Temporal Trends for Patients Hospitalized With Atrial Fibrillation in the United States: An Analysis From the National Inpatient Sample (NIS) Database 2011-2018.

BACKGROUND: Atrial fibrillation (AF) has historically been a growing burden on the global public health system. Previously, literature on the trends associated with AF-related hospitalizations has been published. However, there seems to be a gap in up-to-date information, notably within the last decade. PURPOSE: This study aims to investigate the trends, outcomes, and factors associated with AF hospitalization and the continued impact of AF on the United States health system. METHODS: Patient data were collected from the years 2011 to 2018 from the National Inpatient Sample (NIS) database using the International Classification of Diseases (ICD)-9 and ICD-10 codes. We selected patients hospitalized with a diagnosis of AF. Descriptive statistics, statistical analysis, and Mann-Whitney U testing were employed to compare continuous dichotomous variables. After respective adjustments, multivariate hierarchical logistic regression was used to establish mortality rates, length of stay (LOS), and hospital charges. RESULTS: The study included 509,305 patients hospitalized with a primary diagnosis of unspecified AF. The mean age of patients hospitalized with AF was 71 years. AF hospitalizations were slightly higher in women as compared to men (51.7% vs. 48.2%). The predominant race involved was Caucasians at 77.9% followed by African Americans and Hispanics at 7.4% and 5.4%, respectively. The three most frequent coexisting conditions noted were hypertension (69.9%), diabetes mellitus (24.3%), and chronic obstructive pulmonary disease (16.4%). Medicare/Medicaid was the primary payer associated with the majority of AF hospitalizations at 72.6%. Overall in-hospital mortality associated with AF hospitalizations was 0.96%. Comorbid conditions conferring the highest mortality risks included coagulopathies (644%) and cerebral vascular accidents (597%). Mean LOS was found to be 3.35 days. Hospitalization charges increased year-over-year and correlated with an increase in the national burden of cost for these patients of $3.6 billion. CONCLUSIONS: Our study investigates the national trends surrounding AF hospitalizations. Overall in-hospital mortality rates appear to be stable as compared to prior years and past literature. Comorbid conditions conferring significantly higher mortality rates included coagulopathies, cerebral vascular accidents, acute kidney injury, and end-stage renal disease. Additionally, suboptimal insurance status was also associated with increased mortality risk. The cost of hospitalization in AF patients has increased steadily, conferring a $3.6 billion burden on the US healthcare system.

An Unusual Presentation of COVID-19: Hemorrhagic Pericardial Effusion With Tamponade Physiology.

A 44-year-old woman with a history of factor V Leiden deficiency and recurrent pulmonary emboli was diagnosed with coronavirus disease 2019 (COVID-19) three weeks prior presented to her local ED with severe chest pain. She was found to have a large hemorrhagic pericardial effusion by cardiac MRI with echocardiographic signs of tamponade. She underwent the creation of a pericardial window and was treated with colchicine with improvement in symptoms.

Implantable cardioverter-defibrillator FDA safety advisories: Impact on patient mortality and morbidity.

BACKGROUND: A significant proportion of implantable cardioverter-defibrillators (ICDs) have been subject to Food and Drug Administration (FDA) advisories. The impact of device advisories on mortality or patient care is poorly understood. Although estimated risks of ICD generators under advisory are low, dependency on ICD therapies to prevent sudden death justifies the assessment of long-term mortality. OBJECTIVE: To test the association of FDA advisory status with long-term mortality. METHODS: The study was a retrospective, single-center review of clinical outcomes, including device malfunctions, in patients from implantation to either explant or death. Patients with ICDs first implanted at Cleveland Clinic between August 1996 and May 2004 who became subject to FDA advisories on ICD generators were identified. Mortality was determined by using the Social Security Death Index. RESULTS: In 1644 consecutive patients receiving first ICD implants, 704 (43%) became subject to an FDA advisory, of which 172 (10.5%) were class I and 532 (32.3%) were class II. ICDs were explanted before advisory notifications in 14.0% of class I and 10.1% of class II advisories. Among ICDs under advisory, 28 (4.0%) advisory-related and 15 non-advisory- related malfunctions were documented. Over a median follow-up of 70 months, 814 patients died. Kaplan-Meier 5-year survival rate was 65.6% overall, and 64.2, 61.1, and 69.3% in patients with no, class I, and class II advisories, respectively (P = .17). CONCLUSIONS: ICD advisories impacted 43% of the patients. Advisory-related malfunctions affected 4% within the combined advisory group. Based on a conservative management strategy, ICDs under advisory were not associated with increased mortality over a background of significant disease-related mortality.

Older persons with diabetes receive fewer inappropriate ICD shocks: results from the INTRINSIC RV trial.

In patients with heart disease, diabetes and age predict adverse outcomes. It remains unclear whether persons with diabetes who have implantable cardioverter defibrillators (ICDs) have fewer appropriate and inappropriate ICD shocks. The objective of this study is to determine if persons with diabetes who have ICDs receive a similar amount of appropriate and inappropriate shocks compared to persons without diabetes. In a post hoc analysis of 1,528 patients enrolled in the INTRINSIC RV trial, all-cause mortality and ICD shocks between persons with and without diabetes, stratified by age, was compared. The relationship between shock and mortality was also assessed. Mortality 1 year after ICD implant was lower for persons without diabetes vs. persons with diabetes (3.5% vs. 7.9%, p < 0.001). Young and old persons with diabetes received a similar number of total and appropriate ICD shocks. However, older persons with diabetes were less likely to receive inappropriate ICD shocks vs. older persons without diabetes (1.9% vs. 6.9%, p < 0.01). ICD shocks were not temporally related to mortality regardless of diabetes status. In the INTRINSIC RV trial, persons with diabetes and older persons without diabetes undergoing ICD implant were at a higher risk of death. Older persons with diabetes received less inappropriate shocks and still had a similar amount of appropriate shocks compared to persons without diabetes of similar age.