1
|
Shimizu R, Ishikawa J, Jyubishi C, Futami S, Morozumi A, Saito Y, Komatsu S, Toba A, Ishiyama T, Fujimoto H, Usui S, Tuboko Y, Awata S, Harada K. DASC-21 score and the risk of in-hospital death in elderly patients with heart failure. Geriatr Gerontol Int 2024. [PMID: 38703082 DOI: 10.1111/ggi.14880] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 05/06/2024]
Abstract
AIM We investigated whether the Dementia Assessment Sheet for Community-based Integrated Care System-21 Items (DASC-21), a questionnaire that assesses cognitive function, including activities of daily living (ADL), was predictive of in-hospital death and prolonged hospital stay in elderly patients hospitalized for heart failure. METHODS We retrospectively assessed the DASC-21 score at the time of admission, in-hospital death, length of hospital stay, and change in the Barthel index in 399 patients hospitalized for heart failure between 2016 and 2019. RESULTS The mean patient age was 85.8 ± 7.7 years (61.3% women). The median DASC-21 score was 38 (64.7% higher than 31). On multivariate logistic regression analysis, a higher DASC-21 score was associated with an increased risk of in-hospital death (odds ratio [OR] = 1.045 per 1 point increase, 95% confidence interval [CI]: 1.010-1.081, P = 0.012), even after adjusting for confounding factors, including atrial fibrillation, ejection fraction, and B-type natriuretic peptide. Difficulties (3 or 4) with the self-management of medication in instrumental ADL inside the home (OR = 3.28, 95% CI: 1.05-10.28, P = 0.042), toileting (OR = 3.66, 95% CI: 1.19-11.29, P = 0.024), grooming (OR = 6.47, 95% CI: 2.00-20.96, P = 0.002), eating (OR = 7.96, 95% CI: 2.49-25.45, P < 0.001), and mobility in physical ADL (OR = 5.99, 95% CI: 1.85-19.35, P = 0.003) were identified as risk factors for in-hospital death. Patients in the highest tertile of the DASC-21 score had a significantly longer hospital stay (P = 0.006) and a greater reduction in the Barthel index (P < 0.001). CONCLUSIONS In elderly patients hospitalized for heart failure, higher DASC-21 scores were associated with an increased risk of in-hospital death, prolonged hospital stay, and impaired ADL. Geriatr Gerontol Int 2024; ••: ••-••.
Collapse
Affiliation(s)
- Ruri Shimizu
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Chihiro Jyubishi
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shutaro Futami
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Ai Morozumi
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yoshihiro Saito
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shunsuke Komatsu
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Ayumi Toba
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Taizo Ishiyama
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Hajime Fujimoto
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shinichi Usui
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Yusuke Tuboko
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Shuichi Awata
- Integrated Research Initiative for Living Well with Dementia, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Kazumasa Harada
- Department of Cardiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| |
Collapse
|
2
|
Zhang C, Wang F, Hao C, Liang W, Hou T, Xin J, Su B, Ning M, Liu Y. Prognostic Impact of Early Administration of β-Blockers in Critically Ill Patients with Acute Myocardial Infarction. J Clin Pharmacol 2024; 64:410-417. [PMID: 37830391 DOI: 10.1002/jcph.2370] [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: 07/17/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Abstract
In critically ill patients with acute myocardial infarction (AMI), the relationship between the early administration of β-blockers and the risks of in-hospital and long-term mortality remains controversial. Furthermore, there are conflicting evidences for the efficacy of the early administration of intravenous followed by oral β-blockers in AMI. We conducted a retrospective analysis of critically ill patients with AMI who received the early administration of β-blockers within 24 hours of admission. The data were extracted from the Medical Information Mart for Intensive Care IV database. We enrolled 2467 critically ill patients with AMI in the study, with 1355 patients who received the early administration of β-blockers and 1112 patients who were non-users. Kaplan-Meier survival analysis and Cox proportional hazards models showed that the early administration of β-blockers was associated with a lower risk of in-hospital mortality (adjusted hazard ratio [aHR] 0.52; 95% confidence interval [95%CI] 0.42-0.64), 1-year mortality (aHR 0.54, 95%CI 0.47-0.63), and 5-year mortality (aHR 0.60, 95%CI 0.52-0.69). Furthermore, the early administration of both oral β-blockers and intravenous β-blockers followed by oral β-blockers may reduce the mortality risk, compared with non-users. The risks of in-hospital and long-term mortality were significantly decreased in patients who underwent revascularization with the early administration of β-blockers. We found that the early administration of β-blockers could lower the risks of in-hospital and long-term mortality. Furthermore, the early administration of both oral β-blockers and intravenous β-blockers followed by oral β-blockers may reduce the mortality risk, compared with non-users. Notably, patients who underwent revascularization with the early administration of β-blockers showed the lowest risks of in-hospital and long-term mortality.
Collapse
Affiliation(s)
- Chong Zhang
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, The Third Central Hospital of Tianjin, Tianjin, China
- Artificial Cell Engineering Technology Research Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, The Third Central Hospital of Tianjin, Tianjin, China
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
| | - Fei Wang
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, The Third Central Hospital of Tianjin, Tianjin, China
- Artificial Cell Engineering Technology Research Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, The Third Central Hospital of Tianjin, Tianjin, China
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
| | - Cuijun Hao
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, The Third Central Hospital of Tianjin, Tianjin, China
- Artificial Cell Engineering Technology Research Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, The Third Central Hospital of Tianjin, Tianjin, China
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
| | - Weiru Liang
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin, China
| | - Tianhua Hou
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, The Third Central Hospital of Tianjin, Tianjin, China
- Artificial Cell Engineering Technology Research Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, The Third Central Hospital of Tianjin, Tianjin, China
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
| | - Jiayan Xin
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, The Third Central Hospital of Tianjin, Tianjin, China
- Artificial Cell Engineering Technology Research Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, The Third Central Hospital of Tianjin, Tianjin, China
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
| | - Bin Su
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, The Third Central Hospital of Tianjin, Tianjin, China
- Artificial Cell Engineering Technology Research Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, The Third Central Hospital of Tianjin, Tianjin, China
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
| | - Meng Ning
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, The Third Central Hospital of Tianjin, Tianjin, China
- Artificial Cell Engineering Technology Research Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, The Third Central Hospital of Tianjin, Tianjin, China
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
| | - Yingwu Liu
- The Third Central Clinical College of Tianjin Medical University, Tianjin, China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, The Third Central Hospital of Tianjin, Tianjin, China
- Artificial Cell Engineering Technology Research Center, The Third Central Hospital of Tianjin, Tianjin, China
- Tianjin Institute of Hepatobiliary Disease, The Third Central Hospital of Tianjin, Tianjin, China
- Department of Heart Center, The Third Central Hospital of Tianjin, Tianjin, China
| |
Collapse
|
3
|
Oraii A, Shafeghat M, Ashraf H, Soleimani A, Kazemian S, Sadatnaseri A, Saadat N, Danandeh K, Akrami A, Balali P, Fatahi M, Karbalai Saleh S. Risk assessment for mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: A retrospective cohort study. Health Sci Rep 2024; 7:e1867. [PMID: 38357486 PMCID: PMC10864735 DOI: 10.1002/hsr2.1867] [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: 02/17/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
Background and Aims Primary percutaneous coronary intervention (PCI) is the treatment of choice in ST-elevation myocardial infarction (STEMI) patients. This study aims to evaluate predictors of in-hospital and long-term mortality among patients with STEMI undergoing primary PCI. Methods In this registry-based study, we retrospectively analyzed patients with STEMI undergoing primary PCI enrolled in the primary angioplasty registry of Sina Hospital. Independent predictors of in-hospital and long-term mortality were determined using multivariate logistic regression and Cox regression analyses, respectively. Results A total of 1123 consecutive patients with STEMI were entered into the study. The mean age was 59.37 ± 12.15 years old, and women constituted 17.1% of the study population. The in-hospital mortality rate was 5.0%. Multivariate analyses revealed that older age (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.02-1.10), lower ejection fraction (OR: 0.97, 95% CI: 0.92-0.99), lower mean arterial pressure (OR: 0.95, 95% CI: 0.93-0.98), and higher white blood cells (OR: 1.17, 95% CI: 1.06-1.29) as independent risk predictors for in-hospital mortality. Also, 875 patients were followed for a median time of 21.8 months. Multivariate Cox regression demonstrated older age (hazard ratio [HR] = 1.04, 95% CI: 1.02-1.06), lower mean arterial pressure (HR = 0.98, 95% CI: 0.97-1.00), and higher blood urea (HR = 1.01, 95% CI: 1.00-1.02) as independent predictors of long-term mortality. Conclusion We found that older age and lower mean arterial pressure were significantly associated with the increased risk of in-hospital and long-term mortality in STEMI patients undergoing primary PCI. Our results indicate a necessity for more precise care and monitoring during hospitalization for such high-risk patients.
Collapse
Affiliation(s)
- Alireza Oraii
- Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | - Melika Shafeghat
- School of MedicineTehran University of Medical SciencesTehranIran
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Haleh Ashraf
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Research Development Center, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Abbas Soleimani
- Department of Cardiology, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Sina Kazemian
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Azadeh Sadatnaseri
- Department of Cardiology, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Naser Saadat
- Department of Cardiology, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Khashayar Danandeh
- Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | - Ashley Akrami
- Chicago College of Osteopathic MedicineMidwestern UniversityDowners GroveIllinoisUSA
| | - Pargol Balali
- Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | - Mohamadreza Fatahi
- Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | | |
Collapse
|
4
|
Prasitvarakul K, Attanath N, Chang A. Comparison of scoring systems for predicting clinical outcomes of acute lower gastrointestinal bleeding: A prospective cohort study. World J Surg 2024; 48:474-483. [PMID: 38686770 DOI: 10.1002/wjs.12053] [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: 10/06/2023] [Accepted: 12/13/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND This study aimed to determine the performance of the Oakland, Glasgow-Blatchford, and AIMS65 scores in predicting the clinical outcomes of acute lower gastrointestinal bleeding (LGIB). METHODS This prospective cohort study was conducted from July 2020 to July 2021. Patients admitted with acute lower gastrointestinal bleeding were enrolled. The Oakland, Glasgow-Blatchford, and AIMS65 scores were calculated. The primary outcome was validating the performance of the scores in predicting severe LGIB; secondary outcomes were comparing the performance of the scores in predicting the need for blood transfusion, hemostatic interventions, in-hospital rebleeding, and mortality. Receiver operating characteristic curves were calculated for all outcomes. The associations between all three scores and the primary outcomes were calculated using multivariate logistic regression analysis. RESULTS Patients with acute LGIB (n = 150) were enrolled (88 [58.7%] men and mean age: 63.6 ± 17.3 years). The rates of severe LGIB, need for blood transfusion, hemostatic intervention, in-hospital rebleeding, and in-hospital mortality were 54.7%, 79.3%, 10.7%, and 3.3%, respectively. The Oakland and Glasgow-Blatchford scores had comparable performance in predicting severe LGIB, need for blood transfusion, and mortality, outperforming the AIMS65 score. All scores were suboptimal for predicting hemostatic interventions and rebleeding. CONCLUSIONS Our results demonstrate the predictive performances of the Oakland score and the GBS are excellent and comparable for severe LGIB, the need for blood transfusion, and in-hospital mortality in patients with acute LGIB. Thus, GBS could be considered as an alternative predictive score for stratification of the patients with acute LGIB.
Collapse
Affiliation(s)
- Kamales Prasitvarakul
- Division of Minimally Invasive Surgery, Department of Surgery, Hatyai Hospital, Hatyai, Songkhla, Thailand
| | | | - Arunchai Chang
- Division of Gastroenterology, Department of Internal Medicine, Hatyai Hospital, Hatyai, Songkhla, Thailand
| |
Collapse
|
5
|
Choi J, Choi AY, Park E, Moon S, Son MH, Cho J. Trends in Incidences and Survival Rates in Pediatric In-Hospital Cardiopulmonary Resuscitation: A Korean Population-Based Study. J Am Heart Assoc 2023; 12:e028171. [PMID: 36695322 PMCID: PMC9973657 DOI: 10.1161/jaha.122.028171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Although the outcome of cardiopulmonary resuscitation (CPR) is still unsatisfactory, there are few studies about temporal trends of in-hospital CPR incidence and mortality. We aimed to evaluate nationwide trends of in-hospital CPR incidence and its associated risk factors and mortality in pediatric patients using a database of the Korean National Health Insurance between 2012 and 2018. Methods and Results We excluded neonates and neonatal intensive care unit admissions. Incidence of in-hospital pediatric CPR was 0.58 per 1000 admissions (3165 CPR/5 429 471 admissions), and the associated mortality was 50.4%. Change in CPR incidence according to year was not significant in an adjusted analysis (P=0.234). However, CPR mortality increased significantly by 6.6% every year in an adjusted analysis (P<0.001). Hospitals supporting pediatric critical care showed 37.7% lower odds of CPR incidence (P<0.001) and 27.5% lower odds of mortality compared with other hospitals in the adjusted analysis (P<0.001), and they did not show an increase in mortality (P for trend=0.882). Conclusions Temporal trends of in-hospital CPR mortality worsened in Korea, and the trends differed according to subgroups. Study results highlight the need for ongoing evaluation of CPR trends and for further CPR outcome improvement among hospitalized children.
Collapse
Affiliation(s)
- Jaeyoung Choi
- Department of Critical Care MedicineSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Ah Young Choi
- Department of PediatricsChungnam National University HospitalDaejeonRepublic of Korea
| | - Esther Park
- Department of PediatricsJeonbuk National University Children’s HospitalJeonjuRepublic of Korea
| | - Suhyeon Moon
- Research Institute for Future MedicineSamsung Medical CenterSeoulRepublic of Korea
| | - Meong Hi Son
- Department of PediatricsSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Joongbum Cho
- Department of Critical Care MedicineSamsung Medical Center, Sungkyunkwan University School of MedicineSeoulRepublic of Korea
| |
Collapse
|
6
|
Beadle JL, Perman SM, Pennington J, Gaieski DF. An investigation of temperature and fever burdens in patients with sepsis admitted from the emergency department to the hospital. Acute Med Surg 2023; 10:e902. [PMID: 37929070 PMCID: PMC10622605 DOI: 10.1002/ams2.902] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
Aim We sought to collect granular data on temperature burden to further explore existing conflicting information on the relationship between temperature alterations and outcomes in patients with sepsis requiring hospital admission. Methods This was a prospective cohort study that enrolled a convenience sample of patients with sepsis or septic shock admitted to the hospital from the emergency department (ED). A "unit of temperature burden (UTB)" was defined as >1°C (1.8°F) above or below 37°C (98.6°F) for 1 min. Fever burden was defined as the number of UTBs >38°C (100.4°F). The primary objective was to calculate the fever burden in patients with sepsis during their ED stay. This was analyzed for patients who present to triage febrile or hypothermic and also for those who developed temperature abnormalities during their ED stay. The secondary objectives were correlating fever and hypothermia burden with in-hospital mortality, Systemic Inflammatory Response Syndrome (SIRS) criteria, and the quick Sequential (Sepsis-Associated) Organ Failure Assessment (qSOFA) score and identification of patients who may benefit from early implementation of targeted temperature management. Results A total of 256 patients met the inclusion criteria. The mean age of patients was 60.1 ± 18.4 years; 46% were female and 29.6% were black. The median (interquartile range [IQR]) fever burden for the fever in triage cohort (n = 99) was 364.6 (174.3-716.8) UTB and for the no fever in triage cohort (n = 157) was 179.3 (80.9-374.0) UTB (p = 0.005). The two groups had similar in-hospital mortality (6.1 vs 8.3%; p = 0.5). The median fever burden for the fever anytime cohort was 303.8 (IQR 138.8-607.9) UTB and they had lower mortality than the no fever anytime cohort (4.7% vs 11.2%; p = 0.052). Patients with fever at triage had higher mean SIRS criteria than those without (2.8 vs 2.0; p < 0.001) while qSOFA points were similar (p = 0.199). A total of 27 patients had hypothermia during their ED stay and these patients were older with higher mean SIRS criteria. Conclusions Patients with sepsis and septic shock have a significant temperature burden in the ED. When comparing patients who had fever at any time during their ED stay with those who never had a fever, a trend toward an inverse relationship between fever burden and mortality was found.
Collapse
Affiliation(s)
| | | | | | - David F. Gaieski
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
7
|
Endo T, Khoujah D, Motohashi T, Shinozaki T, Tsushima K, Fujitani S, Shiga T. The National Early Warning Score on admission predicts severe disease and in-hospital mortality of the coronavirus disease 2019 Delta variant: A retrospective cohort study. Acute Med Surg 2023; 10:e851. [PMID: 37261374 PMCID: PMC10227991 DOI: 10.1002/ams2.851] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/04/2023] [Accepted: 04/20/2023] [Indexed: 06/02/2023] Open
Abstract
Background Clinical risk scores are widely used in emergency medicine, and some studies have evaluated their use in patients with coronavirus disease 2019 (COVID-19). However, no studies have evaluated their use in patients with the COVID-19 Delta variant. We aimed to study the performance of four different clinical scores (National Early Warning Score [NEWS], quick Sequential Organ Failure Assessment [qSOFA], Confusion, Respiratory rate, Blood pressure, and Age ≥65 [CRB-65], and Kanagawa score) in predicting the risk of severe disease (defined as the need for intubation and in-hospital mortality) in patients with the COVID-19 Delta variant. Methods This was a retrospective cohort study of patients hospitalized with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant infection between June 1 and December 31, 2021. The primary outcomes were the sensitivity and specificity of the aforementioned clinical risk scores at admission to predict severe disease. Areas under the receiver operating characteristic curves (AUROCs) were compared between the clinical risk scores and we identified new cut-off points for all four scores. Results A total of 249 adult patients were included, of whom 18 developed severe disease. A NEWS ≥7 at admission predicted severe disease with 72.2% sensitivity and 86.2% specificity. The NEWS (AUROC 0.88) was superior to both the qSOFA (AUROC 0.74) and the CRB-65 (AUROC 0.67), and there was no significant difference between the NEWS and Kanagawa score (AUROC 0.86). Conclusion The NEWS at hospital admission predicted the severity of the COVID-19 Delta variant with high accuracy.
Collapse
Affiliation(s)
- Takuro Endo
- Department of Emergency MedicineInternational University of Health and Welfare, School of Medicine, Narita HospitalChibaJapan
| | - Danya Khoujah
- Department of Emergency MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
| | - Takako Motohashi
- Department of Preventive MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of EngineeringTokyo University of ScienceTokyoJapan
| | - Kenji Tsushima
- Department of Pulmonary MedicineInternational University of Health and Welfare, School of Medicine, Narita HospitalChibaJapan
| | - Shigeki Fujitani
- Department of Emergency and Critical Care MedicineSt. Marianna University School of MedicineKawasakiJapan
| | - Takashi Shiga
- Department of Emergency MedicineInternational University of Health and Welfare, School of Medicine, Narita HospitalChibaJapan
| |
Collapse
|
8
|
Wu J, Fan Y, Zhao W, Li B, Pan N, Lou Z, Zhang M. In-Hospital Outcomes of Acute Myocardial Infarction With Essential Thrombocythemia and Polycythemia Vera: Insights From the National Inpatient Sample. J Am Heart Assoc 2022; 11:e027352. [PMID: 36515250 PMCID: PMC9798805 DOI: 10.1161/jaha.122.027352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Acute myocardial infarction (AMI) with essential thrombocythemia (ET) or polycythemia vera is rare, and there are scarce real-world data on its management and impact on in-hospital outcomes. Methods and Results Dates of current retrospective cohort study were obtained from the US National Inpatient Sample from October 2015 to 2019 for hospitalizations with AMI. The primary outcome was in-hospital mortality, and the secondary outcome was major adverse cardiac or cerebrovascular events, stroke, and bleeding; major adverse cardiac or cerebrovascular event was defined by a composite of all-cause mortality, stroke, and cardiac complications. Of the 2 871 934 weighted AMI hospitalizations, 0.27% were with ET and 0.1% were with polycythemia vera. Before propensity matching, AMI hospitalization with ET was associated with increased risk of in-hospital mortality (7.1% versus 5.7%; odds ratio [OR], 1.14 [95% CI, 1.04-1.24]), major adverse cardiac or cerebrovascular events (12.6% versus 9%; OR, 1.36 [95% CI, 1.26-1.45]), bleeding (12.7% versus 5.8%; OR, 2.28 [95% CI, 2.13-2.44]), and stroke (3.1% versus 1.8%; OR, 1.66 [95% CI, 1.46-1.89]). Polycythemia vera was associated with an increased risk of in-hospital mortality (7.8% versus 5.7%; OR, 1.21 [95% CI, 1.04-1.39]) and major adverse cardiac or cerebrovascular events (12.0% versus 9%; OR, 1.18 [95% CI, 1.05-1.33]). After propensity matching, ET was associated with increased risk of bleeding (12.6% versus 6.1%; OR, 2.22 [95% CI, 1.70-2.90]), and AMI with polycythemia vera was not associated with worse in-hospital outcomes. Conclusions AMI hospitalization with ET is associated with high bleeding risk before and after propensity score matching, particularly for hospitalizations treated with percutaneous coronary intervention. The management of AMI requires a multidisciplinary and patient-centered approach to ensure safety and improve outcomes.
Collapse
Affiliation(s)
- Jing Wu
- Department of Translational MedicineThe First Hospital of Jilin UniversityChangchunChina
| | - YongZhen Fan
- Department of CardiologyZhongnan HospitalWuhanChina
| | - Wei Zhao
- Department of Cardiovascular DiseasesThe First Hospital of Jilin UniversityChangchunChina
| | - Bing Li
- Department of Cardiovascular DiseasesThe First Hospital of Jilin UniversityChangchunChina
| | - Naifan Pan
- Department of AnesthesiologyThe First Hospital of Jilin UniversityChangchunChina
| | - Zhiyang Lou
- Department of Cardiovascular DiseasesThe First Hospital of Jilin UniversityChangchunChina
| | - Mingyou Zhang
- Department of Cardiovascular DiseasesThe First Hospital of Jilin UniversityChangchunChina
| |
Collapse
|
9
|
Aikawa T, Kuno T, Van den Eynde J, Briasoulis A, Malik AH. Effects of Clinical Trial or Research Program Participation Status on In-Hospital Mortality After Transcatheter Aortic Valve Implantation. J Am Heart Assoc 2022; 11:e025920. [PMID: 35699177 PMCID: PMC9238665 DOI: 10.1161/jaha.121.025920] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Tadao Aikawa
- Department of Cardiology Hokkaido Cardiovascular Hospital Sapporo Japan.,Department of Radiology Jichi Medical University Saitama Medical Center Saitama Japan
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center Albert Einstein College of Medicine New York NY
| | - Jef Van den Eynde
- Helen B. Taussig Heart Center The Johns Hopkins Hospital and School of Medicine Baltimore MD.,Department of Cardiovascular Sciences KU Leuven Leuven Belgium
| | - Alexandros Briasoulis
- Section of Heart Failure and Transplantation, Division of Cardiovascular Medicine University of Iowa Iowa City IA
| | - Aaqib H Malik
- Department of Cardiology Westchester Medical Center Valhalla NY
| |
Collapse
|
10
|
Al‐Jarallah M, Rajan R, Saber AA, Pan J, Al‐Sultan AT, Abdelnaby H, Alroomi M, Dashti R, Aboelhassan W, Almutairi F, Abdullah M, Alotaibi N, Saleh MA, AlNasrallah N, Al‐Bader B, Malhas H, Ramadhan M, Hamza M, Zhanna KD. In-hospital mortality in SARS-CoV-2 stratified by hemoglobin levels: A retrospective study. EJHaem 2021; 2:335-339. [PMID: 34226901 PMCID: PMC8242736 DOI: 10.1002/jha2.195] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 01/28/2023]
Abstract
This study is to estimate in-hospital mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients stratified by hemoglobin (Hb) level. Patients were stratified according to hemoglobin level into two groups, that is, Hb <100 g/L and Hb >100 g/L. A total of 6931 patients were included. Of these, 6377 (92%) patients had hemoglobin levels >100 g/L. The mean age was 44 ± 17 years, and 66% of the patients were males. The median length of overall hospital stay was 13 days [2; 31]. The remaining 554 (8%) patients had a hemoglobin level <100 g/L. Overall mortality was 176 patients (2.54%) but was significantly higher in the group with hemoglobin levels <100 g/L (124, 22.4%) than in the group with hemoglobin levels >100 g/L (52, 0.82%). Risk factors associated with increased mortality were determined by multivariate analysis. The Kaplan-Meier survival analysis showed hemoglobin as a predictor of mortality. Cox proportional hazards regression coefficients for hemoglobin for the HB ≤ 100 category of hemoglobin were significant, B = 2.79, SE = 0.17, and HR = 16.34, p < 0.001. Multivariate logistic regression showed Hb < 100 g/L had a higher cumulative all-cause in-hospital mortality (22.4% vs. 0.8%; adjusted odds ratio [aOR], 0.33; 95% [CI]: [0.20-0.55]; p < 0.001). In this study, hemoglobin levels <100 g/L were found to be an independent predictor of in-hospital mortality.
Collapse
Affiliation(s)
- Mohammed Al‐Jarallah
- Department of Cardiology, Sabah Al Ahmed Cardiac CentreAl Amiri Hospital, KuwaitKuwait
| | - Rajesh Rajan
- Department of Cardiology, Sabah Al Ahmed Cardiac CentreAl Amiri Hospital, KuwaitKuwait
| | - Ahmad Al Saber
- Department of Mathematics and StatisticsUniversity of StrathclydeGlasgowUK
| | - Jiazhu Pan
- Department of Mathematics and StatisticsUniversity of StrathclydeGlasgowUK
| | - Ahmad T. Al‐Sultan
- Department of Community Medicine and Behavioural Sciences, College of MedicineKuwait UniversityKuwait CityKuwait
| | - Hassan Abdelnaby
- Department of Endemic and Infectious diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. Department of Internal Medicine, Division of gastroenterology, Al Sabah HospitalMinistry of Health, Shuwaikh Medical AreaKuwait
| | - Moudhi Alroomi
- Department of Infectious Diseases, Infectious Diseases HospitalMinistry of Health, Shuwaikh Medical AreaKuwait
| | - Raja Dashti
- Department of Cardiology, Sabah Al Ahmed Cardiac CentreAl Amiri Hospital, KuwaitKuwait
| | - Wael Aboelhassan
- Department of Internal Medicine, Division of gastroenterology, Jaber Al Ahmed HospitalMinistry of Health, South SurraKuwait
| | - Farah Almutairi
- Department of medicine, Farwaniya HospitalMinistry of HealthFarwaniyaKuwait
| | - Mohammed Abdullah
- Department of Infectious Diseases, Infectious Diseases HospitalMinistry of Health, Shuwaikh Medical AreaKuwait
| | - Naser Alotaibi
- Department of Medicine, Al Adan HospitalMinistry of Health, HadiyaKuwait
| | - Mohammad Al Saleh
- Department of medicine, Farwaniya HospitalMinistry of HealthFarwaniyaKuwait
| | - Noor AlNasrallah
- Department of Medicine, Al Adan HospitalMinistry of Health, HadiyaKuwait
| | - Bader Al‐Bader
- Department of medicine, Farwaniya HospitalMinistry of HealthFarwaniyaKuwait
| | - Haya Malhas
- Department of Emergency Medicine, Mubarak Al‐Kabeer HospitalMinistry of HealthJabriyaKuwait
| | - Maryam Ramadhan
- Department of Obstetric and Gynecology, Maternity HospitalMinistry of HealthSabah Area, Shuwaikh Medical AreaKuwait
| | - Mahdy Hamza
- Department of Medical Imaging, Al Adan HospitalMinistry of Health, HadiyaKuwait
| | - Kobalava D. Zhanna
- Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named after V.S. Moiseev, Institute of MedicinePeoples’ Friendship University of Russia (RUDN University)MoscowRussian Federation
| |
Collapse
|
11
|
Osman M, Syed M, Patibandla S, Sulaiman S, Kheiri B, Shah MK, Bianco C, Balla S, Patel B. Fifteen-Year Trends in Incidence of Cardiogenic Shock Hospitalization and In-Hospital Mortality in the United States. J Am Heart Assoc 2021; 10:e021061. [PMID: 34315234 PMCID: PMC8475696 DOI: 10.1161/jaha.121.021061] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background There is a lack of contemporary data on cardiogenic shock (CS) in-hospital mortality trends. Methods and Results Patients with CS admitted January 1, 2004 to December 31, 2018, were identified from the US National Inpatient Sample. We reported the crude and adjusted trends of in-hospital mortality among the overall population and selected subgroups. Among a total of 563 949 644 hospitalizations during the period from January 1, 2004, to December 30, 2018, 1 254 358 (0.2%) were attributed to CS. There has been a steady increase in hospitalizations attributed to CS from 122 per 100 000 hospitalizations in 2004 to 408 per 100 000 hospitalizations in 2018 (Ptrend<0.001). This was associated with a steady decline in the adjusted trends of in-hospital mortality during the study period in the overall population (from 49% in 2004 to 37% in 2018; Ptrend<0.001), among patients with acute myocardial infarction CS (from 43% in 2004 to 34% in 2018; Ptrend<0.001), and among patients with non-acute myocardial infarction CS (from 52% in 2004 to 37% in 2018; Ptrend<0.001). Consistent trends of reduced mortality were seen among women, men, different racial/ethnic groups, different US regions, and different hospital sizes, regardless of the hospital teaching status. Conclusions Hospitalizations attributed to CS have tripled in the period from January 2004 to December 2018. However, there has been a slow decline in CS in-hospital mortality during the studied period. Further studies are necessary to determine if the recent adoption of treatment algorithms in treating patients with CS will further impact in-hospital mortality.
Collapse
Affiliation(s)
- Mohammed Osman
- Division of CardiologyWest Virginia University School of MedicineMorgantownWV
- Knight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | - Moinuddin Syed
- Division of CardiologyWest Virginia University School of MedicineMorgantownWV
| | | | - Samian Sulaiman
- Division of CardiologyWest Virginia University School of MedicineMorgantownWV
| | - Babikir Kheiri
- Knight Cardiovascular InstituteOregon Health and Science UniversityPortlandOR
| | - Mahek K. Shah
- Division of CardiologyThomas Jefferson UniversityPhiladelphiaPA
| | - Christopher Bianco
- Division of CardiologyWest Virginia University School of MedicineMorgantownWV
| | - Sudarshan Balla
- Division of CardiologyWest Virginia University School of MedicineMorgantownWV
| | - Brijesh Patel
- Division of CardiologyWest Virginia University School of MedicineMorgantownWV
| |
Collapse
|
12
|
Sasaki K, Obinata H, Yokobori S, Sakamoto T. Alcohol does not increase in-hospital mortality due to severe blunt trauma: an analysis of propensity score matching using the Japan Trauma Data Bank. Acute Med Surg 2021; 8:e671. [PMID: 34262778 PMCID: PMC8254651 DOI: 10.1002/ams2.671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/02/2021] [Indexed: 11/10/2022] Open
Abstract
Aim Alcohol‐related problems, including trauma, are a great burden on global health. Alcohol metabolism in the Japanese population is genetically inferior to other races. This study aimed to evaluate the effects of alcohol use among a Japanese severe blunt trauma cohort. Methods This retrospective observational study analyzed the data of trauma patients registered in the Japan Trauma Data Bank between 2004 and 2019. The primary outcome of this study was in‐hospital mortality. The lengths of hospital and intensive care unit stay were the secondary outcomes. Propensity score matching was used to adjust the anatomical severity and patient background to reduce the potential alcohol use bias. Results We analyzed 46,361 patients categorized into nondrinking (n = 37,818) and drinking (n = 8,543) groups. After a 1:1 propensity score matching (n = 8,428, respectively), despite the Glasgow Coma Scale and Revised Trauma Score scores being significantly lower in the drinking group (14 vs. 13 and 7.84 vs. 7.55, P < 0.001, respectively) and intensive care unit length of stay being significantly longer in the drinking group (6 vs. 7 days, P = 0.002), in‐hospital mortality was significantly lower in the alcohol group (11.8% vs. 9.0%, P < 0.001) and there were no differences in the duration of hospital stay (19 vs. 19 days, P = 0.848). Conclusion Despite increasing physiological severity on admission, after adjusting for anatomical severity, alcohol consumption could be beneficial in severe blunt trauma patients as regards in‐hospital mortality.
Collapse
Affiliation(s)
- Kazuma Sasaki
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Hirofumi Obinata
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan.,Shock and Trauma Center Nippon Medical School Chiba Hokusoh Hospital Chiba Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
| | - Taigo Sakamoto
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan.,Shock and Trauma Center Nippon Medical School Chiba Hokusoh Hospital Chiba Japan
| |
Collapse
|
13
|
Chen Q, Wang L, Li C, Hu W, Fan Y, Chen Z, Wu L, Lu Z, Ye J, Chen S, Tong J, Ruan L, Mei J, Lu H. Chronic Cardio-Metabolic Disease Increases the Risk of Worse Outcomes Among Hospitalized Patients With COVID-19: A Multicenter, Retrospective, and Real-World Study. J Am Heart Assoc 2021; 10:e018451. [PMID: 34096317 PMCID: PMC8477891 DOI: 10.1161/jaha.120.018451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/08/2023]
Abstract
Background Although chronic cardio-metabolic disease is a common comorbidity among patients with COVID-19, its effects on the clinical characteristics and outcome are not well known. Methods and Results This study aimed to explore the association between underlying cardio-metabolic disease and mortality with COVID-19 among hospitalized patients. This multicenter, retrospective, and real-world study was conducted from January 22, 2020 to March 25, 2020 in China. Data between patients with and without 5 main cardio-metabolic diseases including hypertension, diabetes mellitus, coronary heart disease, cerebrovascular disease, and hyperlipidemia were compared. A total of 1303 hospitalized patients were included in the final analysis. Of them, 520 patients (39.9%) had cardio-metabolic disease. Compared with patients without cardio-metabolic disease, more patients with cardio-metabolic disease had COVID-related complications including acute respiratory distress syndrome (9.81% versus 3.32%; P<0.001), acute kidney injury (4.23% versus 1.40%; P=0.001), secondary infection (13.9% versus 9.8%; P=0.026), hypoproteinemia (12.1% versus 5.75%; P<0.001), and coagulopathy (19.4% versus 10.3%; P<0.001), had higher incidences of the severe type of COVID-19 (32.9% versus 16.7%; P<0.001), more were admitted to the intensive care unit (11.7% versus 7.92%; P=0.021), and required mechanical ventilation (9.8% versus 4.3%; P<0.001). When the number of the patients' cardio-metabolic diseases was 0, 1, and >2, the mortality was 4.2%, 11.1%, and 19.8%, respectively. The multivariable-adjusted hazard ratio of mortality among patients with cardio-metabolic disease was 1.80 (95% CI, 1.17-2.77). Conclusions Cardio-metabolic disease was a common condition among hospitalized patients with COVID-19, and it was associated with higher risks of in-hospital mortality.
Collapse
Affiliation(s)
- Qijian Chen
- Department of Emergency the Fifth Hospital in Wuhan Wuhan Hubei China
| | - Lingling Wang
- Department of Endocrinology & Metabolism the Fifth Affiliated Hospital of Sun Yat-sen University Zhuhai Guangdong China.,Department of Gerontology the Fifth Affiliated Hospital of Sun Yat-sen University Zhuhai Guangdong China
| | - Chang Li
- Department of Cardiology Hubei No. 3 People's Hospital of Jianghan University Wuhan Hubei China
| | - Weihua Hu
- Department of Respiratory Medicine the First Hospital of Jingzhou Clinical Medical College Yangtze University Jingzhou Hubei China
| | - Yameng Fan
- School of Health Sciences Wuhan University Wuhan Hubei China
| | - Zaishu Chen
- People's Hospital of Jiayu County Xianning Hubei China
| | - Longlong Wu
- People's Hospital of Nanzhang County Nanzhang Hubei China
| | - Zhanjin Lu
- Department of Endocrinology & Metabolism the Fifth Affiliated Hospital of Sun Yat-sen University Zhuhai Guangdong China
| | - Jianfang Ye
- Department of Endocrinology & Metabolism the Fifth Affiliated Hospital of Sun Yat-sen University Zhuhai Guangdong China
| | - Shiyan Chen
- Department of Endocrinology & Metabolism the Fifth Affiliated Hospital of Sun Yat-sen University Zhuhai Guangdong China
| | - Junlu Tong
- Department of Endocrinology & Metabolism the Fifth Affiliated Hospital of Sun Yat-sen University Zhuhai Guangdong China
| | - Liemin Ruan
- Central Laboratory Ningbo First Hospital of Zhejiang University Ningbo Zhejiang China
| | - Jin Mei
- Central Laboratory Ningbo First Hospital of Zhejiang University Ningbo Zhejiang China.,Anatomy Department Wenzhou Medical UniversityWenzhou University Town Ningbo Zhejiang China
| | - Hongyun Lu
- Department of Endocrinology & Metabolism Zhuhai Hospital Affiliated with Jinan UniversityZhuhai People's Hospital Zhuhai Guangdong China
| |
Collapse
|
14
|
Taha M, Mishra T, Shokr M, Sharma A, Taha M, Samavati L. Burden and impact of arrhythmias in asthma-related hospitalizations: Insight from the national inpatient sample. J Arrhythm 2021; 37:113-120. [PMID: 33664893 PMCID: PMC7896478 DOI: 10.1002/joa3.12452] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/05/2020] [Accepted: 10/22/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study aimed to analyze the burden and impact of cardiac arrhythmias in adult patients hospitalized with asthma exacerbation using the nationwide inpatient database. METHODS We used the National Inpatient Sample (NIS) database (2010-2014) to identify arrhythmias in asthma-related hospitalization and its impact on inpatient mortality, hospital length of stay (LOS), and hospitalization charges. We also used multivariable analysis to identify predictors of in-hospital arrhythmia and mortality. RESULTS We identified 12,988,129 patients hospitalized with primary diagnosis of asthma; among them, 2,014,459(16%) patients had cardiac arrhythmia. The most frequent arrhythmia identified is atrial fibrillation (AFib) (8.95%). The AFib and non-AFib arrhythmia group had higher mortality (3.40% & 2.22% vs 0.74%), mean length of stay (LOS) (5.9 & 5.4 vs 4.2 days), and hospital charges ($53,172 & $51,105 vs $34,585) as compared to the non-arrhythmia group (P < .005). Predictors of arrhythmia in asthma-related hospitalization were history of PCI or CABG, valvular heart disease, congestive heart failure (CHF), and acute respiratory failure. Predictors of higher mortality in arrhythmia group were acute respiratory failure, sepsis, and acute myocardial infarction. CONCLUSIONS Around 16% of adult patients hospitalized with asthma exacerbation experience arrythmia (mostly AFib 8.95%). The presence of arrhythmias was associated with higher in-hospital mortality, LOS, and hospital charges in hospitalized asthmatics.
Collapse
Affiliation(s)
- Muhanad Taha
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Tushar Mishra
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Mohamed Shokr
- Cardiology Department Leon H. Charney Division of Cardiology, Cardiac Electrophysiology NYU Langone Health New York University Grossman School of Medicine New York NY USA
| | - Aditi Sharma
- Department of Internal Medicine Detroit Medical Centre/Wayne State University Detroit MI USA
| | - Mazen Taha
- Faculty of Medicine Cairo University Giza Egypt
| | - Lobelia Samavati
- Department of Pulmonary Critical Care and Sleep Division Wayne State University Detroit MI USA
| |
Collapse
|
15
|
Ohbe H, Yamana H, Matsui H, Yasunaga H. Development and validation of a procedure-based organ failure assessment model for patients in the intensive care unit: an administrative database study. Acute Med Surg 2021; 8:e719. [PMID: 34987832 PMCID: PMC8695951 DOI: 10.1002/ams2.719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/05/2021] [Accepted: 11/28/2021] [Indexed: 11/11/2022] Open
Abstract
Aim To develop a procedure‐based organ failure assessment model for intensive care unit (ICU) patients and to examine the ability of this model to predict in‐hospital mortality, with reference to the Sequential Organ Failure Assessment (SOFA) score. Methods Using the Japanese nationwide Diagnosis Procedure Combination database, we identified patients aged ≥15 years who were admitted to the ICUs April 2018–March 2019. Since April 2018, Japanese health care providers have been required to input ICU patients' SOFA scores into this database. We extracted data on the following procedures on ICU admission: oxygen supplementation, invasive mechanical ventilation, blood transfusions, catecholamines, chest compression, extracorporeal membrane oxygenation, and renal replacement therapy. A procedure‐based organ failure assessment model (Model 1) for in‐hospital mortality was developed using therapeutic procedures for organ failure on the day of ICU admission in the derivation cohort. We also constructed a model using the SOFA score (Model 2). Discriminatory ability was assessed using area under the receiver operating characteristic curve (AUROC) in the validation cohort, and the discriminatory abilities of the models were compared. Results In total, 69,019 patients were included. Overall in‐hospital mortality was 7.2%. The AUROCs for Model 1 (0.810) and Model 2 (0.817) in the validation cohort did not show a statistically significant difference (P = 0.20). Conclusion The models established using procedure‐based organ failure assessment showed no statistically significant differences from those using the SOFA score, suggesting that procedure records in administrative databases can be used for risk adjustment in clinical studies on ICU mortality.
Collapse
Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo Tokyo Japan
| | - Hayato Yamana
- Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo Tokyo Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health The University of Tokyo Tokyo Japan
| |
Collapse
|
16
|
Reutersberg B, Salvermoser M, Trenner M, Geisbüsch S, Zimmermann A, Eckstein HH, Kuehnl A. Hospital Incidence and In-Hospital Mortality of Surgically and Interventionally Treated Aortic Dissections: Secondary Data Analysis of the Nationwide German Diagnosis-Related Group Statistics From 2006 to 2014. J Am Heart Assoc 2020; 8:e011402. [PMID: 30975011 PMCID: PMC6507201 DOI: 10.1161/jaha.118.011402] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Population‐based data about the incidence and mortality of patients with aortic dissections (ADs) are sparse. Therefore, the hospital incidence and in‐hospital mortality of patients undergoing open or endovascular surgery for type A ADs (TAADs) and type B ADs (TBADs) in Germany were analyzed on a nationwide basis between 2006 and 2014. Methods and Results A secondary data analysis of the nationwide diagnosis‐related group statistics, compiled by the German Federal Statistical Office, was performed for patients who were surgically/interventionally treated for AD (International Classification of Diseases, Tenth Revision, German Modification [ICD‐10‐GM] codes I71.00‐I71.07; n=20 533). By using specific procedure codes, a distinction between TAAD (n=14 911/72.6%) and TBAD (n=5622/27.4%) could be made. The standardized hospital incidence of surgically/interventionally treated AD was 2.7/100 000 per year, comprising 2.0/100 000 per year for TAAD and 0.7/100 000 per year for TBAD. The in‐hospital mortality of TAAD was 19.5%; and of TBAD, 9.3%. Both the incidence and in‐hospital mortality increased over the 9‐year period. The share of endovascularly treated TBAD increased steadily during the same time interval. A multilevel multivariable analysis revealed that, for TAAD, age and comorbidity were significantly associated with a higher mortality risk. The latter was also true for TBAD. Sex was not significantly associated with mortality. A significant association between higher annual center volume and mortality was found for TAAD, but not for TBAD. Conclusions This is the first report on hospital incidence and mortality for surgically/interventionally treated AD on a nationwide basis. Overall, in Germany, hospital incidence and mortality of TAAD and TBAD increased over time. In addition, TAAD is performed more safely in high‐volume centers. See Editorial Svensson
Collapse
Affiliation(s)
- Benedikt Reutersberg
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Michael Salvermoser
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Matthias Trenner
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Sarah Geisbüsch
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Alexander Zimmermann
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Hans-Henning Eckstein
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| | - Andreas Kuehnl
- 1 Department of Vascular and Endovascular Surgery Munich Aortic Centre Klinikum rechts der Isar Technical University of Munich Munich Germany
| |
Collapse
|
17
|
Al'Aref SJ, Singh G, van Rosendael AR, Kolli KK, Ma X, Maliakal G, Pandey M, Lee BC, Wang J, Xu Z, Zhang Y, Min JK, Wong SC, Minutello RM. Determinants of In-Hospital Mortality After Percutaneous Coronary Intervention: A Machine Learning Approach. J Am Heart Assoc 2020; 8:e011160. [PMID: 30834806 PMCID: PMC6474922 DOI: 10.1161/jaha.118.011160] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background The ability to accurately predict the occurrence of in‐hospital death after percutaneous coronary intervention is important for clinical decision‐making. We sought to utilize the New York Percutaneous Coronary Intervention Reporting System in order to elucidate the determinants of in‐hospital mortality in patients undergoing percutaneous coronary intervention across New York State. Methods and Results We examined 479 804 patients undergoing percutaneous coronary intervention between 2004 and 2012, utilizing traditional and advanced machine learning algorithms to determine the most significant predictors of in‐hospital mortality. The entire data were randomly split into a training (80%) and a testing set (20%). Tuned hyperparameters were used to generate a trained model while the performance of the model was independently evaluated on the testing set after plotting a receiver‐operator characteristic curve and using the output measure of the area under the curve (AUC) and the associated 95% CIs. Mean age was 65.2±11.9 years and 68.5% were women. There were 2549 in‐hospital deaths within the patient population. A boosted ensemble algorithm (AdaBoost) had optimal discrimination with AUC of 0.927 (95% CI 0.923–0.929) compared with AUC of 0.913 for XGBoost (95% CI 0.906–0.919, P=0.02), AUC of 0.892 for Random Forest (95% CI 0.889–0.896, P<0.01), and AUC of 0.908 for logistic regression (95% CI 0.907–0.910, P<0.01). The 2 most significant predictors were age and ejection fraction. Conclusions A big data approach that utilizes advanced machine learning algorithms identifies new associations among risk factors and provides high accuracy for the prediction of in‐hospital mortality in patients undergoing percutaneous coronary intervention. See Editorial by Garratt and Schneider
Collapse
Affiliation(s)
- Subhi J Al'Aref
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Gurpreet Singh
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | | | - Kranthi K Kolli
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Xiaoyue Ma
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Gabriel Maliakal
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Mohit Pandey
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Bejamin C Lee
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Jing Wang
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Zhuoran Xu
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - Yiye Zhang
- 2 Division of Health Informatics Weill Cornell Graduate School of Medical Sciences New York NY
| | - James K Min
- 1 Dalio Institute of Cardiovascular Imaging New York-Presbyterian Hospital New York NY
| | - S Chiu Wong
- 3 Division of Cardiology Department of Medicine Weill Cornell Medicine New York NY
| | - Robert M Minutello
- 3 Division of Cardiology Department of Medicine Weill Cornell Medicine New York NY
| |
Collapse
|
18
|
Miyamoto K, Shibata N, Ogawa A, Nakashima T, Kato S. Prehospital and in-hospital quick Sequential Organ Failure Assessment (qSOFA) scores to predict in-hospital mortality among trauma patients: an analysis of nationwide registry data. Acute Med Surg 2020; 7:e532. [PMID: 32587706 PMCID: PMC7311801 DOI: 10.1002/ams2.532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/30/2020] [Accepted: 05/22/2020] [Indexed: 01/31/2023] Open
Abstract
Aim The quick Sequential Organ Failure Assessment (qSOFA) score can be used to predict in‐hospital mortality in trauma patients. We sought to determine whether repeatedly calculating the qSOFA score improves its discriminative ability in predicting in‐hospital mortality in trauma patients. Methods We undertook a multicenter retrospective study, analyzing 90,974 trauma patients registered in the Japan Trauma Data Bank (a nationwide trauma registry) from 2004 to 2017. Patients included were ≥18 years old and transferred directly to hospitals from their respective scenes of injury. We calculated the qSOFA score at two time points: at the scene (prehospital qSOFA score) and on arrival at the hospital (hospital qSOFA score). We evaluated the discriminative ability of repeated calculations of the qSOFA score. The primary outcome in consideration was in‐hospital mortality. Results In‐hospital mortality occurred in 5604 patients (6.2%). The predictive accuracy of the hospital qSOFA score was higher than that of the prehospital qSOFA (area under the receiver operating characteristics curve [AUROC] 0.74 vs. 0.69, P < 0.0001) in predicting in‐hospital mortality. However, the mean qSOFA score had the highest predictive accuracy (AUROC 0.76, P < 0.0001). If the hospital qSOFA score was increased compared to the prehospital score, this indicated an approximately 2‐fold to 4‐fold increase in in‐hospital mortality. Conclusions Repeated calculations of qSOFA score improved its ability to predict in‐hospital mortality in trauma patients. Specifically, we should consider an increasing qSOFA score as a “red flag” to clinicians in the emergency department.
Collapse
Affiliation(s)
- Kyohei Miyamoto
- Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan
| | - Naoaki Shibata
- Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan
| | - Atsuhiro Ogawa
- Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan
| | - Tsuyoshi Nakashima
- Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan
| | - Seiya Kato
- Department of Emergency and Critical Care Medicine Wakayama Medical University Wakayama Japan
| |
Collapse
|
19
|
Trenner M, Salvermoser M, Busch A, Reutersberg B, Eckstein HH, Kuehnl A. Effect Modification of Sex and Age for the Hospital Volume-Outcome Relationship in Abdominal Aortic Aneurysm Treatment: Secondary Data Analysis of the Nationwide German Diagnosis Related Groups Statistics From 2005 to 2014. J Am Heart Assoc 2020; 9:e014534. [PMID: 32172655 PMCID: PMC7335519 DOI: 10.1161/jaha.119.014534] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Trials and registries associated female sex and high age with unfavorable outcomes in abdominal aortic aneurysm treatment. Many studies showed an inverse correlation between annual hospital volume and in-hospital mortality. The volume-outcome relationship has not been investigated separately for women and men or across the age range. The aim was to analyze whether sex and age are effect modifiers or confounders of the volume-outcome association. Methods and Results In a nationwide setting, all in-hospital cases from 2005 to 2014 with a diagnosis of intact abdominal aortic aneurysm and procedure codes for endovascular or open aortic repair were included. Primary outcome was in-hospital mortality. Using a multilevel multivariable regression model, hospital volume was modeled as a continuous variable. Separate analyses were performed for women and men and for predefined age groups. A total of 94 966 cases were included (12% women; median age, 72 years). Mortality was 4.9% in women and 3.0% in men (3.2% overall). Mortality increased with age. Although there was no significant volume-outcome association in women (P=0.57), there was in men (P=0.02). The strongest volume-outcome association was found in younger men. The younger female subpopulation was found to show a trend for an inverse volume-outcome relationship, whereas an opposite association was found for the women aged >79 years. Conclusions Women have a higher mortality risk after elective abdominal aortic aneurysm treatment. Sex and age are modifiers of the volume-outcome relationship. Unlike in male patients, in women there is no consistent effect of hospital volume on outcome.
Collapse
Affiliation(s)
- Matthias Trenner
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
| | - Michael Salvermoser
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
| | - Albert Busch
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
| | - Benedikt Reutersberg
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
| | - Andreas Kuehnl
- Department for Vascular and Endovascular Surgery Klinikum rechts der Isar Technical University of Munich and Munich Aortic Center Munich Germany
| |
Collapse
|
20
|
Muguruma K, Kunisawa S, Fushimi K, Imanaka Y. Epidemiology and volume-outcome relationship of extracorporeal membrane oxygenation for respiratory failure in Japan: A retrospective observational study using a national administrative database. Acute Med Surg 2020; 7:e486. [PMID: 32076555 PMCID: PMC7013206 DOI: 10.1002/ams2.486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/25/2019] [Accepted: 01/05/2020] [Indexed: 01/19/2023] Open
Abstract
Aim To describe the epidemiology of patients on extracorporeal membrane oxygenation (ECMO) and investigate the possible association between outcomes for respiratory ECMO patients and hospital volume of ECMO treatment for any indications. Methods Using data from the Diagnosis Procedure Combination database, a nationwide Japanese inpatient database, between 1 July 2010 and 31 March 2018, we identified inpatients aged ≥18 years who underwent ECMO. Institutional case volume was defined as the mean annual number of ECMO cases; eligible patients were categorized into institutional case volume tertile groups. The primary outcome was in-hospital mortality. For ECMO patients with respiratory failure, the association between institutional case volume group and in-hospital mortality rate was analyzed using a multilevel logistic regression model including multiple imputation. Results Extracorporeal membrane oxygenation was carried out on 25,384 patients during the study period; of those, 1,227 cases were for respiratory failure. Respiratory cases were categorized into low- (<8 cases/year), medium- (8-16 cases/year), and high-volume groups (≥17 cases/year). The overall in-hospital mortality rate for respiratory ECMO was 62.5% in low-, 54.7% in medium-, and 50.4% in high-volume institutions. With reference to low-volume institutions, the adjusted odds ratios (95% confidence interval) of the medium- and high-volume institutions for in-hospital mortality were 0.72 (0.50-1.04; P = 0.082) and 0.65 (0.45-0.95; P = 0.024), respectively. Conclusions The present study showed that accumulating the experience of using ECMO for any indications could positively affect the outcome of ECMO treatment for respiratory failure, which suggests the effectiveness of consolidating ECMO cases in high-volume centers in Japan.
Collapse
Affiliation(s)
- Kohei Muguruma
- Department of Healthcare Economics and Quality Management Graduate School of Medicine Kyoto University Kyoto City Japan
| | - Susumu Kunisawa
- Department of Healthcare Economics and Quality Management Graduate School of Medicine Kyoto University Kyoto City Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics Graduate School of Medicine Tokyo Medical and Dental University Tokyo Japan
| | - Yuichi Imanaka
- Department of Healthcare Economics and Quality Management Graduate School of Medicine Kyoto University Kyoto City Japan
| |
Collapse
|
21
|
Gupta T, Paul N, Kolte D, Harikrishnan P, Khera S, Aronow WS, Mujib M, Palaniswamy C, Sule S, Jain D, Ahmed A, Cooper HA, Frishman WH, Bhatt DL, Fonarow GC, Panza JA. Association of chronic renal insufficiency with in-hospital outcomes after percutaneous coronary intervention. J Am Heart Assoc 2015; 4:e002069. [PMID: 26080814 PMCID: PMC4599544 DOI: 10.1161/jaha.115.002069] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background The association of chronic renal insufficiency with outcomes after percutaneous coronary intervention (PCI) in the current era of drug-eluting stents and modern antithrombotic therapy has not been well characterized. Methods and Results We queried the 2007–2011 Nationwide Inpatient Sample databases to identify all patients aged ≥18 years who underwent PCI. Multivariable logistic regression was used to compare in-hospital outcomes among patients with chronic kidney disease (CKD), patients with end-stage renal disease (ESRD), and those without CKD or ESRD. Of 3 187 404 patients who underwent PCI, 89% had no CKD/ESRD; 8.6% had CKD; and 2.4% had ESRD. Compared to patients with no CKD/ESRD, patients with CKD and patients with ESRD had higher in-hospital mortality (1.4% versus 2.7% versus 4.4%, respectively; adjusted odds ratio for CKD 1.15, 95% CI 1.12 to 1.19, P<0.001; adjusted odds ratio for ESRD 2.29, 95% CI 2.19 to 2.40, P<0.001), higher incidence of postprocedure hemorrhage (3.5% versus 5.4% versus 6.0%, respectively; adjusted odds ratio for CKD 1.21, 95% CI 1.18 to 1.23, P<0.001; adjusted odds ratio for ESRD 1.27, 95% CI 1.23 to 1.32, P<0.001), longer average length of stay (2.9 days versus 5.0 days versus 6.4 days, respectively; P<0.001), and higher average total hospital charges ($60 526 versus $77 324 versus $97 102, respectively; P<0.001). Similar results were seen in subgroups of patients undergoing PCI for acute coronary syndrome or stable ischemic heart disease. Conclusions In patients undergoing PCI, chronic renal insufficiency is associated with higher in-hospital mortality, higher postprocedure hemorrhage, longer average length of stay, and higher average hospital charges.
Collapse
Affiliation(s)
- Tanush Gupta
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | - Neha Paul
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | - Dhaval Kolte
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | - Prakash Harikrishnan
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | - Sahil Khera
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
| | - Wilbert S Aronow
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
| | - Marjan Mujib
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | | | - Sachin Sule
- Department of Medicine, New York Medical College, Valhalla, NY (T.G., N.P., D.K., P.H., M.M., S.S.)
| | - Diwakar Jain
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
| | - Ali Ahmed
- Veterans Affairs Medical Center, Washington, DC (A.A.)
| | - Howard A Cooper
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
| | - William H Frishman
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
| | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (D.L.B.)
| | - Gregg C Fonarow
- David Geffen School of Medicine, University of California at Los Angeles, CA (G.C.F.)
| | - Julio A Panza
- Division of Cardiology, New York Medical College, Valhalla, NY (S.K., W.S.A., D.J., H.A.C., W.H.F., J.A.P.)
| |
Collapse
|
22
|
Sugiyama T, Hasegawa K, Kobayashi Y, Takahashi O, Fukui T, Tsugawa Y. Differential time trends of outcomes and costs of care for acute myocardial infarction hospitalizations by ST elevation and type of intervention in the United States, 2001-2011. J Am Heart Assoc 2015; 4:e001445. [PMID: 25801759 PMCID: PMC4392430 DOI: 10.1161/jaha.114.001445] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [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 Little is known whether time trends of in-hospital mortality and costs of care for acute myocardial infarction (AMI) differ by type of AMI (ST-elevation myocardial infarction [STEMI] vs. non-ST-elevation [NSTEMI]) and by the intervention received (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], or no intervention) in the United States. METHODS AND RESULTS We conducted a serial cross-sectional study of all hospitalizations for AMI aged 30 years or older using the Nationwide Inpatient Sample, 2001-2011 (1,456,154 discharges; a weighted estimate of 7,135,592 discharges). Hospitalizations were stratified by type of AMI and intervention, and the time trends of in-hospital mortality and hospital costs were examined for each combination of the AMI type and intervention, after adjusting for both patient- and hospital-level characteristics. Compared with 2001, adjusted in-hospital mortality improved significantly for NSTEMI patients in 2011, regardless of the intervention received (PCI odds ratio [OR] 0.68, 95% CI 0.56 to 0.83; CABG OR 0.57, 0.45 to 0.72; without intervention OR 0.61, 0.57 to 0.65). As for STEMI, a decline in adjusted in-hospital mortality was significant for those who underwent PCI (OR 0.83; 0.73 to 0.94); however, no significant improvement was observed for those who received CABG or without intervention. Hospital costs per hospitalization increased significantly for patients who underwent intervention, but not for those without intervention. CONCLUSIONS In the United States, the decrease in in-hospital mortality and the increase in costs differed by the AMI type and the intervention received. These non-uniform trends may be informative for designing effective health policies to reduce the health and economic burdens of AMI.
Collapse
Affiliation(s)
- Takehiro Sugiyama
- Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan (T.S.) Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan (T.S., Y.K.)
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (K.H.)
| | - Yasuki Kobayashi
- Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan (T.S., Y.K.)
| | - Osamu Takahashi
- Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan (O.T., T.F.)
| | - Tsuguya Fukui
- Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan (O.T., T.F.)
| | - Yusuke Tsugawa
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (Y.T.) Harvard Interfaculty Initiative in Health Policy, Cambridge, MA (Y.T.)
| |
Collapse
|
23
|
Khera S, Kolte D, Aronow WS, Palaniswamy C, Subramanian KS, Hashim T, Mujib M, Jain D, Paudel R, Ahmed A, Frishman WH, Bhatt DL, Panza JA, Fonarow GC. Non-ST-elevation myocardial infarction in the United States: contemporary trends in incidence, utilization of the early invasive strategy, and in-hospital outcomes. J Am Heart Assoc 2014; 3:jah3604. [PMID: 25074695 PMCID: PMC4310389 DOI: 10.1161/jaha.114.000995] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [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: 12/20/2022]
Abstract
Background There has been a paradigm shift in the definition of timing of early invasive strategy (EIS) for patients admitted with non‐ST‐elevation myocardial infarction (NSTEMI) in the last decade. Data on trends of EIS for NSTEMI and associated in‐hospital outcomes are limited. Our aim is to analyze temporal trends in the incidence, utilization of early invasive strategy, and in‐hospital outcomes of NSTEMI in the United States. Methods and Results We analyzed the 2002–2011 Nationwide Inpatient Sample databases to identify all patients ≥40 years of age with the principal diagnosis of acute myocardial infarction (AMI) and NSTEMI. Logistic regression was used for overall, age‐, sex‐, and race/ethnicity‐stratified trend analysis. From 2002 to 2011, we identified 6 512 372 patients with AMI. Of these, 3 981 119 (61.1%) had NSTEMI. The proportion of patients with NSTEMI increased from 52.8% in 2002 to 68.6% in 2011 (adjusted odds ratio [OR; per year], 1.055; 95% confidence interval [CI], 1.054 to 1.056) in the overall cohort. Similar trends were observed in age‐, sex‐, and race/ethnicity‐stratified groups. From 2002 to 2011, utilization of EIS at day 0 increased from 14.9% to 21.8% (Ptrend<0.001) and utilization of EIS at day 0 or 1 increased from 27.8% to 41.4% (Ptrend<0.001). Risk‐adjusted in‐hospital mortality in the overall cohort decreased during the study period (adjusted OR [per year], 0.976; 95% CI, 0.974 to 0.978). Conclusions There have been temporal increases in the proportion of NSTEMI and, consistent with guidelines, greater utilization of EIS. This has been accompanied by temporal decreases in in‐hospital mortality and length of stay.
Collapse
Affiliation(s)
- Sahil Khera
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Dhaval Kolte
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Wilbert S Aronow
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Chandrasekar Palaniswamy
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Kathir Selvan Subramanian
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Taimoor Hashim
- University of Alabama at Birmingham, Birmingham, AL (T.H., A.A.)
| | - Marjan Mujib
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Diwakar Jain
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Rajiv Paudel
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Ali Ahmed
- University of Alabama at Birmingham, Birmingham, AL (T.H., A.A.)
| | - William H Frishman
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.)
| | - Julio A Panza
- New York Medical College, Valhalla, NY (S.K., D.K., W.S.A., C.P., K.S.S., M.M., D.J., R.P., W.H.F., J.A.P.)
| | - Gregg C Fonarow
- David-Geffen School of Medicine University of California at Los Angeles (UCLA), Los Angeles, CA (G.C.F.)
| |
Collapse
|
24
|
Abstract
BACKGROUND The continuing applicability of the Killip classification system to the effective stratification of long-term and short-term outcome in patients with acute myocardial infarction (MI) and its influence on treatment strategy calls for reanalysis in the setting of today's primary reperfusion treatments. HYPOTHESIS Our study sought to test the hypothesis that Killip classification, established on admission in patients with acute MI, is an effective tool for early prediction of in-hospital mortality and long-term survival. METHODS A series of 909 consecutive Olmsted County patients admitted with acute MI to St. Marys Hospital, Mayo Clinic, between January 1988 and March 1998 was analyzed. Killip classification was the primary variable. Endpoints were in-hospital death, major in-hospital complications, and post-hospital death. RESULTS Patients analyzed included 714 classified as Killip I, 170 classified as Killip II/III, and 25 classified as Killip IV. Increases in in-hospital mortality and prevalence of in-hospital complications correspond significantly with advanced Killip class (p < 0.01), with in-hospital mortality 7% in class I, 17.6% in classes II/III, and 36% in class IV patients (p < 0.001). Killip classification was strongly associated with mode of therapy administered within 24 h of admission (p < 0.01). Killip IV patients underwent primary angioplasty most commonly and were less likely to receive medical therapy. CONCLUSIONS Killip classification remains a strong independent predictor of in-hospital mortality and complications, and of long-term survival. Early primary angioplasty has contributed to a decrease in mortality in Killip IV patients, but effective adjunctive medical therapy is underutilized.
Collapse
Affiliation(s)
- W L Miller
- Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN 55905, USA
| | | | | | | |
Collapse
|