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1.
Curr Probl Cardiol ; 49(1 Pt A): 102034, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37582457

RESUMO

Cardiac biomarkers like troponin have become essential for detecting myocardial ischemia, a hallmark of the acute coronary syndrome (ACS), in the emergency department (ED). However, inappropriate and excessive biomarker testing can lead to false positive results, patient anxiety, and unnecessary treatment. Our study aimed to develop an appropriateness criterion for troponin testing and examine the long-term major adverse cardiac events (MACE) of patients tested with troponin in the ED. We retrospectively evaluated 407 patients who underwent troponin testing at a tertiary-care northeastern US hospital. The majority (n = 252, 62%) of troponin testing was appropriate, with the remainder deemed inappropriate. Baseline characteristics were equally distributed between the 2 groups. Of the appropriately ordered troponins, 34% were positive compared to 28% of the inappropriately ordered troponins (range 0.04-0.10 ng/mL). Patients were followed over 540 days. MACE occurred in 21% and 10% of patients in the appropriate and inappropriate groups, respectively. Unlike the inappropriate group (3.5%), 96% of the events in the appropriate group occurred within the first 200 days. Patients in the appropriate group were at an increased adjusted risk of MACE (HR 2.55, 95% CI (1.59-4.08), P < 0.001) on long-term follow-up. In addition, MACE was comparable between patients with positive and negative troponins in the inappropriate group (HR 1.46, 95% CI (0.28-7.71), P = 0.65). Our study supports judicious troponin testing and the need for robust appropriateness criteria for ordering troponin in the ED to avoid overdiagnosis and inappropriate testing.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Humanos , Troponina , Estudos Retrospectivos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Serviço Hospitalar de Emergência , Dor no Peito/diagnóstico
2.
J Am Heart Assoc ; 11(16): e024890, 2022 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-35929464

RESUMO

BACKGROUND Data on trends, predictors, and outcomes of heart failure (HF) readmissions after transcatheter aortic valve replacement (TAVR) remain limited. Moreover, the relationship between hospital TAVR discharge volume and HF readmission outcomes has not been established. METHODS AND RESULTS The Nationwide Readmission Database was used to identify 30-day readmissions for HF after TAVR from October 1, 2015, to November 30, 2018, using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes. A total of 167 345 weighted discharges following TAVR were identified. The all-cause readmission rate within 30 days of discharge was 11.4% (19 016). Of all the causes of 30-day rehospitalizations, HF comprised 31.4% (5962) of all causes. The 30-day readmission rate for HF did not show a significant decline during the study period (Ptrend=0.06); however, all-cause readmission rates decreased significantly (Ptrend=0.03). HF readmissions were comparable between high- and low-volume TAVR centers. Charlson Comorbidity Index >8, length of stay >4 days during the index hospitalization, chronic obstructive pulmonary disease, atrial fibrillation, chronic HF, preexisting pacemaker, complete heart block during index hospitalization, paravalvular regurgitation, chronic kidney disease, and end-stage renal disease were independent predictors of 30-day HF readmission after TAVR. HF readmissions were associated with higher mortality rates when compared with non-HF readmissions (4.9% versus 3.3%; P<0.01). Each HF readmission within 30 days was associated with an average increased cost of $13 000 more than for each non-HF readmission. CONCLUSIONS During the study period from 2015 to 2018, 30-day HF readmissions after TAVR remained steady despite all-cause readmissions decreasing significantly. All-cause readmission mortality and HF readmission mortality also showed a nonsignificant downtrend. HF readmissions were comparable across low-, medium-, and high-volume TAVR centers. HF readmission was associated with increased mortality and resource use attributed to the increased costs of care compared with non-HF readmission. Further studies are needed to identify strategies to decrease the burden of HF readmissions and related mortality after TAVR.


Assuntos
Estenose da Valva Aórtica , Insuficiência Cardíaca , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Bases de Dados Factuais , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/terapia , Humanos , Readmissão do Paciente , Fatores de Risco , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento
3.
J Interv Card Electrophysiol ; 65(1): 219-226, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35731328

RESUMO

BACKGROUND: Age-stratified analyses of atrial fibrillation (AF) patients undergoing percutaneous left atrial appendage occlusion (LAAO) are limited. The purpose of current study was to compare in-hospital outcomes in elderly AF patients (age > 80 years) to a relatively younger cohort (age £ 80 years) after LAAO. METHODS: Data were extracted from National Inpatient Sample for calendar years 2015-2018. LAAO device implantations were identified on the basis of International Classification of Diseases, 9th and 10th Revision, Clinical Modification codes of 37.90 and 02L73DK. The outcomes assessed in our study included complications, inpatient mortality, and resource utilization with LAAO. RESULTS: A total of 36,065 LAAO recipients were included in the final analysis, of which 34.6% (n=12,475) were performed on elderly AF patients. Elderly AF patients had a higher prevalence of major complications (6.7% vs. 5.7%, p < 0.01) and mortality (0.4% vs. 0.1%, p < 0.01) after LAAO device implantation in the crude analysis. After multivariate adjustment of potential confounders, age > 80 years was associated with increased risk of inpatient mortality (adjusted odds ratio [aOR] 4.439, 95% confidence interval [CI] 2.391-8.239) but not major complications (aOR 1.084, 95% CI 0.971-1.211), prolonged length of stay (aOR 0.943, 95% CI 0.88-1.101), or increased hospitalization costs (aOR 0.909, 95% CI 0.865-0.955). CONCLUSION: Over 1 in 3 LAAO device implantations occurred in elderly AF patients. After adjusting for potential confounding variables, advanced age was associated with inpatient mortality, but not with other LAAO procedural-related outcomes including major complications, prolonged length of stay, or increased hospitalization costs.


Assuntos
Apêndice Atrial , Fibrilação Atrial , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Apêndice Atrial/cirurgia , Hospitais , Humanos , Pacientes Internados , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
5.
Clin Med Res ; 20(2): 70-73, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-34996821

RESUMO

Objective: To perform a quality assurance study assessing if hypo- and hyperthyroidism are appropriately screened for in patients with resistant hypertension.Design: Data was collected from patients diagnosed with resistant hypertension, defined as being on four or more different classes of anti-hypertensive medications. These patients were filtered to determine if thyroid stimulating hormone (TSH) measurement occurred within 90 days of the addition of a fourth medication class.Setting: Two internal medicine residency clinics in Pittsburgh, PA.Participants: Patients were selected who had a diagnosis of hypertension and were seen in clinic between January 1, 2018 and December 23, 2020.Methods: A single center retrospective review was performed.Results: A total of 1,125 patients were identified as having resistant hypertension. Of these, only 74 patients were found to have a TSH measurement taken within 90 days of having a fourth medication class prescribed. Seven TSH values were found to be abnormal with one patient being diagnosed with hyperthyroidism, demonstrating a screening rate of 6.6%. There were statistically significant differences in age, body mass index, and diastolic blood pressure in those screened versus not.Conclusions: Thyroid disease is under-screened as an etiology for resistant hypertension, particularly given the ease of diagnosis and reversibility of these conditions.


Assuntos
Hipertensão , Hipertireoidismo , Doenças da Glândula Tireoide , Humanos , Hipertensão/diagnóstico , Hipertensão/tratamento farmacológico , Hipertireoidismo/complicações , Hipertireoidismo/diagnóstico , Tireotropina
6.
Am J Cardiol ; 167: 83-92, 2022 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-34991843

RESUMO

Contemporary data on gender differences in outcomes after transcatheter aortic valve implantation (TAVI), after stratification by age, remain limited. We studied age-stratified (60 to 70, 71 to 80, and 81 to 90 years) inhospital outcomes by gender after TAVI from the National Inpatient Sample database between 2012 and 2018. We analyzed National Inpatient Sample data using the International Classification of Diseases, Clinical Modification, Ninth Revision, and Tenth Revision claims codes. Between the years 2012 and 2018, a total of 188,325 weighted hospitalizations for TAVI were included in the analysis. A total of 21,957 patients were included in the 60 to 70 age group (44% females), 60,770 (45% females) in the 71 to 80 age group, and 105,580 (50% females) in the 81 to 90 age groups, respectively. Propensity-matched inhospital mortality rates were significantly higher for females than males for the age group of 81 to 90 years (3.0% vs 2.1%, p <0.01). Vascular complications and a need for blood transfusions remained significantly higher for females on propensity-matched analysis across all categories of ages. Conversely, acute kidney injury and the need for pacemaker implantation remained significantly higher for males across all age groups. In conclusion, we report that mortality is higher in female patients who underwent TAVI between the ages of 81 to 90. Moreover, the female gender was associated with higher vascular complications and bleeding requiring transfusions. Conversely, the male gender was associated with higher rates of pacemaker implantation and acute kidney injury.


Assuntos
Injúria Renal Aguda , Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Injúria Renal Aguda/complicações , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Feminino , Mortalidade Hospitalar , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento
7.
Curr Probl Cardiol ; 47(10): 100961, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34391762

RESUMO

Contemporary data on stroke predictors and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) remains limited. We analyzed National Inpatient Sample data from the year 2011 to 2018. A total of 215,938 patients underwent TAVI. Of the patients who underwent TAVI, 4579 (2.2%) suffered from stroke and 211359 (97.8%) did not have a stroke. Adjusted mortality was higher in patients who had a stroke (10.9%) as compared to patients who did not have a stroke (3.1%). Lower percentage of patients were discharged home who developed a stroke compared to patients without a stroke (10.2% vs 52.3%). Multivariate logistic regression analysis showed that at baseline, age, female sex, atrial fibrillation, chronic kidney disease and peripheral vascular disease were significant predictors of stroke. Median Cost of care ($63367 vs $48070) and length of stay (8 vs 4 days) were considerably higher for patients with stroke when compared to the comparison group (P < 0.01 for all). In conclusion we report that stroke is associated with increased mortality, morbidity, and resource utilization in patients undergoing TAVI. Baseline characteristics like age, gender, atrial fibrillation, chronic kidney disease and peripheral vascular disease are significant predictors of this adverse event.


Assuntos
Estenose da Valva Aórtica , Fibrilação Atrial , Implante de Prótese de Valva Cardíaca , AVC Isquêmico , Doenças Vasculares Periféricas , Insuficiência Renal Crônica , Acidente Vascular Cerebral , Substituição da Valva Aórtica Transcateter , Valva Aórtica , Feminino , Humanos , Pontuação de Propensão , Fatores de Risco , Resultado do Tratamento
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