Prevalence and outcomes of atrial fibrillation in patients hospitalized with COVID-19.

OBJECTIVE: Atrial fibrillation (AF) is a common arrhythmia in patients at high cardiovascular risk. COVID-19 patients with underlying cardiovascular disease are at increased risk of poor clinical outcomes. In this study, we aimed to determine hospital outcomes among patients admitted with AF and COVID-19 infection. METHODS: We conducted a retrospective analysis using the 2020 California State Inpatient data, including all COVID-19 hospitalizations of individuals aged ≥18. Primary outcomes were in-hospital mortality, prolonged length of stay (above the 75th percentile), vasopressor use, mechanical ventilation, and ICU admission. We compared adverse hospital outcomes between those with and without AF and used multivariable logistic regression to adjust for confounders. RESULTS: This analysis included 94,114 COVID-19 hospitalizations, of which 9391 (10.0%) had AF. Patients with COVID-19 and AF had higher rates of adverse outcomes, including mortality (27.2% vs. 9.6%, p < .001), prolonged length of stay (40.0% vs. 27.1%, p < .001), vasopressor use (4.4% vs. 1.9%, p < .001), mechanical ventilation (19.0% vs. 9.1%, p < .001), and ICU admission (18.4% vs. 8.8%, p < .001) After multivariable adjustment, the odds of adverse outcomes remained significantly higher, including mortality adjusted odds ratio [OR], 2.04, 95% CI: 1.92-2.16), prolonged length of stay (aOR, 1.37, 95% CI: 1.31-1.44), vasopressor use (aOR, 1.98, 95% CI: 1.86-2.11), mechanical ventilation (aOR, 1.95, 95% CI: 1.72-2.20), and ICU admission (aOR, 2.01, 95% CI: 1.88-2.15). CONCLUSION: COVID-19 hospitalized patients frequently have underlying AF, which confers a higher risk of adverse hospital outcomes and mortality, even after adjusting for baseline comorbidities. Heightened awareness is needed in the treatment of hospitalized COVID-19 patients with AF.

Atrial fibrillation (AF) is a common heart rhythm disorder, especially in patients with high cardiovascular risk. This study aimed to investigate the hospital outcomes for patients admitted with both AF and COVID-19. We used data from the California State Inpatient Database for the year 2020, focusing on COVID-19 hospitalizations of adults aged 18 and older. The main outcomes studied were in-hospital death, extended hospital stays, use of vasopressor medications that raise blood pressure, need for mechanical ventilation, and admission to the intensive care unit (ICU). Our results showed that patients with both COVID-19 and AF had significantly worse outcomes compared to those without AF. Specifically, these patients had higher rates of death, extended hospital stays, vasopressor medication use, mechanical ventilation, and ICU admission, even after accounting for other health conditions. The study concludes that hospitalized COVID-19 patients with underlying AF are at a greater risk for severe complications and death. This highlights the need for increased attention and care for COVID-19 patients with AF to improve their hospital outcomes.

Racial and ethnic disparities in prostate cancer screening following the 2018 US Preventive Services Task Force recommendation statement.

OBJECTIVE: In 2018, the United States Preventive Services Task Force promoted shared decision making between healthcare provider and patient for men aged 55 to 69. This study aimed to analyze rates of prostate-specific antigen (PSA) testing across racial and ethnic groups following this new recommendation. METHODS: A secondary analysis was conducted of the 2020-2021 Behavioral Risk Factor Surveillance System database to assess men aged 55 or older without a history of prostate cancer. We defined four race-ethnicity groups: non-Hispanic Whites (NHWs), non-Hispanic Blacks (NHBs), Hispanics, and Other. The primary outcome was the most recent PSA test (MRT), defined as the respondent's most recent PSA test occurring pre-2018 or post-2018 guidelines. Logistic regression adjusted for covariates including age, socioeconomic status factors, marital status, smoking history, and healthcare access factors. RESULTS: In the age 55 to 69 study sample, NHW men had the greatest proportion of MRT post-2018 guidelines (n = 15,864, 72.5%). NHB men had the lowest percentage of MRT post-2018 guidelines (n = 965, 66.6%). With NHW as referent, the crude odds of the MRT post-2018 guidelines was 0.68 (95% confidence interval (CI) = 0.53-0.90) for NHB. The maximally adjusted odds ratio was 0.78 (0.59-1.02). CONCLUSIONS: We found that NHB aged 55 to 69 reported decreased rates of PSA testing after 2018 when compared to NHW. This was demonstrated on crude analysis but not after adjustment. Such findings suggest the influence of social determinants of health on preventative screening for at-risk populations.

Cardiovascular Risk Factor Control and Lifestyle Factors in Young to Middle-Aged Adults with Newly Diagnosed Obstructive Coronary Artery Disease.

BACKGROUND: While progress in the prevention of cardiovascular disease (CVD) has been noted over the past several decades, there are still those who develop CVD earlier in life than others. OBJECTIVE: We investigated traditional and lifestyle CVD risk factors in young to middle-aged patients compared to older ones with obstructive coronary artery disease (CAD). METHODS: A retrospective analysis of patients with a new diagnosis of obstructive CAD undergoing coronary intervention was performed. Young to middle-aged patients were defined as those in the youngest quartile (n = 281, mean age 50 ± 6 years, 81% male) compared to the other three older quartiles combined (n = 799, mean age 69 ± 7.5 years, 71% male). Obstructive CAD was determined by angiography. RESULTS: Young to middle-aged patients compared to older ones were more likely to be male (p < 0.01), smokers (21 vs. 9%, p < 0.001), and have a higher body mass index (31 ± 6 vs. 29 ± 6 kg/m2, p < 0.001). Younger patients were less likely to eat fruits, vegetables, and fish and had fewer controlled CVD risk factors (2.7 ± 1.2 vs. 3.0 ± 1.0, p < 0.001). Compared to older patients, higher levels of psychological stress (aOR 1.6, 95% CI 1.1-2.4), financial stress (aOR 1.8, 95% CI 1.3-2.5), and low functional capacity (aOR 3.3, 95% CI 2.4-4.5) were noted in the young to middle-aged population as well. CONCLUSION: Lifestyle in addition to traditional CVD risk factors should be taken into account when evaluating risk for development of CVD in a younger population.

The cholesterol-lowering effect of statins is potentiated by whole grains intake. The Polish Norwegian Study (PONS).

BACKGROUND: Hypercholesterolemia treatment guidelines emphasize an adequate whole grains (WG) intake, alone or complementary to pharmacological treatment. We conducted this study to compare the prevalence of adequate WG intake and levels of blood lipids according to the statin/WG intake status. METHODS: This cross-sectional analysis of a community-based study included 12,754 men and women, age 45-64. Statin use over past 30days was recorded by trained nurses. Food intake over past 12months was assessed by a validated food-frequency questionnaire. Adequate WG intake was defined as ≥3oz-equivalents/day, representing ≥3WGservings/day. RESULTS: The prevalence of an adequate WG intake was marginally superior in statin users (26.79%) than non-users (21.51%). This superiority was attenuated after multiple covariates adjustment (PR 1.12, 95%CI 1.02-1.22). Statin users with an adequate WG intake had lower multivariable-adjusted mean blood total cholesterol (185.14mg/dL vs. 190.14mg/dL) and LDL cholesterol (103.30mg/dL vs. 108.19mg/dL) than those with an inadequate WG intake. Statin users with an adequate WG intake had lower odds (OR, 95% CI) of having TC≥240mg/dL (OR 0.67, 95% CI 0.46-0.98) and lower odds of having LDL≥100mg/dL (OR 0.72, 95% CI 0.58-0.89), compared to statin users with inadequate WG intake. A subgroup analysis restricted to those with prevalent CVD yielded similar results. CONCLUSIONS: In this community based sample of middle-aged adults, only one in four statin users had adequate whole grain intake. Statin users with adequate WG intake had statistically and clinically significant lower levels of blood total- and LDL-cholesterol.

Television viewing time among statin users and non-users. The Polish Norwegian Study (PONS).

Sedentary behavior has emerged as an independent cardiovascular disease risk factor. Uncertainty exists about the behaviors of statin users, who may exhibit either a healthy adherer or a false reassurance effect. We conducted this study in order to assess and compare TV viewing among statin users and nonusers. We used data from a cross-sectional study of 12,754 participants, from south-east Poland, age 45 to 64 years in 2010-11. Statin use during last 30 days was recorded by trained nurses. Participants reported time spent viewing TV/week. There were 1728 (13.5%) statin users of which 628 (36.34%) had cardiovascular diseases. The prevalence of viewing TV ≥ 21 h/week was higher among statin users (29.72%) compared to non-users (23.10%) and remained 15% higher after adjusting for age, sex, education, smoking, chronic obstructive pulmonary disease and other chronic diseases (prevalence ratio, PR 1.15, 95% CI 1.06 to 1.25). We found a similar pattern in both those with and without prevalent cardiovascular disease. In conclusion, we found a higher prevalence of prolonged TV-viewing among statin users than non-users. Future studies are needed to explore innovative behavioral interventions and patient counseling strategies to reduce TV viewing among statin users.

Atrial electrocardiography in obesity and hypertension: Clinical insights from the Polish-Norwegian Study (PONS).

OBJECTIVE: Obesity and hypertension often coexist and represent risk factors for atrial fibrillation. This study hypothesized that their single and joint effects on atrial remodeling would be reflected in the PR interval and P-wave durations on electrocardiogram (ECG). METHODS: This cross-sectional analysis of a community-based study included 11,308 men and women age 45-64. Atrial indices were obtained from digital standard 12-lead resting ECG. Analyses were adjusted for traditional cardiovascular risk factors. RESULTS: Both ECG indices displayed a progressive increase across anthropometric indices. Each 5-unit increment in body mass index (BMI) increased P-wave duration by 1.9 ms (95% CI 1.5-2.2) and PR interval by 2.4 ms (95% CI 1.9-3.0), with similar trends for central obesity, even among those without obesity by BMI. Both ECG indices displayed graded increases across levels of blood pressure control, including prehypertension. A joint effect of overweight and hypertension on both ECG indices was detected. P-wave duration or PR interval among people with obesity was not additionally increased by hypertension. CONCLUSIONS: P-wave indices increase in general and central obesity. Hypertension exerts an incremental effect in people with overweight but not in people with obesity. The study furthered the understanding of atrial remodeling in the setting of major atrial fibrillation risk factors.

Student scientific inquiry in the core curriculum.

OBJECTIVE: To design and implement a required student-driven research program as a capstone experience in the doctor of pharmacy (PharmD) curriculum. DESIGN: A research proposal in the form of a competitive grant application was required for each of 65 fourth-year students in an inaugural PharmD class at Touro College of Pharmacy in New York. The focus of the proposals was on hypothesis-driven research in basic science, clinical research, health outcomes, and public health. ASSESSMENT: Students' research proposals were graded using a standardized grading instrument. On a post-experience survey, most students rated the overall experience positively, indicating increased confidence in their research skills. About two-thirds of faculty members were satisfied with their students' performance, and the great majority thought the experience would be useful in the students' careers. CONCLUSION: The capstone research project was a positive experience for fourth-year students.

A case-control study of stroke risk factors and outcomes in African American stroke patients with and without crack-cocaine abuse.

BACKGROUND: Stroke in crack-cocaine abusers is increasingly recognized. We aimed to identify significant differences in stroke risk factors, characteristics, and outcomes between hospitalized stroke patients with and without crack-cocaine abuse. METHODS: This was a retrospective study that compared stroke patients with crack-cocaine abuse (cases) to stroke patients without crack-cocaine (controls). RESULTS: We identified 93 crack-cocaine cases and 93 controls admitted between January 2004 and May 2006 to one teaching hospital. There were significant differences between crack-cocaine cases and controls in age (48.7 years vs. 55 years) (P = 0.0001), male gender (65.6% vs. 40.9%) (odds ratios, OR = 1.64, 95% CI 1.22-2.21), arterial hypertension (61.1% vs. 83.9%) (OR = 0.30, 95% CI 0.15-0.60), hypercholesterolemia (18.7% vs. 68.5%) (OR = 0.10, 95% CI 0.05-0.21), diabetes (20.9% vs. 41.9%) (OR = 0.36, 95% CI 0.19-0.70), cigarette smoking (70.6% vs. 29%) (OR = 5.86, 95% CI 3.07-11.20), ischemic stroke (61.3% vs. 79.6%) (OR = 0.40, 95% CI 0.21-0.78), and intracerebral hemorrhage (33.3% vs. 17.2%) (OR = 3.03, 95% CI 1.53-6.00). Also, there were significant differences in National Institutes of Health Stroke Scale scores (3.3 vs. 7) (P < 0.0001), and MRS scores (1.8 vs. 2.5) (P = 0.0022) at hospital discharge. Using univariable and multivariable logistic regression, we found that crack-cocaine abusers had 2.28 higher odds of having a favorable functional outcome (MRS score ≤ 2) at hospital discharge, after adjusting for stroke risk factors and characteristics. CONCLUSIONS: Our study suggests that crack-cocaine abusers with stroke had fewer traditional risk factors, and more favorable functional outcome as compared to non-crack-cocaine abusers.

Comparison of a single shot T1-weighted in- and out-of-phase magnetization prepared gradient recalled echo with a standard two-dimensional gradient recalled echo: preliminary findings.

PURPOSE: To compare in-phase (IP)/out-of-phase (OP) single shot magnetization-prepared gradient-recalled-echo (MP-GRE) with a standard two-dimensional gradient-recalled-echo (2D-GRE), and to compare image quality of MP-GRE in cooperative and noncooperative subjects. MATERIALS AND METHODS: Ninety-six consecutive subjects (52 males, 44 females; mean age, 53.2 ± 16.7 years), both cooperative (n = 73) and noncooperative (n = 23) subjects who had MRI examinations including precontrast T1-weighted IP/OP MP-GRE with or without IP/OP 2D-GRE were included in the study. The sequences were independently qualitatively evaluated by two radiologists. Quantitative analysis of liver fat index, signal-to-noise ratio (SNR) and liver-lesion contrast-to-noise ratio (CNR) was also performed. Data were subjected to statistical analysis. RESULTS: The visual detection of the presence or absence of liver steatosis showed no differences between 2D-GRE and MP-GRE imaging (k = 1). Minor differences were observed on image quality between MP-GRE and 2D-GRE in cooperative subjects, and between MP-GRE sequences performed in cooperative and noncooperative subjects. Liver fat index results were strongly positively correlated (r = .98; 95% confidence interval [CI] 0.97 to 0.98; P < .0001). Intercept (.14; 95% CI .13 to .15; P < .0001) and slope (.83; 95% CI .79 to .86; P < .0001) were statistically significant. CONCLUSION: IP/OP MP-GRE and 2D-GRE comparably demonstrate the presence or absence of hepatic steatosis. Image quality of MP-GRE was also comparable to 2D-GRE, and was not substantially adversely affected if subjects were unable to cooperate with breathholding instructions.

Race, psychosocial factors, and aortic pulse wave velocity: the Health, Aging, and Body Composition Study.

BACKGROUND: Increasingly, researchers have begun to explore pathways through which psychosocial factors might influence cardiovascular disease, with some emphasis on early markers. The current study examined the cross-sectional association between psychosocial factors and aortic pulse wave velocity (an early marker of cardiovascular disease) in a biracial cohort of older adults. We were particularly interested in determining whether the association between psychosocial factors and aortic pulse wave velocity differed for older blacks compared with whites. METHODS: Participants were 2,488 (40% black and 52% female) older adults from the Health, Aging, and Body Composition Study. Carotid-femoral aortic pulse wave velocity was assessed using standard methodologies. Depressive symptoms, anxiety symptoms, negative life events, and inadequate emotional support were assessed, and a summary psychosocial risk index was created. RESULTS: In multivariable linear regression models, psychosocial risk was not associated with aortic pulse wave velocity (Estimate [Est] = .00, p = .83), but there was a significant Race × Psychosocial risk interaction (Est = .07, p = .01), after adjusting for age, race, sex, and education. Further analyses revealed that this association was driven by the inadequate emotional support component of psychosocial risk (Race × Inadequate emotional support, p = .005). In race-stratified analyses, inadequate emotional support was associated with higher levels of arterial stiffness in older blacks (Est = .05, p = .04) but not whites (Est = -.04, p = .13). This association persisted after adjusting for demographics, cardiovascular risk factors, and social network characteristics. CONCLUSIONS: Findings suggest that older blacks may be particularly vulnerable to the effects of inadequate emotional support on vascular health. Interventions aimed at increasing social support among this population might be beneficial in reducing cardiovascular disease risk.

Enhancement of abdominal organs on hepatic arterial phase: quantitative comparison between 1.5- and 3.0-T magnetic resonance imaging.

PURPOSE: To compare the extent of enhancement of abdominal organs as shown on subphases of hepatic arterial phase quantitatively between 1.5- and 3.0-T MRI among patients with various abdominal conditions. MATERIALS AND METHODS: A total of 126 patients, of whom 68 were women (age range, 3-82 years; mean age, 48 years) and 58 were men (age range, 6-73 years; mean age, 50 years), were included in the study. Of 126 patients, 98 were scanned at 1.5 T and 28 were scanned at 3.0 T. The presence of one of three predefined subphases of hepatic arterial phase was determined on early post-gadolinium sequence in each patient by two reviewers in consensus. Extent of enhancement of the kidney, pancreas, spleen and liver on these subphases was determined quantitatively by measuring the signal intensities. Mann Whitney-Wilcoxon test was used to compare the contrast enhancement of organs on each subphase between 1.5- and 3.0-T MRI. RESULTS: The kidney, spleen, pancreas and liver demonstrated 1.79- to 2.45-, 1.65- to 1.97-, 1.66- to 1.8- and 1.1- to 2.02-fold higher enhancement on the subphases of hepatic arterial phase at 3.0 T compared to 1.5 T, respectively. The differences in contrast enhancement were significant for the kidney, pancreas and spleen on all subphases between 1.5 and 3.0 T. CONCLUSION: The relative enhancement of the kidney, spleen and pancreas is consistently and significantly higher at 3.0 T than at 1.5 T in matched subphases of hepatic arterial enhancement.

Falls following discharge after an in-hospital fall.

BACKGROUND: Falls are among the most common adverse events reported in hospitalized patients. While there is a growing body of literature on fall prevention in the hospital, the data examining the fall rate and risk factors for falls in the immediate post-hospitalization period has not been well described. The objectives of the present study were to determine the fall rate of in-hospital fallers at home and to explore the risk factors for falls during the immediate post-hospitalization period. METHODS: We identified patients who sustained a fall on one of 16 medical/surgical nursing units during an inpatient admission to an urban community teaching hospital. After discharge, falls were ascertained using weekly telephone surveillance for 4 weeks post-discharge. Patients were followed until death, loss to follow up or end of study (four weeks). Time spent rehospitalized or institutionalized was censored in rate calculations. RESULTS: Of 95 hospitalized patients who fell during recruitment, 65 (68%) met inclusion criteria and agreed to participate. These subjects contributed 1498 person-days to the study (mean duration of follow-up = 23 days). Seventy-five percent were African-American and 43% were women. Sixteen patients (25%) had multiple falls during hospitalization and 23 patients (35%) suffered a fall-related injury during hospitalization. Nineteen patients (29%) experienced 38 falls at their homes, yielding a fall rate of 25.4/1,000 person-days (95% CI: 17.3-33.4). Twenty-three patients (35%) were readmitted and 3(5%) died. One patient experienced a hip fracture. In exploratory univariate analysis, persons who were likely to fall at home were those who sustained multiple falls in the hospital (p = 0.008). CONCLUSION: Patients who fall during hospitalization, especially on more than one occasion, are at high risk for falling at home following hospital discharge. Interventions to reduce falls would be appropriate to test in this high-risk population.

Relationship of ankle blood pressures to cardiovascular events in older adults.

BACKGROUND AND PURPOSE: Low values of ankle-arm systolic blood pressure ratio predict mortality and cardiovascular events. High values, associated with arterial calcification, also carry risk for mortality. We focus on the extent to which low and high ankle-arm index values as well as noncompressible arteries are associated with mortality and cardiovascular events, including stroke in older adults. METHODS: We followed 2886 adults aged 70 to 79 for a mean of 6.7 years for vital status and cardiovascular events (coronary heart disease, stroke, and congestive heart failure). RESULTS: Normal ankle-arm index values of 0.91 to 1.3 were found in 80%, low values of 1.3 were obtained in 5%, and noncompressible arteries were found in 2% of the group. Increased mortality was associated with both low and high ankle-arm index values beginning at levels of <1.0 or >or=1.4. Subjects with low ankle-arm index values or noncompressible arteries had significantly higher event rates than those with normal ankle blood pressures for all end points. For coronary heart disease, hazard ratios associated with a low ankle-arm index, high ankle-arm index, and noncompressible arteries were 1.4, 1.5, and 1.7 (P<0.05 for all) after controlling for age, gender, race, prevalent cardiovascular disease, diabetes, and major cardiovascular risk factors. Noncompressible arteries carried a particularly high risk of stroke and congestive heart failure (hazard ratio=2.1 and 2.4, respectively). CONCLUSIONS: Among older adults, low and high ankle-arm index values carry elevated risk for cardiovascular events. Noncompressible leg arteries carry elevated risk for stroke and congestive heart failure specifically.

Short-term repeatability of electrocardiographic spatial T-wave axis and QT interval.

Although ventricular repolarization abnormalities reflect arrhythmic susceptibility, few reliable tools exist to identify their presence. We investigated the repeatability of the spatial T-wave axis and QT interval from standard 12-lead electrocardiograms in 63 asymptomatic volunteers. Certified technicians used a standardized protocol to digitally record 2 electrocardiograms per participant at each of 2 visits separated by 1 to 2 weeks. Absolute paired differences within and between visits were 0.19 degrees and 0.90 degrees for the T-wave axis and 1.08 and 1.55 milliseconds for the QT interval, respectively. The intraclass correlation coefficients for the T-wave axis and QT interval were 0.87 and 0.86, respectively. The impact of repeated measurements on the precision of the QT-interval measurements was evaluated for a hypothetical clinical trial aimed at detecting a drug-induced QT prolongation. We conclude that the spatial T-wave axis is as repeatable a measure of ventricular repolarization as the QT interval.

The association of spatial T wave axis deviation with incident coronary events. The ARIC cohort.

BACKGROUND: Although current evidence suggests that the spatial T wave axis captures important information about ventricular repolarization abnormalities, there are only a few and discordant epidemiologic studies addressing the ability of the spatial T wave axis to predict coronary heart disease (CHD) occurrence. METHODS: This prospective study analyzed data from 12,256 middle-aged African American and white men and women, from the Atherosclerosis Risk in Communities Study (ARIC). Following a standardized protocol, resting standard 12-lead, 10-second electrocardiograms were digitized and analyzed with the Marquette GE program. The median follow-up time was 12.1 years; incident coronary heart disease comprised fatal and non-fatal CHD events. RESULTS: The incidence rate of CHD was 4.26, 4.18, 4.28 and 5.62 per 1000 person-years respectively, across the spatial T wave axis quartiles. Among women for every 10 degrees increase in the spatial T wave axis deviation, there was an estimated increase in the risk of CHD of 1.16 (95% CI 1.04-1.28). After adjustment for age, height, weight, smoking, hypertension, diabetes, QRS axis and minor T wave abnormalities, this hazard rate ratio for women fell to 1.03 (0.92-1.14). The corresponding crude and adjusted hazard ratios for men were 1.05 (95% CI 0.96-1.15) and 0.95 (0.86-1.04) respectively. CONCLUSIONS: In conclusion, this prospective, population-based, bi-ethnic study of men and women free of coronary heart disease at baseline shows that spatial T wave axis deviation is not associated with incident coronary events during long-term follow up. It is doubtful that spatial T wave axis deviation would add benefit in the prediction of CHD events above and beyond the current traditional risk factors.