Unplanned readmissions after Impella mechanical circulatory support.

BACKGROUND: Early readmissions significantly impact on patient-wellbeing, burden the health-care system, and are important quality metrics. Data on 30-day readmission following Impella mechanical circulatory support (MCS) are unknown. We aimed to assess the rates, causes and clinical outcomes associated with 30-day unplanned readmissions after Impella mechanical circulatory support (MCS). METHODS: Discharged patients who underwent Impella MCS between 2016 and 2019 in the U.S. Nationwide Readmission Database were analyzed. Incidence, causes, and outcomes associated with 30-day unplanned readmissions were assessed. RESULTS: Of 22,055 patients who received Impella MCS, 2685 (12.2%) experienced 30-day readmissions. Cardiac readmissions accounted for 51.7% compared to 48.3% of non-cardiac readmissions, and most (70%) patients were readmitted back to the index hospital. Heart failure was the leading cause of cardiac readmissions accounting for 25% of them, whereas infections were the most common cause among non-cardiac readmissions. Patients who were readmitted were significantly older (median age 71 versus 68 years), more likely to be female (31% versus 26%) and had a shorter length-of-stay (index hospitalization, median 8 versus 9 days) compared to those who were not readmitted. Factors independently associated with 30-day readmissions were chronic renal (aOR: 1.46, 95% CI: 1.35-1.57), pulmonary (aOR: 1.23, 95% CI: 1.15-1.33), and liver disease (aOR: 1.38, 95% CI: 1.17-1.63), anemia (aOR: 1.35, 95% CI: 1.26-1.46), female sex (aOR: 1.21, 95% CI: 1.12-1.30), index admission on weekends (aOR: 1.23, 95% CI: 1.13-1.34), STEMI diagnosis (aOR: 1.16, 95% CI: 1.02-1.31), major adverse event during index hospitalization (aOR: 1.11, 95% CI: 1.00-1.24), prolonged length-of-stay (median 9 vs. 8 days, P < 0.001), and discharge against medical advice (aOR: 2.06, 95% CI: 1.37-3.09). Significantly higher mortality rates were overserved during readmissions to a hospital different than the MCS implanting hospital (12% versus 5.9%, P < 0.001). CONCLUSION: Thirty-day readmissions after Impella MCS are relatively common and relate to sex, baseline comorbidities, presentation, expected primary payer, discharge destination and initial length of hospital stay. Heart failure was the leading cause of cardiac readmissions, whereas infections were the most common cause among non-cardiac readmissions. Most patients were readmitted to the same hospital as their index admission for MCS. Higher mortality rates were observed when patients were readmitted to a different hospital.

Postprocedural Radial Artery Compression Time In Chronic AnticoaguLated patients using StatSeal: The PRACTICAL-SEAL study.

BACKGROUND: Patients on uniterrupted chronic oral anticoagulation (OAC) therapy are at high-risk of bleeding during cardiac catheterization. We aimed to investigate the safety and efficacy of the StatSeal® disc for adjunct hemostasis in patients undergoing transradial coronary angiography under uninterrupted OAC therapy. METHODS: Patients who underwent transradial cardiac catheterization without interrupted OAC therapy were included in this study. RESULTS: Among 180 patients, 85 (47.2%) patients were on warfarin and 95 (52.8%) patients on novel oral anticoagulants (NOACs). Patients on NOACs were older (72.9 ± 9.6 versus 69.7 ± 10.8 years, P < 0.001) and had more atrial fibrillation/flutter (94.7% versus 62.4%, P < 0.001), whereas patients on Warfarin were more often women (43.5% versus 26.3%, P = 0.02) and had mechanical heart valves (27.1% versus 0%, P < 0.001). Intravenous unfractioned heparin (UFH) was administered in 96.5% of patients on warfarin (3799 ± 1342 units) and 93.7% patients on NOACs (4028 ± 1362 units), P = 0.27. There were no differences in terms of type and sheath size and the need for ad hoc coronary intervention. Time-to-first release of the hemostatic wristband was 56.2 ± 12.6 min and complete hemostasis was achieved in 71.1 ± 13.0 min, with shorter times among patients on NOACs (54.1 ± 11.7 and 58.5 ± 13.2 min, 68.9 ± 11.7 versus 73.6 ± 14.0 min, P = 0.02, for both). There were no significant differences in terms of bleeding. There was no radial artery occlusion among 112 participants who underwent color Doppler ultrasound. CONCLUSION: The present study shows that in patients undergoing transradial coronary angiogram under contemporary uninterrupted OAC therapy and periprocedural administration of UFH, the use of StatSeal® disc for adjunctive hemostasis was associated with short times to complete hemostasis.

Outcomes of Elderly Patients Undergoing Left Atrial Appendage Closure.

Background Elderly patients have a higher burden of comorbidities that influence clinical outcomes. We aimed to compare in-hospital outcomes in patients ≥80 years old to younger patients, and to determine the factors associated with increased risk of major adverse events (MAE) after left atrial appendage closure. Methods and Results The National Inpatient Sample was used to identify discharges after left atrial appendage closure between October 2015 and December 2018. The primary outcome was in-hospital MAE defined as the composite of postprocedural bleeding, vascular and cardiac complications, acute kidney injury, stroke, and death. A total of 6779 hospitalizations were identified, of which, 2371 (35%) were ≥80 years old and 4408 (65%) were <80 years old. Patients ≥80 years old experienced a higher rate of MAE compared with those aged <80 years old (6.0% versus 4.6%, P=0.01), and this difference was driven by a numerically higher rate of cardiac complications (2.4% versus 1.8%, P=0.09) and death (0.3% versus 0.1%, P=0.05) among individuals ≥80 years old. In patients ≥80 years old, higher odds of in-hospital MAE were observed in women (1.61-fold), and those with preprocedural congestive heart failure (≈2-fold), diabetes (≈1.5-fold), renal disease (≈2.6-fold), anemia (≈2.7-fold), and dementia (≈5-fold). In patients <80 years old, a higher risk of in-hospital MAE was encountered among women (≈1.4-fold) and those with diabetes (≈1.3-fold), renal disease (≈2.6-fold), anemia (≈2-fold), and dyslipidemia (≈1.2-fold). Conclusions Patients ≥80 years old had higher rates of in-hospital MAE compared with patients aged <80 years old. Female sex and the presence of heart failure, diabetes, renal disease, and anemia were factors associated with in-hospital MAE among both groups.

Racial, ethnic and socioeconomic disparities in patients undergoing transcatheter mitral edge-to-edge repair.

BACKGROUND: Transcatheter mitral edge-to-edge repair (TEER) is an increasingly common procedure performed on patients with severe mitral regurgitation. This study assessed the impact of race/ethnicity and socioeconomic status on in-hospital complications after TEER. METHODS: Cohort-based observational study using the National Inpatient Sample between October 2013 and December 2018. The population was stratified into 4 groups based on race/ethnicity and quartiles of neighborhood income levels. The primary outcome was in-hospital complications, defined as the composite of death, bleeding, cardiac and vascular complications, acute kidney injury, and ischemic stroke. RESULTS: 3795 hospitalizations for TEER were identified. Patients of Black and Hispanic race/ethnicity comprised 7.4% and 6.4%, respectively. We estimated that White patients received TEER with a frequency of 38.0/100,000, compared to 29.7/100,000 for Blacks and 30.5/100,000 for Hispanics. In-hospital complications occurred in 20.2% of patients and no differences were found between racial/ethnic groups (P = 0.06). After multilevel modelling, Black and Hispanic patients had similar rate of overall in-hospital complications (OR: 0.84, CI:0.67-1.05 and OR: 0.84, CI:0.66-1.07, respectively) as compared to White patients, however, higher rates of death were observed in Black patients. Individuals living in income quartile-1 had worse in-hospital outcomes as compared to quartile-4 (OR: 1.19, CI:0.99-1.42). CONCLUSION: In this study assessing racial/ethnic disparities in TEER outcomes, aged-adjusted race/ethnicity minorities were less underrepresented as compared to other structural heart interventions. Black patients experienced a higher rate of in-hospital death, but similar overall rate of post-procedural adverse events as compared to White patients. Lower income levels appear to negatively impact on in-hospital outcomes. BRIEF SUMMARY: This study appraises race/ethnic and socioeconomical disparities in access and outcomes following transcatheter mitral edge-to-edge repair. Racial minority groups were less underrepresented as compared to other structural heart interventions. While Black patients experienced a higher rate of in-hospital death, they experienced similar overall rate of post-procedural complications compared to White patients. Lower income levels also appeared to negatively impact on outcomes.

Sex Differences in Outcomes Following Left Atrial Appendage Closure.

OBJECTIVE: To evaluate the effects of female sex on in-hospital outcomes and to provide estimates for sex-specific prediction models of adverse outcomes following left atrial appendage closure (LAAC). PATIENTS AND METHODS: Cohort-based observational study querying the National Inpatient Sample database between October 1, 2015, and December 31, 2017. Demographics, baseline characteristics, and comorbidities were assessed with the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index score (ECS), and CHA2DS2-VASc score. The primary outcome was in-hospital major adverse events (MAEs) defined as the composite of bleeding, vascular, cardiac complications, post-procedural stroke, and acute kidney injury. The associations of the CCI, ECS, and CHA2DS2-VASc score with in-hospital MAE were examined using logistic regression models for women and men, respectively. RESULTS: A total of 3294 hospitalizations were identified, of which 1313 (40%) involved women and 1981 (60%) involved men. Women were older (76.3±7.7 vs 75.2±8.4 years, P<.001), had a higher CHA2DS2-VASc score (4.9±1.4 vs 3.9±1.4, P<.001) but showed lower CCI and ECS compared with men (2.1±1.9 vs 2.3±1.9, P=.01; and 9.3±5.9 vs 9.9±5.7, P=.002, respectively). The primary composite outcome occurred in 4.6% of patients and was higher in women compared with men (women 5.6% vs men 4.0%, P=.04), and this was mainly driven by the occurrence of cardiac complications (2.4% vs 1.2%, P=.01). In women, older age, higher median income, and higher CCI (adjusted odds ratio [aOR], 1.32; 95% confidence interval [CI], 1.21 to 1.44; P<.001), ECS (aOR, 1.04; 95% CI, 1.02 to 1.07; P=.002), and CHA2DS2-VASc score (aOR, 1.24; 95% CI, 1.10 to 1.39; P<.001) were associated with increased risk of in-hospital MAE. In men, non-White race/ethnicity, lower median income, and higher ECS (aOR, 1.06; 95% CI, 1.04 to 1.09; P<.001) were associated with increased risk of in-hospital MAE. CONCLUSION: Women had higher rates of in-hospital adverse events following LAAC than men did. Women with older age and higher median income, CCI, ECS, and CHA2DS2-VASc scores were associated with in-hospital adverse events, whereas men with non-White race/ethnicity, lower median income, and higher ECS were more likely to experience adverse events. Further research is warranted to identify sex-specific, racial/ethnic, and socioeconomic pathways during the patient selection process to minimize complications in patients undergoing LAAC.

Occupational factors and low back pain: a cross-sectional study of Bangladeshi female nurses.

BACKGROUND: The suffering from low back pain (LBP) is very common among nurses. The high prevalence rates of LBP are observed in many countries. Many back injuries are due to individual and work-related factors. Our aim is to investigate whether there is an association of occupational factors with LBP among the female nurses who are currently working in tertiary hospitals of Bangladesh. METHODS: We conducted a cross-sectional study with 229 female nurses from two selected tertiary hospitals in Bangladesh. Data was collected through face-to-face interview using a standard structured questionnaire on four different measures of LBP along with questions on socio-demographic, occupational factors, physical and psychological factors. RESULTS: Prevalence rates of LBP that lasted for at least 1 day, chronic LBP, intense pain and sought medical care because of LBP during the last 12 months were 72.9, 31.8, 24.4 and 36.2%, respectively. The multiple logistic regression analyses indicates that insufficient supporting staffs, overtime working hours and manual lifting in a working environment are associated with LBP. Besides, age and parity are found positively associated with chronic LBP. CONCLUSION: The prevalence of LBP among nurses in Bangladesh is high and should be actively addressed. Certain occupational factors play a key role in developing LBP among nurses. Nurses to patients ratio should be taken into consideration to reduce the occurrence of LBP among nurses employed in hospitals.