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Cheema HA, Majeed Z, Hayat T, Ahmed A, Tariq MH, Shahid A, Titus A, Minhas AMK, Ijaz SH, Ghelani SJ, Kulkarni A, Dani SS. Expectant management of patent ductus arteriosus for preterm infants: A meta-analysis of randomized controlled trials. Am Heart J 2023; 266:179-183. [PMID: 37567354 DOI: 10.1016/j.ahj.2023.07.007] [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: 05/16/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 08/13/2023]
Abstract
We conducted this meta-analysis to compare expectant management of patent ductus arteriosus (PDA) with active treatment for PDA closure in preterm infants. Data from 7 randomized controlled trials (RCTs) showed that all-cause mortality and other clinical adverse outcomes did not differ between expectant management of PDA and active treatment. Future large-scale and double-blinded RCTs with a consistent definition for hemodynamically significant PDA, and focusing on clearly delineated high-risk subgroups or later selective treatment are needed to further evaluate the role of expectant management.
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Affiliation(s)
- Huzaifa Ahmad Cheema
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan; Department of Medicine, King Edward Medical University, Lahore, Pakistan.
| | - Zuhair Majeed
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan
| | - Tajamal Hayat
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan
| | - Arslan Ahmed
- Department of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | - Abia Shahid
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan
| | - Anoop Titus
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA
| | | | - Sardar Hassan Ijaz
- Division of Cardiovascular Medicine, Beth Israel Lahey Health, Lahey Hospital and Medical Center, Burlington, MA
| | - Sunil J Ghelani
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Aparna Kulkarni
- Children's Heart Center at Cohen Children's Medical Center/ Northwell Health, Donald and Barbara Zucker School of Medicine, New York, NY
| | - Sourbha S Dani
- Division of Cardiovascular Medicine, Beth Israel Lahey Health, Lahey Hospital and Medical Center, Burlington, MA
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Cheema HA, Shafiee A, Athar MMT, Rafiei MA, Mehmannavaz A, Jafarabady K, Shahid A, Ahmad A, Ijaz SH, Dani SS, Minhas AMK, Nashwan AJ, Fudim M, Fonarow GC. Efficacy and safety of sodium-glucose cotransporter-2 inhibitors for heart failure with mildly reduced or preserved ejection fraction: a systematic review and meta-analysis of randomized controlled trials. Front Cardiovasc Med 2023; 10:1273781. [PMID: 37900570 PMCID: PMC10602781 DOI: 10.3389/fcvm.2023.1273781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/29/2023] [Indexed: 10/31/2023] Open
Abstract
Aims We sought to conduct a meta-analysis to evaluate the efficacy and safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with heart failure (HF) with preserved ejection fraction (HFpEF) and HF with mildly reduced ejection fraction (HFmrEF). Methods We searched the Cochrane Library, MEDLINE (via PubMed), Embase, and ClinicalTrials.gov till March 2023 to retrieve all randomized controlled trials of SGLT2i in patients with HFpEF or HFmrEF. Risk ratios (RRs) and standardized mean differences (SMDs) with their 95% confidence intervals (95% CIs) were pooled using a random-effects model. Results We included data from 14 RCTs. SGLT2i reduced the risk of the primary composite endpoint of first HF hospitalization or cardiovascular death (RR 0.81, 95% CI: 0.76, 0.87; I2 = 0%); these results were consistent across the cohorts of HFmrEF and HFpEF patients. There was no significant decrease in the risk of cardiovascular death (RR 0.96, 95% CI: 0.82, 1.13; I2 = 36%) and all-cause mortality (RR 0.97, 95% CI: 0.89, 1.05; I2 = 0%). There was a significant improvement in the quality of life in the SGLT2i group (SMD 0.13, 95% CI: 0.06, 0.20; I2 = 51%). Conclusion The use of SGLT2i is associated with a lower risk of the primary composite outcome and a higher quality of life among HFpEF/HFmrEF patients. However, further research involving more extended follow-up periods is required to draw a comprehensive conclusion. Systematic Review Registration PROSPERO (CRD42022364223).
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Affiliation(s)
| | - Arman Shafiee
- Clinical Research Development Unit, Alborz University of Medical Sciences, Karaj, Iran
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | | | - Mohammad Ali Rafiei
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefe Mehmannavaz
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kyana Jafarabady
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Abia Shahid
- Department of Cardiology, King Edward Medical University, Lahore, Pakistan
| | - Adeel Ahmad
- Department of Internal Medicine, Mass General Brigham - Salem Hospital, Salem, MA, United States
| | | | - Sourbha S. Dani
- Lahey Hospital and Medical Center, Burlington, MA, United States
| | | | | | - Marat Fudim
- Department of Medicine, Duke University Medical Center, Durham, NC, United States
- Duke Clinical Research Institute, Durham, NC, United States
| | - Gregg C. Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, University of California Los Angeles, Los Angeles, CA, United States
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Minhas AMK, Bhopalwala HM, Dewaswala N, Ijaz SH, Khan MS, Khan MZ, Dani SS, Warraich HJ, Greene SJ, Edmonston DL, Lopez RD, Virani SS, Bhopalwala A, Fudim M. Association of Chronic Renal Insufficiency with Inhospital Outcomes in Primary Heart Failure Hospitalizations (Insights from the National Inpatient Sample 2004 to 2018). Am J Cardiol 2023; 202:41-49. [PMID: 37419025 DOI: 10.1016/j.amjcard.2023.05.063] [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: 11/11/2022] [Revised: 05/07/2023] [Accepted: 05/29/2023] [Indexed: 07/09/2023]
Abstract
Chronic kidney disease (CKD) is a major co-morbidity in patients with heart failure (HF). There are limited contemporary data characterizing the clinical profile, inhospital outcomes, and resource use in patients hospitalized for HF with co-morbid CKD. We utilized a nationally representative population to address the knowledge gap. We examined the National Inpatient Sample 2004 to 2018 database to study the co-morbid profile, in-hospital mortality, clinical resource utilization, healthcare cost, and length of stay (LOS) in primary adult HF hospitalizations stratified by presence versus absence of a diagnosis codes of CKD. There were a total of 16,050,301 adult hospitalizations with a primary HF diagnosis from January 1, 2004, to December 31, 2018. Of these, 428,175 (33.81%) had CKD; 1,110,778 (6.92%) had end-stage kidney disease (ESKD); and 9,511,348 (59.25%) had no diagnosis of CKD. Patients with hospitalizations for HF with ESKD were younger (mean age 65.4 years) compared with those without ESKD. In multivariable analysis, those with CKD had higher odds of inhospital mortality (2.82% vs 3.57%, adjusted odds ratio [aOR] 1.30, confidence interval [CI] 1.28 to 1.26, p <0.001), cardiogenic shock (1.01% vs 1.79% aOR 2.00, CI 1.95 to 2.05, p <0.001), and the need for mechanical circulatory support (0.4% vs 0.5%, aOR 1.51, 1.44 to 1.57, p <0.001) compared with those without CKD. In multivariable analysis, those with ESKD had higher odds of inhospital mortality (2.82% vs 3.84%, aOR 2.07, CI 2.01 to 2.12, p <0.001), need for invasive mechanical ventilation use (2.04% vs 3.94%, aOR 1.79, CI 1.75 to 1.84, p <0.001), cardiac arrest (0.72% vs 1.54%, aOR 2.09, CI 2.00 to 2.17, p <0.001), longer LOS (Adjusted mean difference 1.48, 1.44 to 1.53, p <0.001) and higher inflation-adjusted cost (Adjusted mean difference 3,411.63, CI 3,238.35 to 3,584.91, p <0.001) compared with those without CKD. CKD and ESKD affected about 40.7% of all primary HF hospitalizations from 2004 to 2018. The inhospital mortality, clinical complications, LOS, and inflation-adjusted cost were higher in hospitalized patients with ESKD compared with patients with and without CKD. In addition, compared with those without CKD, hospitalized patients with CKD had higher inhospital mortality, clinical complications, LOS, and inflation-adjusted cost compared with patients with no diagnosis of CKD.
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Affiliation(s)
| | - Huzefa M Bhopalwala
- Department of Internal Medicine, Appalachian Regional Health Care, Whitesburg, Kentucky
| | - Nakeya Dewaswala
- Department of Cardiovascular Disease, University of Kentucky, Lexington, Kentucky
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Muhammad Zia Khan
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, West Virginia
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephen J Greene
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Daniel L Edmonston
- Department of Medicine, Division of Nephrology, Duke University School of Medicine, Durham, North Carolina
| | - Renato D Lopez
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Adnan Bhopalwala
- Cardiology, Appalachian Regional Health Care, Whitesburg, Kentucky
| | - Marat Fudim
- Division of Cardiology, Department of Medicine, Duke University, Durham, North Carolina
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Ijaz SH, Baron SJ, Shahnawaz A, Kulbak G, Levy M, Resnic F, Ganatra S, Dani SS. Utilization Trends In Platelet Adenosine Diphosphate P2Y12 Receptor Inhibitor and Cost Among Medicare Beneficiaries. Curr Probl Cardiol 2023; 48:101608. [PMID: 36690313 DOI: 10.1016/j.cpcardiol.2023.101608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
Recent guidelines regarding acute coronary syndrome (ACS) have advocated for use of prasugrel and ticagrelor over clopidogrel for acute coronary syndrome. However, analyses from multiple databases have shown that clopidogrel continues to be the most commonly prescribed P2Y12 inhibitor. We aimed to evaluate the trends in utilization and cost of P2Y12 inhibitors for Medicare beneficiaries using data from Medicare Part D Prescription Drug Data Event set from 2011 to 2018 for P2Y12 inhibitors. Medicare part D total beneficiaries for P2Y12 receptor inhibitors increased from 2011 to 2018 by 34.8% from 2.45 million to 3.31 million. The total cost for P2Y12 antiplatelets decreased from $ 3.72 billion in 2011 to $ 0.72 billion in 2018 by 80.4%. The availability of generic clopidogrel drove the considerable total cost reduction. Clopidogrel was the most prescribed P2Y12 inhibitor since its introduction accounting for more than 90% of the Medicare beneficiaries from 2013 to 2018. Overall, the number of beneficiaries on newer P2Y12 inhibitors showed a steady increase with 5.9% beneficiaries on brilinta in 2018 and 2.1 % on prasugrel. The total cost of brilinta beneficiaries grew exponentially accounting for 59.2% of total cost in 2018 and average cost per beneficiary increased by 465% in study period. Despite the availability of generic version clopidogrel and prasugrel, 2,161,175 beneficiaries were on brand plavix and 87,174 on effient which contributed to the increased total expenditure. Earlier introduction and transition to generic versions of medication may help to reduce the drug cost and potentially enhance medication compliance.
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Affiliation(s)
- Sardar Hassan Ijaz
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA.
| | - Suzanne J Baron
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA
| | | | - Guy Kulbak
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA
| | - Michael Levy
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA
| | - Frederic Resnic
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA
| | - Sarju Ganatra
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA
| | - Sourbha S Dani
- Department of Cardiology, Lahey Hospital & Medical Center, Burlington, MA
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Ijaz SH, Minhas AMK, Jain V, Rifai MA, Sharma G, Mehta A, Dani SS, Fudim M, Al-Kindi SG, Sperling L, Shapiro MD, Alam M, Virani SS, Goel SS, Nasir K, Khan SU. Characteristics and outcomes in acute myocardial infarction hospitalizations among the older population (age ≥80 years) in the United States, 2004-2018. Arch Gerontol Geriatr 2023; 111:104930. [DOI: 10.1016/j.archger.2023.104930] [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: 12/20/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/23/2023]
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Minhas AMK, Ijaz SH, Javed N, Sheikh AB, Jain V, Michos ED, Greene SJ, Fudim M, Warraich HJ, Shapiro MD, Al-Kindi SG, Sperling L, Virani SS. National trends and disparities in statin use for ischemic heart disease from 2006 to 2018: Insights from National Ambulatory Medical Care Survey. Am Heart J 2022; 252:60-69. [PMID: 35644222 DOI: 10.1016/j.ahj.2022.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/28/2022] [Revised: 05/15/2022] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Statins are a cornerstone guideline-directed medical therapy for secondary prevention of ischemic heart disease (IHD). However, recent temporal trends and disparities in statin utilization for IHD have not been well characterized. METHODS This retrospective analysis included data from outpatient adult visits with IHD from the National Ambulatory Medical Care Survey (NAMCS) between January 2006 and December 2018. We examined the trends and predictors of statin utilization in outpatient adult visits with IHD. RESULTS Between 2006 and 2018, we identified a total of 542,704,112 weighted adult ambulatory visits with IHD and of those 46.6% were using or prescribed statin. Middle age (50-74 years) (adjusted odds ratio [aOR] 1.65, 95% confidence interval [CI] 1.28-2.13 P < .001) and old age (≥75 years) (aOR = 1.66, CI 1.26-2.19, P < .001) compared to young age (18-49 years), and male sex (aOR = 1.35, CI 1.23-1.48, P < .001) were associated with greater likelihood of statin utilization, whereas visits with non-Hispanic (NH) Black patients (aOR = 0.75, CI 0.61-0.91, P = .005) and Hispanic patients (aOR = 0.74, CI 0.60-0.92, P = .006) were associated with decreased likelihood of statin utilization compared to NH White patient visits. Compared with private insurance, statin utilization was nominally lower in Medicare (aOR = 0.91, CI 0.80-1.02, P = .112), Medicaid (aOR = 0.78, CI 0.59-1.02, P = .072) and self-pay/no charge (aOR = 0.72, CI 0.48-1.09, P = .122) visits, however did not reach statistical significance. There was no significant uptake in statin utilization from 2006 (44.1%) to 2018 (46.2%) (P = .549). CONCLUSIONS Substantial gaps remain in statin utilization for patients with IHD, with no significant improvement in use between 2006 and 2018. Persistent disparities in statin prescription remain, with the largest treatment gaps among younger patients, women, and racial/ethnic minorities (NH Blacks and Hispanics).
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Affiliation(s)
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital, and Medical Center, Beth Israel Lahey Health, Burlington, MA
| | - Nismat Javed
- Department of Internal Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Vardhmaan Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Erin D Michos
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stephen J Greene
- Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Marat Fudim
- Division of Cardiology, Duke University Medical Center, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, OH
| | - Laurence Sperling
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX
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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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Minhas AMK, Mahmood Shah SM, Shahid I, Siddiqi TJ, Arshad MS, Jain V, Ullah W, Ahmad MM, Bhopalwala HM, Dewaswala N, Ijaz SH, Dani SS. Utilization of Implantable Cardioverter-Defibrillators in Patients With Heart Transplant (from National Inpatient Sample Database). Am J Cardiol 2022; 175:65-71. [PMID: 35595555 DOI: 10.1016/j.amjcard.2022.03.051] [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] [Received: 01/20/2022] [Revised: 03/11/2022] [Accepted: 03/18/2022] [Indexed: 11/01/2022]
Abstract
Heart transplant (HT) recipients represent a unique and vulnerable population in whom medium and long-term outcomes are significantly affected by the risk of arrhythmias and sudden cardiac death. The use of implantable cardioverter-defibrillators (ICDs) in this population remains debated. A retrospective analysis of the National Inpatient Sample data between 2009 and 2018 was conducted. Hospitalization data on patients who underwent HT, or who had a preexisting HT, and who received a new ICD were included (excluding the preexisting ICD). Outcomes assessed included inpatient mortality, length of stay, and inflation-adjusted costs. We explored temporal trends in ICD placement and mean length of stay, and predictors of ICD placement. Between 2009 and 2018, 22,673 hospitalizations were recorded for HT, during which patients either received a concurrent new ICD placement (n = 70 [0.31%]) or no new ICD placement (n = 22,603 [99.7%]). During the same period, 146,555 admissions were recorded in patients with a history of HT. ICD placement in patients with a preexisting HT was associated with significantly higher inflation-adjusted costs ($55,680.7 vs $17,219.2; p <0.001). Predictors of ICD placement in preexisting patients with HT included cardiac arrest during hospitalization (odds ratio [OR]:14.3 [3.5 to 58.6]), drug abuse (OR:6.0 [1.3 to 27.1]), and previous PCI (OR:6.0 [2.1 to 17.3]). In conclusion, ICD placement in patients with HT history was associated with significantly higher inflation-adjusted costs. In patients with HT history, factors predicting ICD placement included cardiac arrest at hospitalization, previous PCI, and drug abuse.
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Affiliation(s)
| | | | - Izza Shahid
- Ziauddin Medical University, Karachi, Pakistan
| | - Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Vardhman Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Waqas Ullah
- Division of Cardiovascular Medicine, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Mohsin M Ahmad
- Department of Internal Medicine, Merit Health Wesley, Hattiesburg, Mississippi
| | - Huzefa M Bhopalwala
- Department of Internal Medicine, Appalachian Regional Healthcare, Whitesburg, Kentucky
| | - Nakeya Dewaswala
- Department of Cardiovascular Disease, University of Kentucky, Lexington, Kentuck
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, Massachusetts
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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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Minhas AMK, Ijaz SH. Disparities in Statin Use During Outpatient Visits of Adults (Age 18 to 64 Years) With Coronary Heart Disease in the Medicaid Population in the United States (from the National Ambulatory Medical Care Survey Database 2006 to 2015). Am J Cardiol 2022; 166:140-142. [PMID: 34974897 DOI: 10.1016/j.amjcard.2021.11.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/01/2022]
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12
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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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Jamal S, Ijaz SH, Minhas AMK, Kichloo A, Khan MZ, Albosta M, Aljadah M, Banga S, Baloch ZQ, Aboud H, Haji AQ, Sheikh A, Kanjwal K. Outcomes of Hospitalizations with Acute Respiratory Distress Syndrome with and without Atrial Fibrillation - Analyses from the National Inpatient Sample (2004-2014). Am J Med Sci 2022; 364:289-295. [DOI: 10.1016/j.amjms.2022.01.020] [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: 06/19/2021] [Revised: 10/17/2021] [Accepted: 01/31/2022] [Indexed: 11/01/2022]
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14
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Minhas AMK, Ijaz SH, Jamal S, Dani SS, Khan MS, Greene SJ, Fudim M, Warraich HJ, Shapiro MD, Virani SS, Nasir K, Khan SU. Trends in Characteristics and Outcomes in Primary Heart Failure Hospitalizations Among Older Population in the United States, 2004-2018. Circ Heart Fail 2022; 15:e008943. [PMID: 35078346 DOI: 10.1161/circheartfailure.121.008943] [Citation(s) in RCA: 2] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure (HF) accounts for a significant proportion of morbidity, mortality, and health care costs among older adults in the United States. We evaluated trends in clinical outcomes and the economic burden of HF hospitalizations in older patients (≥80 years). METHODS This analysis included data from the National Inpatient Sample between January 2004 and December 2018. We examined the trends of clinical characteristics, inpatient mortality, and health care cost utilization in older US adults for HF hospitalizations. RESULTS We identified 6 034 951 weighted HF hospitalizations for older adults (3527 per 100 000 person-years). After an initial decline in HF hospitalizations per 100 000 older US older adults from 4211 in 2004 to 3089 in 2014, there was increase to 3388 in 2018 (P trend <0.001 for both). There was an overall increase in cardiometabolic and chronic comorbidities during the study period. Overall, inpatient mortality was 4.7%; the adjusted inpatient mortality decreased from 6.1% in 2004 to 3.6% in 2018 (P trend <0.001). There was a decrease in adjusted mean length of stay (from 6.0 days in 2004 to 4.7 days in 2018) and adjusted inflation-adjusted care costs (from $11 865 in 2004 to $9677 in 2018) during the study period (P trend <0.001 for both). In comparison with younger adults (<80 years), older adults had higher inpatient mortality (4.7% versus 2.2%) but lower inflation-adjusted care costs ($10 587 versus $14 088). CONCLUSIONS This 15-year national data suggests that despite a higher comorbidity burden and the recent increase in hospitalizations for HF in older patients, there has been an encouraging trend towards lower inpatient mortality, health care cost, and hospital length of stay among older adults in the United States.
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Affiliation(s)
| | - Sardar Hassan Ijaz
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA (S.H.I., S.S.D.)
| | - Shakeel Jamal
- Central Michigan University, College of Medicine, Saginaw (S.J.)
| | - Sourbha S Dani
- Division of Cardiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA (S.H.I., S.S.D.)
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Duke University Medical Center, Durham, NC (M.S.K., S.J.G., M.F.)
| | - Stephen J Greene
- Division of Cardiology, Duke University Medical Center, Durham, NC (M.S.K., S.J.G., M.F.).,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.).,Duke Clinical Research Institute, Durham, NC (S.J.G., M.F.)
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA (H.J.W.).,Department of Medicine, Cardiology Section, VA Boston Healthcare System, MA (H.J.W.)
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (M.D.S.)
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX (S.S.V.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX. (K.N.).,Center for Outcomes Research, Houston Methodist, TX (K.N.)
| | - Safi U Khan
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX. (S.U.K.)
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Virk HUH, Tripathi B, Kumar V, Lakhter V, Khan MS, Ijaz SH, Dean S, Gupta S, Sharma P, Mishra R, George JC, Gopalan R, Zidar D, Janzer S. Causes, Trends, and Predictors of 90-Day Readmissions After Spontaneous Coronary Artery Dissection (from A Nationwide Readmission Database). Am J Cardiol 2019; 124:1333-1339. [PMID: 31551116 DOI: 10.1016/j.amjcard.2019.07.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/21/2019] [Accepted: 07/23/2019] [Indexed: 11/25/2022]
Abstract
Spontaneous coronary artery dissection (SCAD) is a frequently missed diagnosis in patients presenting with acute coronary syndrome (ACS). Our aim was to evaluate the causes, trends, and predictors of 90-day hospital readmission in patients presenting with SCAD. The Nationwide Readmissions Database (2013 to 2014) was utilized to identify patients with primary discharge diagnosis of SCAD using the International Classification of Diseases, Ninth Revision, Clinical Modification, diagnostic code 414.12. The primary outcome was 90-day readmission. Among 11,228 patients admitted with the primary diagnosis of SCAD, 2,424 patients (21.6%) were readmitted within 90 days (68% women, 82% <65 years of age). Common causes for 90-day readmission were ACS (25%), acute heart failure (11%), acute respiratory failure (7%), and arrhythmias (5%). Multivariate predictors of 90-day readmissions were hypertension, chronic obstructive pulmonary disease, peripheral arterial disease, discharge to facility and increased length of stay (LOS) during index admission. Multivariate predictors of increased healthcare-related costs were older age, female gender, discharge to facility, and increased LOS. Over half of the readmissions (52%) occurred in first 30 days after discharge. In conclusion, we found a high rate of rehospitalization among SCAD patients, particularly within the first 30 days of index hospitalization. ACS, heart failure, and acute respiratory failure were the most common reasons for readmission. Hypertension, chronic obstructive pulmonary disease, peripheral arterial disease, and increased LOS were independent predictors of readmission. Further studies are warranted to confirm these predictors of readmission in this high-risk population.
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Asad ZUA, Ijaz SH, Chaudhary AMD, Khan SU, Pakala A. Hemorrhagic Cardiac Tamponade Associated with Apixaban: A Case Report and Systematic Review of Literature. Cardiovasc Revasc Med 2019; 20:15-20. [PMID: 31088720 DOI: 10.1016/j.carrev.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Hemorrhagic cardiac tamponade (HCT) is characterized by rapid accumulation of blood in the pericardium causing hemodynamic collapse. We report a case of HCT due to Apixaban use in a patient with renal cell carcinoma, supplemented with a systematic review of pericardial tamponade associated with the use of direct oral anticoagulants (DOACs). CASE REPORT A 62-year-old African American male with a history of metastatic renal cell carcinoma presented with dyspnea while taking Apixaban. He was diagnosed with pericardial tamponade and 800 ml of hemorrhagic effusion was drained. The pericardial fluid analysis was negative for malignancy and suggestive of HCT. He had a complicated hospital course and died several days later. METHODS We searched MEDLINE, EMBASE and other sources for published cases of pericardial tamponade associated with DOACs. Our outcomes of interest included patient characteristics, risk factors, timing from the start of anticoagulation to tamponade, treatment and mortality. Simple descriptive statistics using percentages for categorical variables were used to describe the included cases. RESULTS A total of 26 cases were included in the final systematic review after searching MEDLINE, EMBASE and other sources. The mean age was 70 years (range 43-88) with 19 (73%) males. Twelve cases (46%) were associated with Rivaroxaban, 9 (37%) with Dabigatran and 5(19%) with Apixaban. Sixteen cases had elevated INR and 15 had elevated creatinine. Only 2 patients died but 24 had to undergo pericardiocentesis. CONCLUSION Cardiac tamponade is rarely associated with DOACs and elderly male patients with renal and coagulation abnormalities appear to have the highest risk.
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Affiliation(s)
| | | | | | - Safi U Khan
- West Virginia University, Morgantown, WV, USA
| | - Aneesh Pakala
- University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Ijaz SH. Relapsing Hepatitis B (HBV)-Associated Vasculitis with Features of Polyarteritis Nodosa (PAN) and cANCA-Associated Vasculitis. ACTA ACUST UNITED AC 2018. [DOI: 10.19080/jojcs.2018.09.555768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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