Sepsis and septic shock outcomes and 90-day readmissions in heart failure with reduced ejection fraction: A national readmission database study.

BACKGROUND: Patients with heart failure with reduced ejection fraction (HFrEF) are at increased risk for sepsis/septic shock. METHOD: A retrospective study was conducted using the Nationwide Readmission Database (2016-2020). Adult patients admitted with sepsis or septic shock were identified and stratified based on the presence of underlying HFrEF. Multivariable logistic regression assessed the association between HFrEF and in-hospital mortality, 90-day readmission, and other complications. RESULTS: Among 7,326,930 sepsis/septic shock admissions, 6.2 % had HFrEF. HFrEF patients had higher in-hospital mortality (17 % vs. 9.6 %, p < 0.01) and 90-day readmission rates (30.2 % vs. 22.5 %, p < 0.01) compared to those without HFrEF. These differences persisted after adjustment with increased risk of in-hospital mortality (aOR 1.40, 95 %CI 1.38-1.42) and 90-day readmission (aOR 1.15, 95 %CI 1.13-1.16). CONCLUSION: HFrEF patients admitted with sepsis/septic shock have significantly higher rates of in-hospital mortality, complications, and 90-day readmissions compared to those without HFrEF.

Relationships between adrenal insufficiency and cardiovascular outcomes in patients with atrial fibrillation, atrial flutter and paroxysmal supraventricular tachycardia.

BACKGROUND: Patients with Adrenal Insufficiency (AI) face elevated cardiovascular risks, but little remains known about arrhythmia outcomes in this context. METHOD: Analyzing the 2016-2019 Nationwide Inpatient Sample, we identified cases of Atrial Fibrillation, Atrial Flutter, and paroxysmal supraventricular tachycardia (PSVT) with a secondary diagnosis of AI. Mortality was the primary outcome while vasopressors and/or mechanical ventilation use, length of stay (LOS), and total hospitalization charges (THC) constituted secondary outcomes. Multivariate linear and logistic regression models were used to adjust for confounders. RESULTS: Among patients with Atrial Fibrillation, Atrial Flutter, and PSVT (N=1,556,769), 0.2% had AI. AI was associated with higher mortality (adjusted OR [aOR] 2.29, p=0.001), vasopressor and/or mechanical ventilation use (aOR 2.54, p<0.001), THC ($62,347 vs. $41,627, p<0.001) and longer LOS (4.4 vs. 3.2 days, p<0.001) compared to no AI. CONCLUSION: AI was associated with higher adverse outcomes in cases of Atrial Fibrillation, Atrial Flutter, and PSVT.

Evolution of LDL-C lowering medications and their cardiovascular benefits: Past, present, and future.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Hyperlipidemia, particularly elevated low-density lipoprotein cholesterol (LDL-C) is one of the major risk factors for CVD. Major landmark cardiovascular outcome clinical trials demonstrated that LDL-C lowering medications reduce cardiovascular events, and the lower the LDL-C the better the outcome. This article discusses the evolution of LDL-C lowering medications starting from bile acid sequestrants (BAS), statin therapy, bempedoic acid, the proprotein convertase subtilisin kexin 9 (PCSK9) synthesis inhibitor, novel small interfering RNA-based therapy (inclisiran) to the most recent oral PCSK9 inhibitors (MK-0616) which is currently under phase 3 clinical trial studies.

Relationships between socioeconomic status and cardiovascular outcomes in patients with complete heart block.

BACKGROUND: Literature illustrates an association between adverse outcomes and lower socioeconomic status (SES) in patients with critical cardiovascular presentations; however. limited data exist on complete heart block (CHB) outcomes in the context of SES. OBJECTIVES: The purpose of this study was to assess the association of SES (using zip code income quartiles) with the outcomes of CHB cases. METHODS: We queried the 2016-2019 Nationwide Inpatient Sample and identified CHB as the primary diagnosis. We compared in-hospital outcomes based on zip code mean income quartiles (≤2 [< $59,000] vs ≥3). The primary outcome was mortality. Secondary outcomes included total and early permanent pacemaker (PPM) and temporary pacemaker (TPM) use, cardiogenic shock, palliative care involvement, mechanical ventilation use, length of stay (LOS), and total charges. Multivariable regression models were used to adjust for potential confounders. RESULTS: Of 150,265 CHB hospitalizations, 76,635 (51%) involved patients with a lower income quartile. Lower quartiles were associated with lower odds of early PPM use (adjusted odds ratio [aOR] 0.86; 95% confidence interval [CI] 0.81-0.90) and higher odds of in-hospital mortality (aOR 1.23; 95% CI 1.05-1.46), total TPM use (aOR 1.08; 95% CI 1.02-1.14), palliative care (aOR 1.2; 95% CI 1.02-1.43), mechanical ventilation use (aOR 1.11; 95% CI 1.01-1.23), cardiogenic shock (aOR 1.15; 95% CI 1.01-1.31), and longer LOS (4 days vs 3.6 days; P <.001) compared to patients in higher quartiles. CONCLUSION: Patients with lower income admitted for CHB were less likely to receive an early PPM and had higher adverse outcomes compared to patients with higher income.

Consumer-grade wearable cardiac monitors: What they do well, and what needs work.

Consumer-grade smart devices, including smartwatches and smartphones, are potentially valuable tools in detecting cardiac arrhythmias, particularly atrial fibrillation, and their use is increasing. These devices, which use photoplethys mography, show remarkably high sensitivity and specificity for detection of atrial fibrillation, with implications for stroke prevention and management in at-risk patients. The ability of the devices to detect atrial fibrillation is being compared with single-lead electrocardiography. Physicians will increasingly be asked to interpret data from these nonmedical-grade devices as they become more common. Limitations include high false-positive rates in certain populations and disparities in access.