ABSTRACT
ObjectivesTo evaluate COVID-19 infection and mortality in ethnic and racial sub-groups across all states in the United States. MethodsPublicly available data from "The COVID Tracking Project at The Atlantic" was accessed between 09/09/2020 and 09/14/2020. For each state and the District of Columbia, % infection, % death, % population proportion for subgroups of race (African American (AA), Asian, American Indian or Alaska Native, (AI/AN) and White), and ethnicity (Hispanic/Latino, and non-Hispanic), were recorded. Absolute and relative excess infection (AEI and REI) and mortality (AEM and REM) were computed as absolute and relative difference between % infection or % mortality and % population proportion for each state. Median (IQR) REI is provided below. ResultsThe Hispanic population had a median of 158% higher COVID-19 infection relative to their % population proportion (median REI 158%, [IQR: 100% to 200%]). This was followed by AA, with 50% higher COVID-19 infection relative to their % population proportion (median REI, 50% [IQR 25% to 100%]). The AA population had the most disproportionate mortality with a median of 46% higher mortality than % population proportion, (median REM 46% [IQR, 18% to 66%]). Disproportionate impact of COVID-19 was also seen in AI/AN and Asian population with [≥]100% excess infections than % population proportion seen in 35 states for Hispanic, 14 states for AA, 9 states for AIAN, and 7 states for Asian populations. There was no disproportionate impact in the white population in any state. ConclusionsRacial/ethnic minorities (AA, Hispanic, AIAN and Asian populations) are disproportionately affected by COVID 19 infection and mortality across the nation. These findings underscore the potential role of social determinants of health in explaining the disparate impact of SARS-CoV-2 on vulnerable demographic groups, as well as the opportunity to improve outcomes in chronically marginalized populations.
ABSTRACT
INTRODUCTION: Catheter ablation has shown to reduce mortality in patient with atrial fibrillation (AF) and heart failure (HF) with reduced ejection fraction. Its effect on mortality in patients without HF has not been well elucidated. METHODS: Thirteen randomized controlled trials encompassing 3856 patients were selected using PubMed, Embase and the CENTRAL till April 2019. Estimates were reported as random effects risk ratio (RR) with 95% confidence intervals (CI). RESULTS: Compared with medical therapy, catheter ablation did not reduce the risk of all-cause mortality (RR, 0.86, 95% CI, 0.62-1.19, P=0.36; I2=0), stroke (RR, 0.55, 95% CI, 0.18-1.66, P=0.29; I2=0), need for cardioversion (RR, 0.84, 95% CI, 0.66-1.08, P=0.17; I2=0) or pacemaker (RR, 0.59, 95% CI, 0.34-1.01, P=0.06; I2=0). However, ablation reduced the RR of cardiac hospitalization (0.37, 95% CI, 0.18-0.77, P=0.01; I2=86), and recurrent atrial arrhythmia (0.46, 95% CI, 0.35-0.60, P<0.001; I2=87). There were non-significant differences among treatment groups with respect to major bleeding (RR, 1.89, 95% CI, 0.59-6.08, P=0.29; I2=15), and pulmonary vein stenosis (RR, 3.00, 95% CI, 0.83-10.87, P=0.09; I2=0), but had significantly higher rates of pericardial tamponade (RR, 4.46, 95 % CI, 1.70-11.72, P<0.001; I2=0). CONCLUSIONS: Catheter ablation did not improve survival compared with medical therapy in patients with AF without HF. Catheter ablation reduced cardiac hospitalization and recurrent atrial arrhythmia at the expense of pericardial tamponade.
ABSTRACT
BACKGROUND: Liver disease is a risk factor for development of atrial fibrillation (AF). We aim to study inpatient mortality and resource utilization of end-stage liver disease (ESLD) patients with AF from a nationally representative United States population sample. METHODS: For the purpose of our study, we utilized data from National Inpatient Sample for calendar years 2005-2015. Patients with ESLD and AF were identified using relevant International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Key outcomes of inpatient mortality and resource utilization were assessed. We also constructed a multiple logistic regression model to determine predictors of mortality in ESLD patients. Propensity matching was also done to balance confounding variables. RESULTS: A total of 309,959 ESLD patients were included in final analysis. Out of these, about 32,858 (10.6%) patients have concomitant AF. ESLD patients with AF were older and had higher burden of key co-morbidities such as heart failure, diabetes and hypertension. Mortality was significantly higher in both unmatched (12.3% vs. 9.2%, p < 0.01) and matched cohorts (12.2% vs. 10.8%, p < 0.01). Additionally, ESLD patients with AF have longer length of stay, increased facility discharge and cost of hospitalization compared to ESLD patients with out AF. In multivariate analysis, AF is an independent predictor of mortality in ESLD patients. CONCLUSIONS: AF portends worse outcomes in patients with ESLD. Strong index of suspicion is warranted to timely identify AF in this patient population.
