor initiation following PVI, reported as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS A total of 91,569 PVI procedures were deemed potentially eligible for factor Xa inhibitor initiation and were included in this analysis. Overall rates of factor Xa inhibitor initiation after PVI increased from 3.5% in 2018 to 9.1% in 2022 (P < .0001). The strongest positive predictors of factor Xa inhibitor initiation after PVI were non-elective (OR, 4.36; 95% CI, 4.06-4.68; P < .0001) or emergent (OR, 8.20; 95% CI, 7.14-9.41; P < .0001) status. The strongest negative predictor was postoperative dual antiplatelet therapy prescription (OR, 0.20; 95% CI, 0.17-0.23; P < .0001), highlighting significant hesitation about use of DPI after PVI and limited translation of VOYAGER PAD findings into clinical practice. Antiplatelet medications remain the most common antithrombotic regimen after PVI, with almost 70% of subjects discharged on dual antiplatelet therapy and approximately 20% discharged on single antiplatelet therapy. CONCLUSIONS Factor Xa inhibitor initiation after PVI has increased in recent years, although the absolute rate remains low, and most eligible patients are not prescribed this treatment.
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Affiliation(s)
- Sapan Bhuta
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Robert W Ariss
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Li Ding
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Salik Nazir
- Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Parveen K Garg
- Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rajesh Gupta
- Division of Cardiovascular Medicine, University of Toledo, Toledo, OH.
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Issa R, Nazir S, Khan Minhas AM, Lang J, Ariss RW, Kayani WT, Khalid MU, Sperling L, Shapiro MD, Jneid H, Gupta R. Demographic and regional trends of peripheral artery disease-related mortality in the United States, 2000 to 2019. Vasc Med 2023; 28:205-213. [PMID: 36597656 DOI: 10.1177/1358863x221140151] [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] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Peripheral artery disease (PAD) is a common progressive atherosclerotic disease associated with significant morbidity and mortality in the US; however, data regarding PAD-related mortality trends are limited. This study aims to characterize contemporary trends in mortality across sociodemographic and regional groups. METHODS The Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) was queried for data regarding PAD-related deaths from 2000 to 2019 in the overall sample and different demographic (age, sex, race/ethnicity) and regional (state, urban-rural) subgroups. Crude and age-adjusted mortality rates (CMR and AAMR, respectively) per 100,000 people were calculated. Associated annual percentage changes (APC) were computed using Joinpoint Regression Program Version 4.9.0.0 trend analysis software. RESULTS Between 2000 and 2019, a total of 1,959,050 PAD-related deaths occurred in the study population. Overall, AAMR decreased from 72.8 per 100,000 in 2000 to 32.35 per 100,000 in 2019 with initially decreasing APCs followed by no significant decline from 2016 to 2019. Most demographic and regional subgroups showed initial declines in AAMRs during the study period, with many groups exhibiting no change in mortality in recent years. However, men, non-Hispanic (NH) Black or African American individuals, people aged ⩾ 85 years, and rural counties were associated with the highest AAMRs of their respective subgroups. Notably, there was an increase in crude mortality rate among individuals 25-39 years of age from 2009 to 2019. CONCLUSION Despite initial improvement, PAD-related mortality has remained stagnant in recent years. Disparities have persisted across several demographic and regional groups, requiring further investigation.
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Affiliation(s)
- Rochell Issa
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | | | - Jacob Lang
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Robert W Ariss
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Waleed Tallat Kayani
- Section of Interventional Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Mirza Umair Khalid
- Section of Interventional Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Laurence Sperling
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Hani Jneid
- Section of Interventional Cardiology, Baylor College of Medicine, Houston, TX, USA
| | - Rajesh Gupta
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
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Vyas R, Nazir S, Ahuja KR, Minhas AMK, Elzanaty A, Mir T, Sheikh M. Endovascular Transcatheter Aortic Valve Replacement Outcomes in Hypertrophic Cardiomyopathy: Insights from the National Inpatient Sample (2014-2018). Cardiology 2023; 148:289-292. [PMID: 37231865 DOI: 10.1159/000530043] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/01/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Outcomes of patients with hypertrophic cardiomyopathy (HCM) following transcatheter aortic valve replacement (TAVR) remain largely unknown. OBJECTIVES This study sought to assess the clinical characteristics and outcomes of HCM patients following TAVR. METHODS We queried the National Inpatient Sample from 2014 to 2018 for TAVR hospitalizations with and without HCM, creating a propensity-matched cohort to compare outcomes. RESULTS 207,880 patients that underwent TAVR during the study period, 810 (0.38%) had coexisting HCM. In the unmatched population, TAVR patients with HCM compared to those without HCM, were more likely to be female, had a higher prevalence of heart failure, obesity, cancer, and history of pacemaker/implantable cardioverter defibrillation, and were more likely to have nonelective and weekend admissions (p for all <0.05). TAVR patients without HCM had higher prevalence of coronary artery disease, prior percutaneous coronary intervention, prior coronary artery bypass grafting, and peripheral arterial disease compared to their counterparts (p for all <0.05). In the propensity-matched cohort, TAVR patients with HCM had significantly higher incidence of in-hospital mortality, acute kidney injury/hemodialysis, bleeding complications, vascular complications, permanent pacemaker requirement, aortic dissection, cardiogenic shock, and mechanical ventilation requirement. CONCLUSION Endovascular TAVR in HCM patients is associated with an increased incidence of in-hospital mortality and procedural complications.
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Affiliation(s)
- Rohit Vyas
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA
| | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA
| | - Keerat Rai Ahuja
- Department of Cardiology, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | | | - Ahmed Elzanaty
- Division of Cardiovascular Medicine, University of Toledo, Toledo, Ohio, USA
| | - Tanveer Mir
- Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA
| | - Mujeeb Sheikh
- Division of Cardiovascular Medicine, ProMedica Toledo Hospital, Toledo, Ohio, USA
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9
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Narendrula A, Minhas AMK, Issa R, Ariss RW, Nazir S, Jain V, Ali M, Mahmood A. Age stratified trends in pulmonary hypertension-related mortality in the United States, 2004-2019. Am J Med Sci 2023; 365:470-471. [PMID: 36828122 DOI: 10.1016/j.amjms.2023.02.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/31/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Aparna Narendrula
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | | | - Rochell Issa
- Department of Medicine, University of Toledo Medical Center, Toledo, OH USA
| | - Robert W Ariss
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA USA
| | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH USA
| | - Vardhmaan Jain
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH USA
| | - Muhammad Ali
- Department of Medicine, University of Toledo Medical Center, Toledo, OH USA
| | - Asif Mahmood
- Department of Medicine, University of Toledo Medical Center, Toledo, OH USA
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10
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Jain V, Minhas AMK, Ariss RW, Nazir S, Khan SU, Khan MS, Rifai MA, Michos E, Mehta A, Qamar A, Vaughan EM, Sperling L, Virani SS. Demographic and Regional Trends of Cardiovascular Diseases and Diabetes Mellitus-Related Mortality in the United States From 1999 to 2019. Am J Med 2023:S0002-9343(23)00202-4. [PMID: 37183138 DOI: 10.1016/j.amjmed.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 10/14/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The purpose of this research was to study the contemporary trends in cardiovascular disease (CVD) and diabetes mellitus (DM)-related mortality. METHODS We used the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database to identify adults ≥25 years old where both CVD and DM were listed as an underlying or contributing cause of death between 1999 and 2019. Crude and age-adjusted mortality rates per 100,000 population were determined. RESULTS The overall age-adjusted mortality rate was 99.18 in 1999 and 91.43 in 2019, with a recent increase from 2014-2019 (annual percent change 1.0; 95% confidence interval [CI], 0.3-1.6). Age-adjusted mortality rate was higher for males compared with females, with increasing mortality in males between 2014 and 2019 (annual percent change 1.5; 95% CI, 0.9-2.0). Age-adjusted mortality rate was highest for non-Hispanic Black adults and was ∼2-fold higher compared with non-Hispanic White adults. Young and middle-aged adults (25-69 years) had increasing age-adjusted mortality rates in recent years. There were significant urban-rural disparities, and age-adjusted mortality rates in rural counties increased from 2014 to 2019 (annual percent change 2.2; 95% CI, 1.5-2.9); states in the 90th percentile of mortality had age-adjusted mortality rates that were ∼2-fold higher than those in the bottom 10th percentile of mortality. CONCLUSION After an initial decrease in DM + CVD-related mortality for a decade, this trend has reversed, with increasing mortality from 2014 to 2019. Significant geographic and demographic disparities persist, requiring targeted health policy interventions to prevent the loss of years of progress.
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Affiliation(s)
| | | | - Robert W Ariss
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Salik Nazir
- Department of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Safi U Khan
- Department of Cardiology, Houston Methodist Hospital, Texas
| | | | | | - Erin Michos
- Department of Cardiology, Johns Hopkins University, Baltimore, Md
| | - Anurag Mehta
- VCU Health Pauley Heart Center, Virginia Commonwealth University School of Medicine, Richmond
| | - Arman Qamar
- Division of Cardiology, NorthShore University Hospital, Evanston, Ill
| | | | | | - Salim S Virani
- Department of Cardiology, Baylor College of Medicine, Houston, Texas
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11
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Ariss RW, Alhazmi L, Nazir S, Khouri SJ, Malhotra D, Rees M, Moukarbel GV. Brain-type natriuretic peptide levels and invasive hemodynamic parameters in dialysis dependent patients. Am J Med Sci 2023; 365:258-262. [PMID: 36152812 DOI: 10.1016/j.amjms.2022.04.035] [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] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) is associated with increased mortality in patients with end-stage renal disease (ESRD). The prevalence of PH within ESRD as measured by right heart catheterization (RHC) is poorly described, and the correlation of BNP to pulmonary artery pressure (PAP) is unknown. METHODS The renal transplant database at our center was used to identify adult ESRD patients from July 2013 to July 2015 who had a plasma BNP level measurement and invasive hemodynamic assessment by RHC within a 1-month period. Pulmonary hypertension was defined as a mean pulmonary artery pressure (PAP) ≥ 25 mmHg. Multivariate linear regression analysis was used to identify correlations between BNP and RHC parameters. To estimate the utility of BNP in the screening of PH, a receiver-operating characteristic (ROC) curve was generated. RESULTS Eighty-eight patients were included in the study of which 43 had PH. Compared to patients without PH, BNP was significantly higher within the PH cohort (1619 ± 2602 pg/ml vs. 352 ± 491 pg/ml). A statistically significant association (r [86] = 0.60, p<0.001) between plasma BNP and mean PAP was identified. ROC curve indicated an acceptable predictive value of BNP in PH with a c-statistic of 0.800 (95% CI 0.708 - 0.892). CONCLUSIONS In ESRD patients being considered for renal transplantation, PH is highly prevalent and BNP levels are elevated and significantly correlated with higher PAP. BNP may be a useful non-invasive marker of PH in these patients.
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Affiliation(s)
- Robert W Ariss
- Department of Medicine, University of Toledo, Toledo, Ohio, USA
| | - Luai Alhazmi
- Department of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Salik Nazir
- Department of Medicine, University of Toledo, Toledo, Ohio, USA
| | - Samer J Khouri
- Department of Medicine, University of Toledo, Toledo, Ohio, USA
| | - Deepak Malhotra
- Department of Medicine, University of Toledo, Toledo, Ohio, USA
| | - Michael Rees
- Department of Urology, University of Toledo, Toledo, Ohio, USA
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12
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Ahuja KR, Nazir S, Ariss RW, Bansal P, Garg R, Ahuja SK, Minhas AMK, Harb S, Krishnaswamy A, Unai S, Kapadia SR. Derivation and Validation of Risk Prediction Model for 30-Day Readmissions Following Transcatheter Mitral Valve Repair. Curr Probl Cardiol 2023; 48:101033. [PMID: 34748783 DOI: 10.1016/j.cpcardiol.2021.101033] [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: 10/01/2021] [Accepted: 10/16/2021] [Indexed: 02/01/2023]
Abstract
Transcatheter mitral valve repair (TMVr) has shown to reduce heart failure (HF) rehospitalization and all cause mortality. However, the 30-day all-cause readmission remains high (∼15%) after TMVr. Therefore, we sought to develop and validate a 30-day readmission risk calculator for TMVr. Nationwide Readmission Database from January 2014 to December 2017 was utilized. A linear calculator was developed to determine the probability for 30-day readmission. Internal calibration with bootstrapped calculations was conducted to assess model accuracy. The root mean square error and mean absolute error were calculated to determine model performance. Of 8339 patients who underwent TMVr, 1246 (14.2%) were readmitted within 30 days. The final 30-day readmission risk prediction tool included the following variables: Heart failure, Atrial Fibrillation, Anemia, length of stay ≥4 days, Acute kidney injury (AKI), and Non-Home discharge, Non-Elective admission and Bleeding/Transfusion. The c-statistic of the prediction model was 0.63. The validation c-statistic for readmission risk tool was 0.628. On internal calibration, our tool was extremely accurate in predicting readmissions up to 20%. A simple and easy to use risk prediction tool identifies TMVr patients at increased risk of 30-day readmissions. The tool can guide in optimal discharge planning and reduce resource utilization.
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Affiliation(s)
- Keerat Rai Ahuja
- Department of Cardiology, Reading Hospital, Tower Health, West Reading, PA.
| | - Salik Nazir
- Department of Cardiology University of Toledo, Toledo, OH
| | - Robert W Ariss
- Department of Cardiology University of Toledo, Toledo, OH
| | | | - Rajat Garg
- Department of Internal Medicine, Forrest General Hospital, Hattiesburg, MS
| | - Satish Kumar Ahuja
- Department of Cardiology, Reading Hospital, Tower Health, West Reading, PA
| | | | - Serge Harb
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | | | - Shinya Unai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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13
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Gupta M, Minhas AMK, Goel SS, Dani SS, Alam M, Nazir S, Khan SU, Aronow W, Jain V. Contemporary trends in utilization and outcomes of percutaneous left atrial appendage occlusion in the United States from 2016 to 2019. Heart Rhythm 2023; 20:313-314. [PMID: 36257480 DOI: 10.1016/j.hrthm.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/21/2022] [Accepted: 10/12/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Mohak Gupta
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Abdul M K Minhas
- Department of Medicine, Forrest General Hospital, Hattiesburg, Mississippi
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Salik Nazir
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Wilbert Aronow
- Department of Cardiology, Westchester Medical Center, New York Medical College, Valhalla, New York
| | - Vardhmaan Jain
- Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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14
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Minhas AMK, Gul S, Sheikh AB, Nazir S, Ahuja KR, Anwar MN, Dani SS, Goel SS, Virani SS, Alam M. Association of Body Mass Index With Outcomes in Patients Undergoing Percutaneous Left Atrial Appendage Closure With the Watchman Device. Curr Probl Cardiol 2022; 47:101009. [PMID: 34599987 DOI: 10.1016/j.cpcardiol.2021.101009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/19/2022]
Affiliation(s)
| | - Sajjad Gul
- Department of Internal Medicine, Reading Hospital-Tower Health System, West Reading, PA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM.
| | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH
| | - Keerat Rai Ahuja
- Department of Cardiology, Reading Hospital-Tower Health System, West Reading, PA
| | - Muhammad Nadeem Anwar
- Department of Internal Medicine, Oklahoma City Veterans Affair Medical Center, Oklahoma City, OK
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Mahboob Alam
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
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15
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Kalsoom T, Nazir S. Thermodynamics, electronic, and magnetic properties of Cr-doped Cr 2CoAl: Biaxial ([110]) strain impact. Materials Science in Semiconductor Processing 2022; 150:106934. [DOI: 10.1016/j.mssp.2022.106934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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16
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Andres M, Murphy TM, Poku N, Nazir S, Ramalingam S, Chambers V, Rosen SD, Lyon AR. Cardio-Oncology: a medical specialty in constant growth and evolution. the 10-year experience of the first cardio-oncology service in the United Kingdom. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2564] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Survivorship has increased significantly in cancer patients with the advent of novel therapies. However, this improvement has been at the cost of higher rates of cardiotoxicity. Cardiovascular disease has become the main cause of death or cancer therapy interruption in many of these patients. The need for specialist services to deal with these emerging problems has led to global development of many Cardio-Oncology services.
Objectives
To describe how a Cardio-Oncology service has grown and evolved over a 10 year period in response to the constantly changing oncological landscape.
Methods and results
Prospective, single center, study of cancer patients referred to our service from February 2011 to December 2021. 1499 patients were referred to the service. Mean age was 60 years (SD: 15) and 60% were female. CV risk factors including hypertension (32%), dyslipidaemia (12%) and diabetes (6%) were common.
The most frequent primary tumour location was breast (427 patients, 28%), followed by haematological (151, 10%) and gastrointestinal tract (114, 8%). The average number of referrals per month increased 6 fold from 2011, from 3.3 patients per month to 21 patients in 2021. In the last 5 years there was a 10 fold increase in the number of outpatient consultations from 189 consultations in 2016 to 1988 consultations in 2021.
The most frequent reason for referral was pre-treatment assessment (39%), followed by cancer therapy related cardiac dysfunction (CTRCD) (33%) and other acute cancer therapy related CV diseases (CTR-CVDs) (22%). From 2011 to 2017 CTRCD was the main CTR-CVD due to anthracycline and trastuzumab. This ratio changed in 2018 when other CTR-CVDs became the most frequent referral reason following pre-treatment assessment. Patients referred to our service were or had been, mostly under medical therapy alone or in combination with surgery or radiotherapy (1058 patients, 70%), anthracyclines being the predominant treatment (435 patients, 40%). Targeted therapies and immune check point inhibitors became more popular in the last two years (2020–2021). A multivariable logistic regression model was built to assess the relation between the medical treatment and the prevalence of CTRCD vs other CTR-CVDs. Anthracyclines and HER2 therapy are independently associated with a higher prevalence of CTRCD while tyrosine kinase inhibitors and immune checkpoint inhibitors increase the risk of other CTR-CVDs e.g. hypertension, arrhythmias and myocarditis.
Conclusions
Cardio-Oncology has rapidly evolved from its origin as a subspecialty of heart failure medicine, to a diverse medical specialty that encompasses many different domains of cardiology. Future cardio-oncology services should reflect this and be dynamic, collaborating with cardiac sub-specialities as necessary. Provision of cardio-oncology services requires a considerable knowledge and understanding of the ever growing and changing oncology therapies.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Andres
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - T M Murphy
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - N Poku
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - S Nazir
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - S Ramalingam
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - V Chambers
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - S D Rosen
- Royal Brompton and Harefield Hospital , London , United Kingdom
| | - A R Lyon
- Royal Brompton and Harefield Hospital , London , United Kingdom
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17
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Ariss RW, Minhas AMK, Lang J, Ramanathan PK, Khan SU, Kassi M, Warraich HJ, Kolte D, Alkhouli M, Nazir S. Demographic and Regional Trends in Stroke-Related Mortality in Young Adults in the United States, 1999 to 2019. J Am Heart Assoc 2022; 11:e025903. [PMID: 36073626 DOI: 10.1161/jaha.122.025903] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Indexed: 11/16/2022]
Abstract
Background Despite improvements in the management and prevention of stroke, increasing hospitalizations for stroke and stagnant mortality rates have been described in young adults. However, there is a paucity of contemporary national mortality estimates in young adults. Methods and Results Trends in mortality related to stroke in young adults (aged 25-64 years) were assessed using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Age-adjusted mortality rates per 100 000 people with associated annual percentage change were calculated. Joinpoint regression was used to assess the trends in the overall sample and different demographic (sex, race and ethnicity, and age) and geographical (state, urban-rural, and regional) subgroups. Between 1999 and 2019, a total of 566 916 stroke-related deaths occurred among young adults. After the initial decline in mortality in the overall population, age-adjusted mortality rate increased from 2013 to 2019 with an associated annual percentage change of 1.5 (95% CI, 1.1-2.0). Mortality rates were higher in men versus women and in non-Hispanic Black people versus individuals of other races and ethnicities. Non-Hispanic American Indian or Alaskan Native people had a marked increase in stroke-related mortality (annual percentage change 2010-2019: 3.3). Furthermore, rural (nonmetropolitan) counties experienced the greatest increase in mortality (annual percentage change 2012-2019: 3.1) compared with urban (metropolitan) counties. Conclusions Following the initial decline in stroke-related mortality, young adults have experienced increasing mortality rates from 2013 to 2019, with considerable differences across demographic groups and regions.
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Affiliation(s)
- Robert W Ariss
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH.,ProMedica Heart and Vascular Institute, ProMedica Toledo Hospital Toledo OH.,Department of Medicine Brigham and Women's Hospital, Harvard Medical School Boston MA
| | | | - Jacob Lang
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH
| | - P Kasi Ramanathan
- ProMedica Heart and Vascular Institute, ProMedica Toledo Hospital Toledo OH
| | - Safi U Khan
- Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Mahwash Kassi
- Department of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TX
| | - Haider J Warraich
- Division of Cardiovascular Medicine Brigham and Women's Hospital Boston MA.,Cardiology Section, Department of Medicine VA Boston Healthcare System Boston MA
| | - Dhaval Kolte
- Cardiology Division Massachusetts General Hospital and Harvard Medical School Boston MA
| | | | - Salik Nazir
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH.,ProMedica Heart and Vascular Institute, ProMedica Toledo Hospital Toledo OH.,Section of Cardiology Baylor College of Medicine Houston TX
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18
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Minhas AMK, Wyand RA, Ariss RW, Nazir S, Shahzeb Khan M, Jia X, Greene SJ, Fudim M, Wang A, Warraich HJ, Kalra A, Alam M, Virani SS. Demographic and Regional Trends of Hypertrophic Cardiomyopathy-Related Mortality in the United States, 1999 to 2019. Circ Heart Fail 2022; 15:e009292. [PMID: 36126142 DOI: 10.1161/circheartfailure.121.009292] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM)-related mortality has been decreasing within the United States; however, persistent disparities in demographic subsets may exist. In this study, we assessed nationwide trends in mortality related to HCM among people ≥15 years of age in the United States from 1999 to 2019. METHODS Trends in mortality related to HCM were assessed through a cross-sectional analysis of the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiological Research database. Age-adjusted mortality rates per 1 000 000 people and associated annual percent changes with 95% CIs were determined. Joinpoint regression was used to assess the trends in the overall, demographic (sex, race and ethnicity, age), and regional groups. RESULTS Between 1999 and 2019, 39 200 HCM-related deaths occurred. In the overall population, age-adjusted mortality rate decreased from 11.2 in 1999 to 5.4 in 2019. Higher mortality rates were observed for males, Black patients, and patients ≥75 years of age. Large metropolitan counties experienced pronounced declines in age-adjusted mortality rate over the study period. In addition, California had the highest overall age-adjusted mortality rate. CONCLUSIONS Over the past 2 decades, HCM-related mortality has decreased overall in the United States. However, demographic and geographic disparities in HCM-related mortality have persisted over time and require further investigation.
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Affiliation(s)
| | - Rachel A Wyand
- Department of Pediatrics, Medical University of South Carolina, Charleston (R.A.W.)
| | - Robert W Ariss
- Division of Cardiovascular Medicine, University of Toledo Medical Center, OH (R.W.A., S.N.)
| | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, OH (R.W.A., S.N.)
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Duke University Medical Center, Durham, NC (M.S.K., S.J.G., M.F., A.W.)
| | - Xiaoming Jia
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (X.J., M.A., S.S.V.)
| | - Stephen J Greene
- Division of Cardiology, Duke University Medical Center, Durham, NC (M.S.K., S.J.G., M.F., A.W.).,Duke Clinical Research Institute, Durham, NC (S.J.G., M.F.)
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC (M.S.K., S.J.G., M.F., A.W.).,Duke Clinical Research Institute, Durham, NC (S.J.G., M.F.)
| | - Andrew Wang
- Division of Cardiology, Duke University Medical Center, Durham, NC (M.S.K., S.J.G., M.F., A.W.)
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.J.W.)
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (A.K.)
| | - Mahboob Alam
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (X.J., M.A., S.S.V.)
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX (X.J., M.A., S.S.V.).,Michael E. DeBakey Veterans Affair Medical Center, Houston, TX (S.S.V.)
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19
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Nazir S, Minhas AMK, Deshotels M, Kamat IS, Cheema T, Birnbaum Y, Moukarbel GV, Bozkurt B, Hemant R, Jneid H. Outcomes and Resource Utilization in Patients Hospitalized with Gastrointestinal Bleeding Complicated by Types 1 and 2 Myocardial Infarction. Am J Med 2022; 135:975-983.e2. [PMID: 35469737 DOI: 10.1016/j.amjmed.2022.04.001] [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: 01/09/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Types 1 and 2 myocardial infarction (MI) may occur in the setting of gastrointestinal bleeding (GIB). There is a paucity of data pertinent to the contemporary prevalence and impact of types 1 and 2 MI following GIB. We examined clinical profiles and the prognostic impact of both MI types on outcomes of patients hospitalized with GIB. METHODS The 2018 Nationwide Readmission Database was queried for patients hospitalized for the primary diagnosis of GIB and had concomitant diagnoses of type 1 or type 2 MI. Baseline characteristics, in-hospital mortality, resource utilization, and 30-day all-cause readmissions were compared among groups. RESULTS Of 381,867 primary GIB hospitalizations, 2902 (0.75%) had type 1 MI and 3963 (1.0%) had type 2 MI. GIB patients with type 1 and type 2 MI had significantly higher in-hospital mortality compared to their counterparts without MI (adjusted odds ratios [aOR]: 4.72, 95% confidence interval [CI] 3.43-6.48; and aOR: 2.17, 95% CI 1.48-3.16, respectively). Both types 1 and 2 MI were associated with higher rates of discharge to a nursing facility (aOR of type 1 vs. no MI: 1.65, 95% CI 1.45-1.89, and aOR of type 2 vs no MI: 1.37, 95% CI 1.22-1.54), longer length of stay, higher hospital costs, and more 30-day all-cause readmissions (aOR of type 1 vs no MI: 1.22, 95% CI 1.08-1.38; aOR of type 2 vs no MI: 1.17, 95% CI 1.05-1.30). CONCLUSION Types 1 and 2 MI are associated with higher in-hospital mortality and resource utilization among patients hospitalized with GIB in the United States.
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Affiliation(s)
- Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio
| | | | - Matt Deshotels
- Section of Cardiology, Baylor College of Medicine, Houston, Tex
| | - Ishan S Kamat
- Division of Medicine, West Suburban Medical Center, Oak Park, Ill
| | - Tayyab Cheema
- Division of Medicine, West Suburban Medical Center, Oak Park, Ill
| | - Yochai Birnbaum
- Section of Cardiology, Baylor College of Medicine, Houston, Tex
| | - George V Moukarbel
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Biykem Bozkurt
- Section of Cardiology, Baylor College of Medicine, Houston, Tex
| | - Roy Hemant
- Division of Medicine, West Suburban Medical Center, Oak Park, Ill
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine, Houston, Tex.
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20
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Ariss RW, Minhas AMK, Lang J, Ramanathan PK, Khan SU, Kassi M, Warraich HJ, Kolte D, Alkhouli M, Nazir S. Urban-Rural Trends in Young Stroke-Related Mortality in the United States, 1999-2019. J Am Coll Cardiol 2022; 80:466-468. [PMID: 35863854 DOI: 10.1016/j.jacc.2022.05.018] [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] [Received: 12/06/2021] [Revised: 04/28/2022] [Accepted: 05/13/2022] [Indexed: 10/17/2022]
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Minhas AMK, Sagheer S, Ijaz SH, Nazir S, Khan MS, Zaidi SH, Fudim M, Rodriguez F, Johnson HM, Virani SS. Persistent Racial/Ethnic Disparities in Cardiology Trainees in the United States. J Am Coll Cardiol 2022; 80:276-279. [PMID: 35835499 DOI: 10.1016/j.jacc.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/19/2022] [Indexed: 11/18/2022]
Affiliation(s)
| | - Shazib Sagheer
- Department of Cardiology, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts, USA
| | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | | | - Syeda Humna Zaidi
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina, USA; Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Heather M Johnson
- Christine E. Lynn Women's Health and Wellness Institute, Boca Raton Regional Hospital/Baptist Health South Florida, Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center and Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
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Minhas AMK, Sheikh AB, Ijaz SH, Mostafa A, Nazir S, Khera R, Loccoh EC, Warraich HJ. Rural-Urban Disparities in Heart Failure and Acute Myocardial Infarction Hospitalizations. Am J Cardiol 2022; 175:164-169. [PMID: 35577603 DOI: 10.1016/j.amjcard.2022.04.014] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/01/2022]
Abstract
Substantial gaps in clinical outcomes exist in rural and urban hospitals in the United States. We used the National Inpatient Sample to examine trends in hospitalizations, in-hospital mortality, length of stay, and inflation-adjusted cost of adults admitted for heart failure (HF) and acute myocardial infarction (AMI) in rural and urban hospitals between 2004 and 2018. From 2004 to 2013 and 2014, there was an initial decrease in age-adjusted HF hospitalizations in both urban (annual percent change [APC] -3.9 [95% confidence interval [CI] -4.3 to -3.5] p <0.001) and rural hospitals (APC -5.9 [95% CI -6.4 to -5.3] p <0.001), after which hospitalizations for HF increased in urban areas (APC 4.2 [95% CI 3.2 to 5.3] p <0.001) and remained stable in rural areas (APC 0.2 [95% CI -2.1 to 2.6] p = 0.863). Urban AMI hospitalizations decreased between 2004 and 2010 (APC -4.4 [95% CI -5.3 to -3.3] p <0.001) and subsequently remained stable (APC 0.2 [95% CI -0.5 to 0.9] p = 0.552), whereas rural AMI hospitalizations had a consistent decrease throughout the study period (APC -4.2 [95% CI -5.0 to -3.4] p <0.001). Overall, urban hospitals had lower in-hospital mortality for HF and AMI than rural hospitals (3.1% vs 3.5%, p <0.001% and 5.4% vs 6.5%, p <0.001), respectively. Initially, in-hospital mortality was higher in rural hospitals; however, the rural-urban hospital mortality gap decreased during the study period for both HF and AMI. Rural hospitals had a shorter mean length of stay for HF and AMI (4.4 vs 5.5 days, p <0.001 and 3.9 vs 4.7 days, p <0.001) and lower inflation-adjusted costs for both HF and AMI ($8,897.1 vs $13,420.8, p <0.001 and $15,301.6 vs $22,943.7, p <0.001) when compared with urban hospitals. In conclusion, a consistent decrease in the in-hospital mortality gap in rural and urban hospitals for HF and AMI suggests improvement in inpatient rural cardiovascular care during the study period. Continued healthcare policy reforms are warranted to alleviate the disparities in rural-urban cardiovascular outcomes.
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Kamat IS, Nazir S, Minhas AMK, Nambi V, Kulkarni P, Musher D, Bozkurt B, Plana JC, Jneid H. Outcomes of Hospitalizations With Septic Shock Complicated by Types 1 and 2 Myocardial Infarction. Am J Cardiol 2022; 174:27-33. [PMID: 35523592 DOI: 10.1016/j.amjcard.2022.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/20/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
Septic shock is a life-threatening host response to infection and a significant contributor to cost burden in the United States. Furthermore, sepsis-related inflammation has been linked to myocardial infarction (MI). We sought to examine the association of type 1 and type 2 MI with outcomes in hospitalizations admitted with septic shock. The National Readmission Database 2018 was queried to identify hospitalizations with hospital discharge diagnoses of septic shock without MI, septic shock with type 1 MI, or septic shock with type 2 MI. Complex-sample multivariable logistic and linear regression models were used to determine the association of these conditions with clinical outcomes. Of 354,528 hospitalizations with septic shock, 11,519 had type 1 MI (3.2%) and 13,970 had type 2 MI (3.9%). Compared with septic shock without MI, type 1 MI was associated with higher mortality (adjusted odds ratio [OR] 1.67, 95% confidence interval [CI] 1.57 to 1.77), costs (adjusted parameter estimate $4,571, 95% CI 3,020 to 6,122), and discharge to facility (adjusted OR 1.09, 95% CI 1.01 to 1.17). In contrast, septic shock with type 2 MI was associated with similar mortality and discharge to nursing facility and higher costs (adjusted parameter estimate 1,798, 95% CI 549 to 3,047). Septic shock hospitalizations with type 1 MI had higher in-hospital mortality (adjusted OR 1.74, 95% CI 1.60 to 1.90, p <0.001) compared with type 2 MI. In conclusion, type 1 MI is associated with higher mortality and resource utilization among septic shock hospitalizations. Furthermore, type 2 MI was associated with higher resource utilization.
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Affiliation(s)
| | - Salik Nazir
- Section of Cardiology, University of Toledo Medical Center, Toledo, Ohio
| | | | - Vijay Nambi
- Section of Cardiology; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Prathit Kulkarni
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Daniel Musher
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Biykem Bozkurt
- Section of Cardiology; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | | | - Hani Jneid
- Section of Cardiology; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
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Hassan N, Nazir S, Sharif U. Effect of risperidone on the cravings of patients with methamphetamine use disorder. Eur Psychiatry 2022. [PMCID: PMC9567441 DOI: 10.1192/j.eurpsy.2022.933] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction Methamphetamine associated psychosis has increased globally because of the increased usage of the substance. The use of risperidone is noted to reduce the cravings of methamphetamine in patients who have methamphetamine use disorder. This becomes relevant because the number of patients who are being treated with MAP tends to have high relapse rates. MAP is being treated with different antipsychotics and the treatment protocol is made usually for alleviating the symptoms, a formal treatment regimen for patients with MAP is yet to be developed (Chiang et al 2018; Srisurapanont 2021; Edwards and Mooney 2014) Objectives The purpose of this review is to highlight the use of risperidone in reducing the cravings of methamphetamine in patients who have methamphetamine use disorder Methods PubMed, SCOPUS and Web of Science literature databases were screened and filtered.With established Inclusion and exclusion criteria, obtained a total of 15578 hits which was refined to 133articles. A total of 10papers were reviewed in detail Results Multiple clinical trials have shown that risperidone was effective in lowering drug cravings in methamphetamine use disorder. Along with the effects on craving, risperidone has also been studied for its effect on positive symptoms in patients with MAP (Samei 2016). Risperidone was noted to be effective in reducing positive symptoms. Conclusions Risperidone can be effectively used in the acute setting for psychosis and future cravings in the patients. Considering the limited clinical trials and research on risperidone and the cravings of methamphetamine use disorder, studies are needed with longer follow-ups and more samples in the future. Disclosure No significant relationships.
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Nazir S, Talpur A, Hassan N, Sharif U. Olanzapine and its use for methamphetamine-induced psychosis. Eur Psychiatry 2022. [PMCID: PMC9567821 DOI: 10.1192/j.eurpsy.2022.1853] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Over time the prevalence of methamphetamine associated psychosis (MAP) has increased globally including Asia and Europe. Shoptaw et al looked at an RCT and concluded that olanzapine is superior to haloperidol in terms of tolerability and the side effect profile as it causes fewer extrapyramidal symptoms. Another study by Xue et al compared the efficacy of olanzapine and haloperidol and found that they had comparable effects but the onset time in the olanzapine group was significantly earlier than the haloperidol group. Srisurapanont et al analyzed 6 RCTs and concluded that quetiapine and olanzapine are probably superior than aripiprazole and risperidone. Objectives The purpose of this review is to find out if olanzapine is better than other antipsychotics in treating methamphetamine-induced psychosis. Methods PubMed, SCOPUS, and Web of Science literature databases were screened and filtered by using specific search terms, inclusion/exclusion criteria. Texts of the selected articles and trials were reviewed and the search terms generated a total of 248 results from the databases. After applying the criteria 200 citations were left and 15 papers were reviewed. Results The literature review concluded that olanzapine can be used as an effective treatment for methamphetamine-induced psychosis. Olanzapine can help to reduce the psychotic symptoms in MAP with a quicker onset and lesser side effects. Conclusions Olanzapine can help in the treatment of methamphetamine-associated psychosis and can be considered as the first-line therapy. Research is further needed with a higher pool of candidates in the future to compare the efficacy and tolerability of different typical and atypical antipsychotics. Disclosure No significant relationships.
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Nazir S, Ariss RW, Khan Minhas AM, Ahuja KR, Jneid H, Moukarbel GV. Outcomes of Patients With Type 2 Myocardial Infarction Complicating Acute Ischemic Stroke. Mayo Clin Proc 2022; 97:1145-1155. [PMID: 35487788 DOI: 10.1016/j.mayocp.2021.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 10/31/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To study the patient profiles and the prognostic impact of type 2 myocardial infarction (MI) on outcomes of acute ischemic stroke (AIS). METHODS The National Readmission Database 2018 was queried for patients with primary AIS hospitalizations with and without type 2 MI. Baseline characteristics, inpatient outcomes, and 30-day all-cause readmissions between cohorts were compared. RESULTS Of 587,550 AIS hospitalizations included in the study, 4182 (0.71%) had type 2 MI. Patients with type 2 MI were older (73.6 years vs 70.1 years; P<.001) and more likely to be female (52% vs 49.7%; P<.001), and they had a higher prevalence of heart failure (32.6% vs 15.5%; P<.001), atrial fibrillation (38.5% vs 24.2%; P<.001), prior MI (8.8% vs 7.7%; P<.001), valvular heart disease (17% vs 9.8%; P<.001), peripheral vascular disease (12.2% vs 9.2%; P<.001), and chronic kidney disease (24.4% vs 16.7%; P<.001). Compared with patients without type 2 MI, AIS patients with type 2 MI had significantly higher in-hospital mortality (adjusted odds ratio [aOR], 1.96; 95% CI, 1.65 to 2.32), poor functional outcome (aOR, 1.80; 95% CI, 1.62 to 2.00), more hospital costs (adjusted parameter estimate, $5618; 95% CI, $4480 to $6755), higher rate of discharge to a facility (aOR, 1.70; 95% CI, 1.52 to 1.90), increased length of stay (adjusted parameter estimate, 2.22; 95% CI, 1.72 to 2.72), and higher rate of 30-day all-cause readmissions (aOR, 1.38; 95% CI, 1.18 to 1.60). CONCLUSION Type 2 MI in patients hospitalized with AIS is associated with poor prognosis and higher resource utilization.
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Affiliation(s)
- Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH
| | - Robert W Ariss
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH
| | | | - Keerat Rai Ahuja
- Department of Cardiology, Reading Hospital-Tower Health System, West Reading, PA
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine, Houston, TX
| | - George V Moukarbel
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH.
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Nazir S, Minhas AMK, Patel VB, Hirji S, Sheikh M, Ramanathan PK, Preventza O, Jneid H. Outcomes of Minimally Invasive Surgery Versus Surgical and Transcatheter Aortic Valve Replacement. Am J Cardiol 2022; 169:154-156. [PMID: 35168756 DOI: 10.1016/j.amjcard.2022.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 01/18/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio
| | | | - VivekKumar B Patel
- Division of Cardiothoracic Surgery, Baylor college of Medicine, Houston, Texas
| | - Sameer Hirji
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mujeeb Sheikh
- Section of Cardiology, ProMedica Toledo Hospital, Toledo, Ohio
| | | | - Ourania Preventza
- Division of Cardiothoracic Surgery, Baylor college of Medicine, Houston, Texas
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine, Houston, Texas.
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Ijaz SH, Jamal S, Minhas AMK, Sheikh AB, Nazir S, Khan MS, Minhas AS, Hays AG, Warraich HJ, Greene SJ, Fudim M, Honigberg MC, Khan SS, Paul TK, Michos ED. Trends in Characteristics and Outcomes of Peripartum Cardiomyopathy Hospitalizations in the United States Between 2004 and 2018. Am J Cardiol 2022; 168:142-150. [PMID: 35074213 PMCID: PMC9944609 DOI: 10.1016/j.amjcard.2021.12.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Received: 10/27/2021] [Revised: 12/25/2021] [Accepted: 12/28/2021] [Indexed: 12/20/2022]
Abstract
Data are limited on contemporary temporal trends in maternal characteristics and outcomes in hospitalized patients with peripartum cardiomyopathy (PC). We used the National Inpatient Sample database from January 1, 2004, to December 31, 2018, to identify PC hospitalizations in women aged 15 to 54 years. Weighted survey data were used to derive national estimates for the United States population and examine trends. Between 2004 and 2018, there was a total of 23,420 weighted hospitalizations for PC in women aged 15 to 54 years. The mean (standard error) age of this hospitalized PC population was 30.3 (0.1) years, with 44.6% White, 39.3% Black, 9.0% Hispanics, and 7.1% "Other" racial/ethnic groups. There was a nonsignificant increase in the PC hospitalization per 100,000 live births from 33.6 in 2004 to 42.4 in 2018 (p-trend = 0.06) over the study period, driven by a statistically significant increase in the younger women age group 15 to 35 years (p-trend = 0.04). The PC hospitalizations per 100,000 live births for women aged 36 to 54 years were more than double that observed in women aged 15 to 35 years (77.6 vs 33.5). PC hospitalizations were more than threefold greater in Black versus White women (103.5 vs 32.0 per 100,000 live births). Overall, inpatient mortality was 0.8%; the adjusted inpatient mortality showed a nonsignificant overall decrease from 1.1% in 2004 to 0.5% in 2018 (p-trend = 0.15). The overall mean length of stay was 4.6 days; the adjusted mean length of stay decreased from 5.8 days in 2004 to 4.6 days in 2018 (p-trend <0.01). In conclusion, there has been a nonsignificant increase in hospitalizations for PC, driven by an increasing rate of hospitalizations in younger women. The older maternal age group and Black patients had a higher proportional hospitalization as compared with the younger age group and White patients. There was a nonsignificant decrease in inpatient mortality.
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Affiliation(s)
- Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Shakeel Jamal
- College of Medicine, Central Michigan University, Saginaw, Michigan
| | | | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, Ohio
| | | | - Anum S. Minhas
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Haider J. Warraich
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stephen J. Greene
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina,Duke Clinical Research Institute, Durham, North Carolina
| | - Marat Fudim
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina,Duke Clinical Research Institute, Durham, North Carolina
| | | | - Sadiya S. Khan
- Division of Cardiology, Department of Medicine,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Timir K. Paul
- Division of Cardiology, East Tennessee State University, Johnson City, Tennessee
| | - Erin D. Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Mhanna M, Minhas AMK, Ariss RW, Nazir S, Khan SU, Vaduganathan M, Blankstein R, Alam M, Nasir K, Virani SS. Racial Disparities in Clinical Outcomes and Resource Utilization of Type 2 Myocardial Infarction in the United States: Insights from the National Inpatient Sample Database. Curr Probl Cardiol 2022:101202. [DOI: 10.1016/j.cpcardiol.2022.101202] [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] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 11/03/2022]
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Mhanna M, Minhas AMK, Ariss RW, Ahuja KR, Mostafa A, Nazir S, Sheikh M. Transcatheter Versus Surgical Aortic Valve Replacement in Hypertrophic Cardiomyopathy Patients with Aortic Stenosis. Curr Probl Cardiol 2022:101180. [PMID: 35341800 DOI: 10.1016/j.cpcardiol.2022.101180] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/22/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are well established treatment options for severe aortic stenosis (AS). However, patients with hypertrophic cardiomyopathy (HCM) were excluded from pivotal randomized controlled trials of TAVR versus SAVR. METHOD We queried the 2016 to 2019 National Inpatient Sample to identify adult hospitalizations with HCM who underwent SAVR or TAVR for severe AS. The primary outcome was in-hospital mortality. Secondary outcomes included cardiac arrest, new permanent pacemaker (PPM), cardiac tamponade, bleeding requiring transfusion, stroke/transient ischemic attack (TIA), acute kidney injury (AKI), and resource utilization (length of stay [LOS], hospital costs, and discharge to facility). RESULTS Of 1,245 HCM hospitalizations with severe AS, 595(47.8%) underwent TAVR and 650 (52.2%) underwent SAVR. In-hospital mortality rate was lower in the TAVR group. Cardiac arrest, cardiogenic shock, pressor use, new PPM, and cardiac tamponade were not significantly different between the two groups. When compared to SAVR, TAVR was associated with lower rates of bleeding requiring transfusion, vascular complications, AKI, and invasive mechanical ventilation. Furthermore, TAVR was associated with a shorter hospital stay, fewer facility discharges, but comparable hospital costs. CONCLUSION Our findings indicate that TAVR is associated with lower risk of in-hospital mortality, certain peri-procedural complications, shorter hospital stay, and fewer facility discharges in HCM patients with isolated AS compared to SAVR. Further studies are needed to assess the mid- and long-term outcomes of TAVR versus SAVR in HCM patients with AS.
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Affiliation(s)
- Mohammed Mhanna
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA.
| | | | - Robert W Ariss
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Keerat Rai Ahuja
- Division of Cardiology, Reading Hospital-Tower Health System, West Reading, Pennsylvania, USA
| | - Abdelmonem Mostafa
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Salik Nazir
- Department of Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Mujeeb Sheikh
- Division of Cardiovascular Medicine, ProMedica Toledo Hospital, Toledo, OH, USA.
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Nazir S, Ariss RW, Minhas AMK, Issa R, Michos ED, Birnbaum Y, Moukarbel GV, Ramanathan PK, Jneid H. Demographic and Regional Trends of Mortality in Patients With Aortic Dissection in the United States, 1999 to 2019. J Am Heart Assoc 2022; 11:e024533. [PMID: 35301872 PMCID: PMC9075427 DOI: 10.1161/jaha.121.024533] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Aortic dissection (AoD) is associated with high morbidity and mortality. However, the burden of AoD mortality is not well characterized, and contemporary data and mortality trends in different demographic and geographic subgroups have not been described. Methods and Results Trends in AoD mortality were assessed using a cross‐sectional analysis of the Centers for Disease Control and Prevention Wide‐Ranging Online Data for Epidemiologic Research database. Crude and age‐adjusted mortality rates (AAMR) per 1 million people with associated annual percent changes were determined. Joinpoint regression was used to assess trends in the overall sample and different demographic (sex, race and ethnicity, age) and geographic subgroups. Between 1999 and 2019, a total of 86 855 AoD deaths occurred within the United States. In the overall population, AAMR was 21.1 per 1 million in 1999 and 21.3 in 2019. After an initial decline in mortality, AAMR increased from 2012 to 2019, with an associated annual change of 2.5% (95% CI, 1.8–3.3). Men, older adults (aged ≥85 years), and non‐Hispanic Black or African American individuals had higher mortality rates than women, younger individuals, and other racial and ethnic individuals, respectively. Despite lower AAMRs throughout the study period, women experienced greater increases in AAMR from 2012 to 2019 compared with men. Similarly, non‐Hispanic Black or African American individuals had a pronounced increase in AAMR from 2012 to 2019. Conclusions Despite an initial decline in AoD mortality, the mortality rate has been increasing from 2012 to 2019, with pronounced increases among women and non‐Hispanic Black or African American individuals.
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Affiliation(s)
- Salik Nazir
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH.,Section of Cardiology ProMedica Toledo Hospital Toledo OH
| | - Robert W Ariss
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH.,Section of Cardiology ProMedica Toledo Hospital Toledo OH
| | | | - Rochell Issa
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH.,Section of Cardiology ProMedica Toledo Hospital Toledo OH
| | - Erin D Michos
- Division of Cardiology Johns Hopkins University School of Medicine Baltimore MD
| | | | - George V Moukarbel
- Division of Cardiovascular Medicine University of Toledo Medical Center Toledo OH
| | | | - Hani Jneid
- Section of Cardiology Baylor College of Medicine Houston TX
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Elzanaty A, Khalil M, Patel N, Meenakshisundaram C, Nazir S, Zafrullah F, Elgendy I, Maraey AM, Aboulnour H. IMPACT OF MEDIASTINAL IRRADIATION HISTORY ON CORONARY ARTERY BYPASS GRAFTING SHORT TERM OUTCOMES: INSIGHTS FROM NATIONAL READMISSION DATABASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01913-1] [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: 10/18/2022]
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Elzanaty A, Maraey AM, Khalil M, Nazir S, Elsharnoby HR, Harhash A, Moukarbel GV. THE ASSOCIATION OF RIGHT HEART CATHETERIZATION TIMING AND OUTCOMES OF PATIENTS WITH CARDIOGENIC SHOCK. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01238-4] [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: 10/18/2022]
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Kamat I, Nazir S, Minhas AK, Deshotels M, Cheema T, Birnbaum Y, Jneid H. OUTCOMES AND RESOURCE UTILIZATION IN PATIENTS HOSPITALIZED WITH GASTROINTESTINAL BLEEDING COMPLICATED BY TYPES 1 AND 2 MYOCARDIAL INFARCTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02080-0] [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: 10/18/2022]
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Ahuja KR, Qatanani A, Khan Minhas AM, Ariss RW, Mahmood A, Ahuja SK, Vyas R, Nazir S. Urban-Rural Disparity Trends in Aortic Aneurysm Mortality in the United States, 1999-2019. J Am Coll Cardiol 2022; 79:614-616. [PMID: 35144753 DOI: 10.1016/j.jacc.2021.12.004] [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] [Received: 09/27/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022]
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Mir T, Uddin M, Qureshi W, Micho-Ulbeh T, Nazir S, Kichloo A, Babu MA, Ullah W, Sattar Y, Abohashem S, Saydain G, Bhat Z, Sheikh M. Acute myocardial infarction and acute heart failure among renal transplant recipients: a national readmissions database study. J Nephrol 2022; 35:1851-1862. [PMID: 35138626 DOI: 10.1007/s40620-022-01252-w] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/27/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The literature on the mortality and 30-day readmissions for acute heart failure and for acute myocardial infarction among renal-transplant recipients is limited. OBJECTIVE To study the in-hospital mortality, cardiovascular complications, and 30-day readmissions among renal transplant recipients (RTRs). METHODS Data from the national readmissions database sample, which constitutes 49.1% of all hospitals in the United States and represents more than 95% of the stratified national population, was analyzed for the years 2012-2018 using billing codes. RESULTS A total of 588,668 hospitalizations in renal transplant recipients (mean age 57.7 ± 14.2 years; 44.5% female) were recorded in the study years. A total of 15,788 (2.7%) patients had a diagnosis of acute heart failure; 11,320 (71.7%) had acute heart failure with preserved ejection fraction and 4468 (28.3%) had acute heart failure with reduced ejection fraction; 17,256 (3%) patients had myocardial infarction, 3496 (20%) had ST-Elevation myocardial infarction while 13,969 (80%) had non-ST-elevation myocardial infarction. Overall, 11,675 (2%) renal-transplant patients died, of whom 757 (6.5%) had acute heart failure, 330 (2.8%) had acute reduced and 427 (3.7%) had acute preserved ejection fraction failure. Among 1652 (14.1%) patient deaths with myocardial infarction, 465 (4%) were ST-elevation- and 1187 (10.1%) were non-ST-Elevation-related. The absolute yearly mortality rate due to acute heart failure increased over the years 2012-2018 (p-trend 0.0002, 0.001, 0.002, 0.05, respectively), while the mortality rate due to myocardial infarction with ST-elevation decreased (p-trend 0.002). CONCLUSION Cardiovascular complications are significantly associated with hospitalizations among RTRs. The absolute yearly mortality, and rate of heart failure (with reduced or preserved ejection fraction) increased over the study years, suggesting that more research is needed to improve the management of these patients.
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Affiliation(s)
- Tanveer Mir
- Internal Medicine, Wayne State University, 4201, St Antoine St., Detroit, MI, 4820, USA.
| | - Mohammed Uddin
- Internal Medicine, Wayne State University, 4201, St Antoine St., Detroit, MI, 4820, USA
| | - Waqas Qureshi
- Cardiology Division, University of Massachusetts, Worcester, MA, USA
| | - Tarec Micho-Ulbeh
- Internal Medicine, Wayne State University, 4201, St Antoine St., Detroit, MI, 4820, USA
| | - Salik Nazir
- Cardiology Division, University of Toledo, Toledo, OH, USA
| | - Asim Kichloo
- Internal Medicine, Central Michigan University, Saginaw, MI, USA
| | - Mohammed Amir Babu
- Division of Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Waqas Ullah
- Division of Cardiology, Abington Jefferson Health, Abington, PA, USA
| | - Yasar Sattar
- Division of Cardiology, University of West Virginia, Morgantown, WV, USA
| | - Shady Abohashem
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ghulam Saydain
- Internal Medicine, Wayne State University, 4201, St Antoine St., Detroit, MI, 4820, USA
| | - Zeenat Bhat
- Nephrology Division, Wayne State University, Detroit, MI, USA
| | - Mujeeb Sheikh
- Division of Cardiology, Promedica, Toledo, Toledo, OH, USA
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Ariss RW, Minhas AMK, Issa R, Ahuja KR, Patel MM, Eltahawy EA, Michos ED, Fudim M, Nazir S. Demographic and Regional Trends of Mortality in Patients With Acute Myocardial Infarction in the United States, 1999 to 2019. Am J Cardiol 2022; 164:7-13. [PMID: 34857365 DOI: 10.1016/j.amjcard.2021.10.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 01/15/2023]
Abstract
Acute myocardial infarction (AMI)-related mortality has been decreasing within the United States because of improvements in management and preventive efforts; however, persistent disparities in demographic subsets such as race may exist. In this study, the nationwide trends in mortality related to AMI in adults in the United States from 1999 to 2019 are described. Trends in mortality related to AMI were assessed through a cross-sectional analysis of the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Age-adjusted mortality rates per 100,000 people and associated annual percentage change and average annual percentage changes with 95% confidence intervals (CIs) were determined. Joinpoint regression was used to assess the trends in the overall, demographic (gender, race/ethnicity, age), and regional groups. Between 1999 and 2019, a total of 3,655,274 deaths related to AMI occurred. In the overall population, age-adjusted mortality rates decreased from 134.7 (95% CI 134.2 to 135.3) in 1999 to 48.5 (95% CI 48.3 to 48.8) in 2019 with an average annual percentage change of -5.0 (95% CI -5.5 to -4.6). Higher mortality rates were seen in Black individuals, men, and those living in the South. Patients older than 85 years experienced substantial decreases in mortality. In addition, rural counties had persistently higher mortality rates in comparison with urban counties. In conclusion, despite decreasing mortality rates in all groups, persistent disparities continued to exist throughout the study period.
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Akhlaq A, Ali HF, Sheikh AB, Muhammad H, Ijaz SH, Sattar MH, Nazir S, Ud Din MT, Nasir U, Khan MZ, Muslim MO, Wazir MHK, Dani SS, Fudim M, Minhas AMK. Cardiovascular Diseases in the Patients with Psoriatic Arthritis. Curr Probl Cardiol 2022; 48:101131. [PMID: 35124075 DOI: 10.1016/j.cpcardiol.2022.101131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
There are limited data regarding the burden and trend of cardiovascular diseases (CVD) in psoriatic arthritis (PsA). We analyzed the National Inpatient Sample database from January 2005 to December 2018 to examine the hospitalization trends amongst adults with PsA primarily for heart failure (HF), acute myocardial infarction (AMI), and stroke. The primary outcomes of interest included in-hospital mortality, length of stay (LOS), and inflation-adjusted cost. The age-adjusted percentage of HF hospitalizations among PsA patients decreased from 2.5% (2005/06) to 1.4% (2011/12; P-trend 0.013) and subsequently increased to 2.0% (2017/18; P-trend 0.044). The age-adjusted percentage of AMI hospitalizations among PsA patients showed a non-statistically significant decreasing trend from 2.1% (2005/06) to 1.7% (2011/12; P-trend 0.248) and showed a non-statistically significant increase to 2.3% (2017/18; P-trend 0.056). The age-adjusted stroke hospitalizations increased from 1.1% (2005/06) to 1.3% (2017/18; P-trend 0.036). Apart from a decrease in adjusted inflation-adjusted cost among heart failure hospitalizations, there was no significant change in inpatient mortality, length of stay or hospital cost, during the study period. We found an increasing trend of cardiovascular hospitalizations in patients with PsA. These findings will raise awareness and inform further research and clinical practice for PSA patients with CVD.
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Affiliation(s)
- Anum Akhlaq
- Department of Internal Medicine, University of Mississippi Medical Center, MS, USA
| | | | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Hafiz Muhammad
- Department of Internal Medicine, Agha Khan University Hospital, Karachi, Pakistan
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | | | - Salik Nazir
- Division of Cardiovascular Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Mian Tanveer Ud Din
- Department of Internal Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Usama Nasir
- Department of Internal Medicine, Reading Hospital, Reading, PA, USA
| | | | | | | | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
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Rani S, Kansal S, Singla AK, Nazir S, Mehra R. A comprehensive study of exhalation rates in soil samples to understand the high-risk potential area in Barnala and Moga districts of Punjab, India. J Radioanal Nucl Chem 2022. [DOI: 10.1007/s10967-021-08129-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cash A, Minhas AMK, Pasadyn V, Nazir S, Ariss RW, Gupta R. Trends in pulmonary embolism mortality rates by age group in the United States, 1999-2019. Am Heart J Plus 2022; 13:100103. [PMID: 38560063 PMCID: PMC10978166 DOI: 10.1016/j.ahjo.2022.100103] [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] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 04/04/2024]
Abstract
Introduction Acute pulmonary embolism (PE) is a major cause of mortality in the United States. Recent reports indicate that PE-related mortality rates have increased among individuals younger than 65 years old. It remains unclear whether this increase in PE-related mortality is evenly distributed. A narrowly focused and clinically meaningful age group analysis is necessary. Methods Death certificate data from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database were examined to determine all-cause PE mortality trends from 1999 to 2019 among adults 25-39, 40-54, 55-69, 70-84, and ≥85 years old. The crude death rates for individual years and annual percentage change (APC) were calculated to determine trends. Results PE-related mortality rates increased among those 25-39, 40-54, and 55-69. Among individuals 25-39 years old, death rate increased from 1.8 to 2.0 (APC 0.7 [95% confidence interval (CI) 0.2 to 1.1]) between 1999 and 2014 and continued to increase from 2.0 to 2.4 (APC 4.1 [95% CI 1.8 to 6.5]) between 2014 and 2019. Among those 40-54 years old, the crude death rate increased from 5.7 to 7.5 (APC 2.0 [95% CI, 1.6 to 2.5]) between 2007 and 2019. Among those 55-69 years old the crude death rate increased from 15.6 to 18.5 (APC 2.2 [95% CI, 1.9 to 2.5]) between 2010 and 2019. Recent death rates decreased or plateaued among individuals older than 70. Conclusions Individuals younger than 70 years had increase in PE-related mortality between 1999 and 2019 with marked increase among those 25-39 years old.
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Affiliation(s)
- Ayla Cash
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA
| | | | - Vanessa Pasadyn
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA
| | - Salik Nazir
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA
- Division of Cardiovascular Medicine, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA
| | - Robert W. Ariss
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA
| | - Rajesh Gupta
- University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA
- Division of Cardiovascular Medicine, University of Toledo College of Medicine and Life Sciences, 3000 Arlington Avenue, Toledo, OH 43614, USA
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Ahuja KR, Ariss RW, Kolte D, Zachariah S, Nazir S, Sandhu CS, Ameen M, Ramanathan PK, Macciocca M, Elgin EE. Outcomes of Percutaneous Left Atrial Appendage Occlusion in the Elderly. JACC Cardiovasc Interv 2021; 14:2752-2754. [PMID: 34949402 DOI: 10.1016/j.jcin.2021.09.002] [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] [Received: 07/09/2021] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 11/24/2022]
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Maraey A, Elzanaty AM, Salem M, Khalil M, Elsharnoby H, Younes A, Elsharnouby M, Nazir S, Elgendy IY, Siragy HM. Relation of Type 2 Myocardial Infarction and Readmission With Type 1 Myocardial Infarction in Hypertensive Crises (from a Nationwide Analysis). Am J Cardiol 2021; 161:56-62. [PMID: 34794619 DOI: 10.1016/j.amjcard.2021.08.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 02/02/2023]
Abstract
Type 2 myocardial infarction (T2MI) is an ischemic injury that occurs due to a mismatch between myocardial oxygen supply and demand. T2MI can occur with hypertensive crisis. Nevertheless, the impact of T2MI on hypertensive crisis outcome is poorly understood due to limited data. This study was a retrospective analysis of the National Readmission Database year 2018. Patients were included if the primary diagnosis was hypertensive crisis, hypertensive urgency, or hypertensive emergency. Patients were excluded if they had type 1 myocardial infarction (T1MI), severe sepsis, septic shock, gastrointestinal bleeding, or hemorrhagic anemia at index admission. The primary outcome was 90-day readmission with T1MI. Secondary outcomes were in-hospital mortality, length of stay, resource utilization, and all-cause 90-day readmission. Subgroup analysis was done according to urgency and emergency presentation. A total of 101,211 index hospitalizations were included in our cohort, of whom 3,644 (3.6%) received a diagnosis of T2MI. A total of 912 patients were readmitted within 90 days with T1MI. T2MI was an independent predictor of 90-day readmission with T1MI (adjusted odds ratio [aOR] 2.64, 95% confidence interval [CI] 1.90 to 3.66, p <0.01). Subgroup analysis including only hypertensive urgency and hypertensive emergency yielded similar results (aOR 2.80, 95% CI 1.56 to 5.01, p <0.01 and aOR 2.28, 95% CI 1.59 to 3.27, p <0.01, respectively). In conclusion, T2MI was an independent predictor of poor outcome in patients presenting with hypertensive crisis. Further studies are needed to guide the management of T2MI in this population.
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Mhanna M, Beran A, Nazir S, Al-Abdouh A, Barbarawi M, Sajdeya O, Ayesh H, Nesheiwat Z, Malhas SE, Eltahawy EA. Outcomes of distal versus conventional transradial access for coronary angiography and intervention: An updated systematic review and meta-analysis. Int J Cardiol 2021; 344:47-53. [PMID: 34626744 DOI: 10.1016/j.ijcard.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/07/2021] [Revised: 09/06/2021] [Accepted: 10/04/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Distal transradial artery access (DTRA) has recently gained attention due to potential benefits in terms of local complications. In this meta-analysis, we aimed to evaluate the utility of DTRA compared to conventional transradial artery access (CTRA) for coronary angiography and intervention. METHOD Multiple databases were searched from inception through May 2021 for all the studies that evaluated the efficacy and safety of DTRA in the coronary field. The primary outcome was the access success rate. The secondary outcomes were periprocedural local complications (site hematoma, radial artery occlusion, and spasm) and procedural characteristics (cannulation, fluoroscopy, procedure, and radial artery compression times). All meta-analyses were conducted using a random-effect model. RESULTS A total of 12 studies (including four randomized control trials) with 1634 patients who underwent DTRA vs. 1657 with CTRA were included in the final analysis. The access success rate was similar between the two groups (odds ratio (OR):0.62; 95% confidence interval (CI):0.30-1.26; P = 0.18; I2 = 61%). DTRA was associated with a statistically significant lower rate of radial artery occlusion (OR:0.36; 95% CI: 0.22-0.59; P < 0.001; I2 = 0%) but similar rates of radial artery spasm and site hematoma when compared to CTRA. Regarding the procedural characteristics, despite having a longer canulation time (mean difference (min.) [MD] 0.89, 95% CI 0.36-1.42; P < 0.0001), DTRA was associated with shorter compression time and comparable fluoroscopy and procedure times. CONCLUSIONS Our meta-analysis demonstrates that the DTRA is effective and safe with superiority in preventing radial artery occlusion when compared to CTRA.
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Affiliation(s)
- Mohammed Mhanna
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA.
| | - Azizullah Beran
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Salik Nazir
- Department of Cardiovascular Medicine, The University of Toledo, Toledo, OH, USA
| | - Ahmad Al-Abdouh
- Department of Internal Medicine, Saint Agnes Hospital, Baltimore, MD, USA
| | - Mahmoud Barbarawi
- Department of Cardiovascular Medicine, University of Connecticut, Farmington, CT, USA
| | - Omar Sajdeya
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Hazem Ayesh
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Zeid Nesheiwat
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Saif-Eddin Malhas
- Department of Internal Medicine, The University of Toledo, Toledo, OH, USA
| | - Ehab A Eltahawy
- Department of Cardiovascular Medicine, The University of Toledo, Toledo, OH, USA
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Farid M, Khan N, Fatima M, Rasool F, Azmat H, Iqbal KJ, Nazir S, Bano S, Khizar A, Asghar M. Performance evaluation of the commercial aquafeeds available in the market of Pakistan on Channa marulius (Sole). BRAZ J BIOL 2021; 84:e250821. [PMID: 34755812 DOI: 10.1590/1519-6984.250821] [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: 04/08/2021] [Accepted: 07/15/2021] [Indexed: 11/22/2022] Open
Abstract
The present study aimed to determine the effect of different levels of protein on the growth, body composition, amino acid profile and serology of Channa marulius fingerlings. The experiment was conducted in ten happas installed in earthen ponds, each stocked with 10 fishes for 90 days. Four commercial fish feeds having 25%, 30%, 32% and 40% crude protein (CP) levels were fed to fish at 3% of their wet body weight three times a day. The results of the study revealed that highest weight gain, feed conversion ratio and survival rate were observed in 30% protein feed. Meanwhile, moisture content was higher in fish fed with 30% CP feed while highest crude protein was recorded in 40% CP fed fish. Lowest fat content was observed in 32% CP feed. Amino acid profile of fish revealed better results in 30% CP feed. Total protein, glucose and globulin were also highest in fish feeding 30% CP feed, while albumin was highest in 40% CP feed. It is concluded that 30% CP feed showed better results in terms of growth, amino acid profile and serological parameters without effecting fish body composition.
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Affiliation(s)
- M Farid
- University of Veterinary and Animal Sciences, Department of Fisheries and Aquaculture, Lahore, Pakistan
| | - N Khan
- University of Veterinary and Animal Sciences, Department of Fisheries and Aquaculture, Lahore, Pakistan
| | - M Fatima
- University of Veterinary and Animal Sciences, Department of Fisheries and Aquaculture, Lahore, Pakistan
| | - F Rasool
- University of Veterinary and Animal Sciences, Department of Fisheries and Aquaculture, Lahore, Pakistan
| | - H Azmat
- University of Veterinary and Animal Sciences, Department of Fisheries and Aquaculture, Lahore, Pakistan
| | - K J Iqbal
- Islamia University of Bahawalpur, Department of Zoology, Bahawalpur, Pakistan
| | - S Nazir
- University of Veterinary and Animal Sciences, Department of Fisheries and Aquaculture, Lahore, Pakistan
| | - S Bano
- University of Veterinary and Animal Sciences, Department of Fisheries and Aquaculture, Lahore, Pakistan
| | - A Khizar
- University of Veterinary and Animal Sciences, Department of Fisheries and Aquaculture, Lahore, Pakistan
| | - M Asghar
- University of Veterinary and Animal Sciences, Department of Fisheries and Aquaculture, Lahore, Pakistan
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Saleem S, Ullah W, Mukhtar M, Sarvepalli D, Younas S, Arab SA, Al Hemyari B, Zahid S, Nazir S, Cheema T, Mir T, Abdul-Waheed M. Angiographic-only or intravascular ultrasound-guided approach for left-main coronary artery intervention: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2021; 19:1029-1035. [PMID: 34747315 DOI: 10.1080/14779072.2021.2004122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The use of intravascular ultrasound (IVUS) in percutaneous revascularization of left-main coronary artery disease (LMCAD) warrants further exploration. We aimed to collate all available data on the merits of IVUS in LMCAD to help decision-making. METHODS The MEDLINE, Embase, and Cochrane databases were queried for relevant randomized controlled trials (RCTs) and observational cohort studies (OCS). The data were analyzed using random-effects model to calculate unadjusted odds ratio (OR) between IVUS-guided and angiography-only LMCA revascularization. RESULTS A total of 14 studies (2 RCTs and 12 OCS), comprising 18944 patients, were included. The pooled odds of all-cause mortality (OR 0.57, 95%CI 0.46-0.70, p = <0.00001), cardiovascular mortality (OR 0.37, 95%CI 0.26-0.54, p = <0.00001), left-main revascularization (OR 0.63, 95%CI 0.45-0.89, p = 0.009) and myocardial infarction (OR 0.80, 95% CI 0.66-0.97, p = 0.02) were significantly lower with IVUS-guidance. There was no difference observed in the odds of the stent thrombosis (OR 0.57, 95% CI 0.31-1.05, p = 0.07) and stroke (OR 1.7, 95%CI 0.56-5.14, p = 0.35) between the two groups. A subgroup analysis based on the study design and follow-up duration mirrored the pooled estimates. CONCLUSION IVUS-guided LMCA intervention is associated with overall improved cardiovascular outcomes than the angiography-only approach. This needs to be tested in a large randomized controlled trial.
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Affiliation(s)
- Sameer Saleem
- Cardiovascular Medicine, University of Kentucky, Lexington, USA
| | - Waqas Ullah
- Cardiovascular Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maryam Mukhtar
- Cardiovascular Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Sundas Younas
- Cardiovascular Medicine, Western Kentucky Heart and Lung, Bowling Green, KY
| | - Shuaib Ahmed Arab
- Cardiovascular Medicine, Western Kentucky Heart and Lung, Bowling Green, KY
| | | | - Salman Zahid
- Cardiovascular Medicine Rochester General Hospital, Rochester, USA
| | - Salik Nazir
- Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Tayyab Cheema
- Cardiovascular Medicine, West Suburban Medical Center, Oak Park, IL, USA
| | - Tanveer Mir
- Cardiovascular Medicine, Detroit Medical Center, Detroit, MI, USA
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Nazir S, Minhas AMK, Kamat IS, Ariss RW, Moukarbel GV, Gomez JCP, Fedson S, Nair A, Bozkurt B, Jneid H. Patient Characteristics and Outcomes of Type 2 Myocardial Infarction During Heart Failure Hospitalizations in the United States. Am J Med 2021; 134:1371-1379.e2. [PMID: 34214459 PMCID: PMC9131468 DOI: 10.1016/j.amjmed.2021.05.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/04/2021] [Revised: 05/14/2021] [Accepted: 05/19/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Type 2 myocardial infarction (MI) is increasingly diagnosed in patients with heart failure (HF). A paucity of data exists pertinent to the contemporary prevalence and impact of type 2 MI in patients with HF. We studied the patient profiles and the prognostic impact of type 2 MI on outcomes of HF hospitalizations. METHODS The Nationwide Readmission Database 2018 was queried for patients with HF hospitalizations with and without type 2 MI. Baseline characteristics, inpatient outcomes, and 30-day all-cause readmissions between both cohorts were compared. RESULTS Of 1,072,674 primary HF hospitalizations included in the study, 28,813 (2.7%) had type 2 MI. Patients with type 2 MI were more likely to be males (56.5% vs 51.6%; P < .001) and had a higher prevalence of hypertension (94% vs 92.2%; P < .001), prior myocardial infarction (17.1% vs 14.9%; P < .001), anemia (9.1% vs 8.1%; P < .001), chronic kidney disease (55.7% vs 49.4%; P < .001), neurological disorders (9.4% vs 7.3%; P < .001), and weight loss (7.3% vs 5.6%; P < .001). Compared with their counterparts without type 2 MI, patients with HF with type 2 MI had significantly higher in-hospital mortality (adjusted odds ratio [aOR], 1.53; 95% confidence interval [CI], 1.37-1.72), hospital costs (adjusted parameter estimate, $1785; 95% CI, 1388-2182), discharge to nursing facility (aOR, 1.22; 95% CI, 1.15-1.29), longer length of stay (adjusted parameter estimate, 0.53; 95% CI, 0.42-0.64), and rate of 30-day all-cause readmissions (aOR, 1.06; 95% CI, 1.01-1.12). CONCLUSION Type 2 MI in patients hospitalized with HF is associated with higher mortality and resource utilization in the United States.
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Affiliation(s)
- Salik Nazir
- Section of Cardiology, University of Toledo Medical Center, Toledo, Ohio
| | | | - Ishan S Kamat
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Robert W Ariss
- Section of Cardiology, University of Toledo Medical Center, Toledo, Ohio
| | - George V Moukarbel
- Section of Cardiology, University of Toledo Medical Center, Toledo, Ohio
| | | | - Savitri Fedson
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Ajith Nair
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Biykem Bozkurt
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Hani Jneid
- Section of Cardiology, Baylor College of Medicine, Houston, Texas.
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Ariss R, Minhas A, Nazir S, Meenakshisundaram C, Ali M, Ahuja K, Grande R, Ramanathan P, Kayani W, Sheikh M. Outcomes and resource utilization of atrial fibrillation hospitalizations with type 2 myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0432] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Patients with atrial fibrillation (AF) are often elderly and have higher rates of comorbidities which may predispose them to an increased risk of myocardial oxygen demand-supply mismatch. Scarce data exist on the prognostic impact of type 2 myocardial infarction (MI) in AF.
Purpose
To examine the association of type 2 MI with outcomes and resource utilization in primary AF hospitalizations.
Methods
We utilized the Nationwide Readmission Database 2018 to identify primary AF hospitalizations with and without type 2 MI. The International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes I48.0, I48.1, I48.2, I48.91 were utilized to identify primary AF hospitalizations within the United States. Of these, AF hospitalizations complicated by type 2 MI were identified using ICD-10 code I21.A1. Comorbidities and outcomes were identified using the corresponding ICD-10 codes. Complex samples multivariable logistic and linear regression models were used to determine the association between type 2 MI and outcomes (in-hospital mortality, index length of stay [LOS], hospital costs, discharge to nursing facility, and 30-day all-cause readmissions). Predictors of in-hospital mortality in AF with type 2 MI were also determined.
Results
Of 382,896 primary AF hospitalizations included in this study, 7,375 (1.9%) had type 2 MI. Compared to AF hospitalization without type 2 MI, those with type 2 MI are older (74.5 vs. 70.7-years-old) and have higher prevalence of chronic pulmonary disease, dyslipidemia, diabetes mellitus, hypertension, heart failure, peripheral vascular disease, chronic kidney disease, neurological disorders, deficiency anemia, coagulopathy, valvular disease, prior myocardial infarction, prior coronary artery bypass grafting, prior percutaneous coronary intervention, and prior cerebrovascular accident (P for all <0.001). AF with type 2 MI is associated with significantly higher in-hospital mortality (1.3% vs. 0.5%; P<0.001), LOS (4.1 vs. 3.3 days; P<0.001), hospital costs ($10,293.6 vs. $8,820.3; P<0.001), discharges to nursing facility (18.1% vs. 10.2%; P<0.001), and 30-day all-cause readmissions (18.5% vs. 13.5%; P=0.001) compared to AF hospitalizations without type 2 MI (Table 1). Heart failure, chronic kidney disease, neurological disorders, and age (per year) were identified as independent predictors of in-hospital mortality among AF patients with type 2 MI (Figure 1).
Conclusion
In this large nationwide analysis, type 2 MI in the setting of AF hospitalization is associated with higher in-hospital mortality and increased resource utilization compared to AF hospitalizations without type 2 MI.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- R.W Ariss
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
| | - A.M Minhas
- Forrest General Hospital, Medicine, Hattiesburg, United States of America
| | - S Nazir
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
| | - C Meenakshisundaram
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
| | - M.M Ali
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
| | - K.R Ahuja
- Reading Hospital, Cardiology, West Reading, United States of America
| | - R.D Grande
- ProMedica Toledo Hospital, ProMedica Heart Institute, Toledo, United States of America
| | - P.K Ramanathan
- ProMedica Toledo Hospital, ProMedica Heart Institute, Toledo, United States of America
| | - W.T Kayani
- Baylor College of Medicine, Interventional Cardiology, Houston, United States of America
| | - M Sheikh
- ProMedica Toledo Hospital, ProMedica Heart Institute, Toledo, United States of America
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48
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Ariss RW, Nazir S, Minhas AM, Moukarbel GV, Jneid H. Patient characteristics and clinical outcomes of type 2 myocardial infarction in patients with acute ischemic stroke in the united states. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Type 2 myocardial infarction (MI) due to supply-demand mismatch may occur as a sequala of acute ischemic stroke (AIS). However, scarce data exits on the patient profiles and the prognostic impact of type 2 MI on outcomes of AIS.
Purpose
To determine the risk profiles and examine the association of type 2 MI with outcomes and resource utilization in primary AIS hospitalizations.
Methods
We utilized the Nationwide Readmission Database from October 1st, 2017 to December 31st, 2018 to identify primary AIS hospitalizations with and without type 2 MI in the United States. The International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes I63.x were utilized to identify patients with AIS. Complex samples multivariable logistic and linear regression models were used to determine the predictors of type 2 MI and the association with outcomes (in-hospital mortality, poor functional outcomes [defined as a composite of mortality or discharge to hospice or to a long-term facility], index length of stay, hospital costs, discharge to nursing facility, and 30-day all-cause readmissions).
Results
Of 587,550 AIS hospitalizations included in this study, 4,182 (0.71%) had type 2 MI. Compared to AIS hospitalization without type 2 MI, those with type 2 MI were older (73 years vs. 70 years; P<0.001), more likely to be females (52% vs. 49.7%; P<0.001), and had a higher prevalence of heart failure (32% vs. 15.5%; P<0.001), atrial fibrillation (38.5% vs. 24.2%; P<0.001), prior myocardial infarction (8.8% vs. 7.7%; P<0.001), valvular heart disease (17% vs. 9.8%; P<0.001), peripheral vascular disease (12.2% vs. 9.2%; P<0.001), chronic kidney disease (24.4% vs. 16.7%; P<0.001), neurological disorders (49.3% vs. 34.6%; P<0.001), drug abuse (4.9% vs. 4.1%; P=0.04), chronic liver disease (2.6% vs. 1.7%; P<0.001), chronic lung disease (18.1% vs. 15.8%; P<0.001), anemia (4.3% vs. 2.8%; P<0.001), and weight loss (9.7% vs. 4.4%; P<0.001). Compared with their counterparts without type 2 MI, AIS with type 2 MI had significantly higher in-hospital mortality, poor functional outcomes, hospital costs, rate of discharge to nursing facility, length of stay, and rate of 30-day all-cause readmissions (Table 1). Heart failure, weight loss, neurological disorders, drug abuse, valvular heart disease, atrial fibrillation, chronic kidney disease, and age (per year) were identified as independent predictors of type 2 MI among AIS hospitalizations (Figure 1).
Conclusion
Patients with AIS complicated by type 2 MI have a high prevalence of underlying cardiovascular disease. In addition, type 2 MI in patients hospitalized with AIS is associated with poor prognosis and higher resource utilization.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R W Ariss
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
| | - S Nazir
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
| | - A M Minhas
- Forrest General Hospital, Medicine, Hattiesburg, United States of America
| | - G V Moukarbel
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
| | - H Jneid
- Baylor College of Medicine, Section of Cardiology, Houston, United States of America
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Mhanna M, Beran A, Nazir S, Al-Abdouh A, Barbarawi M, Sajdeya O, Srour O, Burmeister C, Malhas S, Eltahawy E. Distal versus conventional transradial access for coronary angiography and intervention: a systematic review and meta-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2079] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Distal transradial artery access (DTRA) has recently gained attention due to potential benefits in terms of local complications and risk of superficial palmar arch ischemia in case of radial artery occlusion.
Purpose
In this meta-analysis, we aimed to evaluate the utility of DTRA compared to conventional transradial artery access (CTRA) for coronary angiography and intervention.
Method
We performed a comprehensive literature search using multiple databases from inception through February 2021 for all the studies that evaluated the efficacy and safety of DTRA for coronary angiography and intervention. The primary outcome of interest was access success rate. The secondary outcomes were periprocedural local complications (site hematoma, radial artery occlusion or spasm) and procedural characteristics (cannulation, fluoroscopy, and radial artery compression times). All meta-analyses were conducted using a random-effect model.
Results
A total of 8 studies including 1630 patients (805 underwent DTRA vs. 825 with CTRA), were included in the final analysis. Three of the included studies were randomized controlled trials (RCTs), and the remainder were observational studies. The access success rate was similar in the two groups (odds ratio (OR): 0.61; 95% confidence interval (CI): 0.18–2.09; P=0.43; I2=72%). Similarly, no difference was observed in the overall periprocedural local complications rate (OR 0.63, 95% CI 0.38–1.04, P=0.07, I2=25%). On subgroup analysis, the rate of radial artery occlusion was significantly lower in DRTA group (OR 0.33, 95% CI 0.13–0.82, P=0.02, I2=0%). Regarding the procedural characteristics, the two approaches were different only in the cannulation time favoring the CTRA group (mean difference in minutes [MD] 0.96, 95% CI 0.16–1.76; P=0.02).
Conclusions
The DTRA represents an alternative site for radial artery access for coronary angiography and interventions, with a high success rate accompanied by a low risk of complications. Although the cannulation time was longer for the DTRA, this can potentially improve with training, practice, and utilization of ultrasound-guided punctures. The major advantage provided by the DTRA is the trend toward a lower risk of radial artery occlusion, which is frequently observed with the conventional approach. Further adequately powered RCTs are needed to confirm the safety and efficacy of this approach.
Funding Acknowledgement
Type of funding sources: None. Central illustration
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Affiliation(s)
- M Mhanna
- University Toledo Medical Center, Internal medicine, Toledo, United States of America
| | - A Beran
- University Toledo Medical Center, Internal medicine, Toledo, United States of America
| | - S Nazir
- University Toledo Medical Center, Cardiovascular medicine, Toledo, United States of America
| | - A Al-Abdouh
- Saint agnes hospital, Internal medicine, Baltimore, United States of America
| | - M Barbarawi
- University of Connecticut, Cardiovascular medicine, Farmington, United States of America
| | - O Sajdeya
- University Toledo Medical Center, Internal medicine, Toledo, United States of America
| | - O Srour
- University Toledo Medical Center, Internal medicine, Toledo, United States of America
| | - C Burmeister
- University Toledo Medical Center, Internal medicine, Toledo, United States of America
| | - S Malhas
- University Toledo Medical Center, Internal medicine, Toledo, United States of America
| | - E Eltahawy
- University Toledo Medical Center, Cardiovascular medicine, Toledo, United States of America
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50
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Ariss RW, Elzanaty AM, Minhas AMK, Nazir S, Gul S, Patel N, Ahuja KR, Mochon A, Eltahawy EA. Sex-based differences in clinical outcomes and resource utilization of type 2 myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2777] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sex-based differences in clinical outcomes have been previously well described in type 1 myocardial infarction (MI). However, type 2 MI is common in contemporary practice with scarce data regarding sex-based differences of clinical outcomes and resource utilization.
Purpose
To examine the association of sex category with clinical outcomes and resource utilization in hospitalizations with type 2 MI.
Methods
The Nationwide Readmission Database 2018 was queried for hospitalizations within the United States with type 2 MI using The International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code I21.A1. Comorbidities and outcomes were identified using the corresponding ICD-10 codes. Complex samples multivariable logistic and linear regression models were used to determine the association between type 2 MI and outcomes (in-hospital mortality, index length of stay [LOS], hospital costs, discharge to nursing facility, and 30-day all-cause readmissions) in females compared to males with type 2 MI.
Results
A total of 252,641 hospitalizations [119,783 (47.4%) females and 132,858 (52.6%) males] were included in this analysis. Females with type 2 MI were more likely to be older (72.8 years vs. 69.7 years; P<0.001), admitted on the weekend (26.5% vs. 25.9%; P=0.02), and have a higher prevalence of chronic pulmonary disease (35.6% vs. 32.0%; P<0.001), obesity (17.9% vs. 15.7%; P<0.001), neurological disorders (22.9% vs. 22.3%; P=0.02), deficiency anemias (7.5% vs. 6.6%; P<0.001), and hypothyroidism (22.1% vs. 10.1%; P<0.001) compared to males with type 2 MI. Female with type 2 MI was associated with lower in-hospital mortality, shorter LOS, less hospital costs, and increased nursing home discharge compared to males with type 2 MI. Females and males with type 2 MI had similar rates of 30-day all-cause readmission [Table 1].
Conclusion
Among type 2 MI hospitalizations, females have lower in-hospital mortality, less hospitalization cost, shorter LOS, but increased rates of nursing home discharge compared to males. Thirty-day all-cause readmission was similar between males and females with type 2 MI.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R W Ariss
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
| | - A M Elzanaty
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
| | - A M K Minhas
- Forrest General Hospital, Medicine, Hattiesburg, United States of America
| | - S Nazir
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
| | - S Gul
- Reading Hospital, Cardiology, West Reading, United States of America
| | - N Patel
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
| | - K R Ahuja
- Reading Hospital, Cardiology, West Reading, United States of America
| | - A Mochon
- Reading Hospital, Cardiology, West Reading, United States of America
| | - E A Eltahawy
- University Toledo Medical Center, Cardiovascular Medicine, Toledo, United States of America
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