Effect of influenza on outcomes in patients with heart failure.
Female; Humans; Male; Aged; Retrospective Studies; Risk Factors; United States/epidemiology; Incidence; Follow-Up Studies; heart failure; hospitalization; Hospitalization/trends; vaccination; influenza; Survival Rate/trends; Risk Assessment/methods; Inpatients; Morbidity/trends; Hospital Mortality/trends; Propensity Score; Heart Failure/complications/epidemiology; Influenza Human/complications/epidemiology/prevention & control; Vaccination/methods
OBJECTIVES: This study sought to determine whether influenza infection increases morbidity and mortality in patients hospitalized with heart failure (HF). BACKGROUND: Patients with HF may be at increased risk of morbidity and mortality from influenza infection. However, there are limited data for the associated hazards of influenza infection in patients with HF. METHODS: We queried the 2013 to 2014 National Inpatient Sample database for all adult patients (18 years of age or older) admitted with HF with and without concomitant influenza infection. Propensity score matching was used to match patients across age, race, sex, and comorbidities. Outcomes included in-hospital mortality, in-hospital complications, length of stay, and average hospital costs. RESULTS: Of 8,189,119 all-cause hospitalizations in patients with HF, 54,590 (0.67%) had concomitant influenza infection. Patients with concomitant influenza had higher incidence of in-hospital mortality (6.2% vs. 5.4%, respectively; odds ratio [OR]: 1.15 [95% confidence interval [CI]: 1.03 to 1.30]; p = 0.02), acute respiratory failure (36.9% vs. 23.1%, respectively; OR: 1.95 [95% CI: 1.83 to 2.07]; p < 0.001), acute respiratory failure requiring mechanical ventilation (18.2% vs. 11.3%, respectively; OR: 1.75 [95% CI: 1.62 to 1.89]; p < 0.001), acute kidney injury (AKI) (30.3% vs. 28.7%, respectively; OR: 1.08 [95% CI: 1.02 to 1.15]; p = 0.01), and AKI requiring dialysis (2.4% vs. 1.8%, respectively; OR: 1.37 [95% CI: 1.14 to 1.65]; p = 0.001). Patients with influenza had longer mean lengths of stay (5.9 days vs. 5.2 days, respectively; p <0.001) but similar average hospital costs ($12,137 vs. $12,003, respectively; p = 0.40). CONCLUSIONS: Influenza infection is associated with increased in-hospital morbidity and mortality in patients with HF. Our results emphasize the need for efforts to mitigate the incidence of influenza, specifically in this high-risk patient cohort.
Panhwar MS; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Ginwalla M
Journal of the American College of Cardiology. Heart failure
2019
2019-02
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.jchf.2018.10.011" target="_blank" rel="noreferrer noopener">10.1016/j.jchf.2018.10.011</a>
PMID: 30611718
Relation of concomitant heart failure to outcomes in patients hospitalized with influenza.
Female; Humans; Male; Aged; Middle Aged; Retrospective Studies; United States/epidemiology; Incidence; Comorbidity; Follow-Up Studies; Survival Rate/trends; Hospitalization/statistics & numerical data; Inpatients; Length of Stay/trends; Heart Failure/epidemiology; Hospital Mortality/trends; Influenza Human/epidemiology
Influenza is a major public health challenge. Patients hospitalized with influenza who also have heart failure (HF) may be at risk for worse outcomes compared with patients without HF. There is a lack of large studies examining this issue. We queried the 2013 to 2014 National Inpatient Sample for all adult patients (aged ≥ 18 years) admitted with influenza with and without concomitant HF. Using propensity score matching, patients were matched across demographics, discharge weights, and comorbidities. Outcomes included in-hospital mortality, complications, length of stay, and average hospital costs. Of 218,540 influenza hospitalizations, 45,460 (20.8%) had concomitant HF. Patients with HF had higher in-hospital mortality (6.1% vs 3.8%, adjusted odds ratio [aOR] 1.66 [95% confidence interval [CI] 1.44 to 1.91]; p <0.001), acute kidney injury (29.5% vs 22.2%, aOR 1.47 [95% CI 1.37 to 1.57]; p <0.001), acute kidney injury requiring dialysis (2.0% vs 1.0%, aOR 2.08 [1.62 to 2.67], acute respiratory failure (36.2% vs 23.5%, aOR 1.85 [1.73 to 1.97]; p <0.001), and acute respiratory failure requiring mechanical ventilation (17.1% vs 9.3%, OR 2.01 [1.84 to 2.21]; p <0.001), longer length of stay (5.70 ± 0.02 days vs 4.60 ± 0.01 days, p <0.001) and higher average hospital costs ($11,609 ± $52 vs $9,003 ± $38, p <0.001). In conclusion, in patients hospitalized with influenza, HF is associated with increased risk of in-hospital mortality and complications. Our results highlight a need for early recognition and aggressive treatment of HF in these patients to try to improve outcomes.
Panhwar MS; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Ginwalla M
The American journal of cardiology
2019
2019-05-01
Copyright © 2019 Elsevier Inc. All rights reserved.
journalArticle
<a href="http://doi.org/10.1016/j.amjcard.2019.01.046" target="_blank" rel="noreferrer noopener">10.1016/j.amjcard.2019.01.046</a>
PMID: 30819433
Derivation and external validation of a simple risk tool to predict 30-day hospital readmissions after transcatheter aortic valve replacement.
Humans; Treatment Outcome; Risk Factors; Time Factors; Aortic Valve; Patient Readmission; Aortic Valve Stenosis; Transcatheter Aortic Valve Replacement
AIMS: Patients undergoing transcatheter aortic valve replacement (TAVR) possess a higher risk of recurrent healthcare resource utilisation due to multiple comorbidities, frailty, and advanced age. We sought to devise a simple tool to identify TAVR patients at increased risk of 30-day readmission. METHODS AND RESULTS: We used the Nationwide Readmissions Database from January 2013 to September 2015. Complex survey methods and hierarchical regression in R were implemented to create a prediction tool to determine probability of 30-day readmission. Boot-strapped internal validation and cross-validation were performed to assess model accuracy. External validation was performed using a single-centre data set. Of 39,305 patients who underwent endovascular TAVR, 6,380 (16.2%) were readmitted within 30 days. The final 30-day readmission risk prediction tool included the following variables: chronic kidney disease, end-stage renal disease on dialysis (ESRD), anaemia, chronic lung disease, chronic liver disease, atrial fibrillation, length of stay, acute kidney injury, and discharge disposition. ESRD (OR 2.11, 95% CI: 1.7-2.63), length of stay ≥5 days (OR 1.64, 95% CI: 1.50-1.79), and short-term hospital discharge disposition (OR 1.81, 95% CI: 1.2-2.7) were the strongest predictors. The c-statistic of the prediction model was 0.63. The c-statistic in the external validation cohort was 0.69. On internal calibration, the tool was extremely accurate in predicting readmissions up to 25%. CONCLUSIONS: A simple and easy-to-use risk prediction tool utilising standard clinical parameters identifies TAVR patients at increased risk of 30-day readmission. The tool may consequently inform hospital discharge planning, optimise transitions of care, and reduce resource utilisation.
Khera S; Kolte D; Deo VS; Kalra A; Gupta T; Abbott JD; Kleiman NS; Bhatt DL; Fonarow GC; Khalique OK; Kodali S; Leon MB; Elmariah S
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
2019
2019-06-20
Copyright © 2019. Published by Elsevier Inc.
journalArticle
<a href="http://doi.org/10.4244/EIJ-D-18-00954" target="_blank" rel="noreferrer noopener">10.4244/EIJ-D-18-00954</a>
PMID: 30803938
Association of acute venous thromboembolism with in-hospital outcomes of coronary artery bypass graft surgery.
venous thrombosis; coronary artery bypass; coronary artery bypass graft surgery; venous thromboembolism
Background While venous thromboembolism (VTE) prophylaxis is a strong recommendation after most surgeries, it is controversial in cardiac surgeries such as coronary artery bypass grafting (CABG), because of perceived low VTE incidence and increased bleeding risk. Prior studies may not have been adequately powered to study outcomes of VTE in this population. We sought to investigate the postoperative incidence and outcomes of CABG patients using a large national inpatient database. Methods and Results We utilized the 2013 to 2014 National Inpatient Sample to identify all patients >18 years of age who underwent CABG (without concomitant valvular procedures), and had VTE during the hospital stay. We then compared clinically relevant outcomes in patients with and without VTE. We identified 331 950 CABG procedures. Of these, 1.3% (n=4205) had VTE. Patients with VTE were more likely to be older (mean 67.2±10.4 years versus 65.2±10.4 years, P<0.001). VTE was associated with higher incidence of inpatient mortality (6.8% versus 1.7%; adjusted odds ratio 1.92 [95% CI 1.40-2.65]; P<0.001) and complications. VTE was also associated with higher cost (mean±SE $81 995±$923 versus $48 909±$55) and longer length of stay (mean±SE 17.06±0.16 days versus 8.52±0.01 days). Conclusions Our analysis of >330 000 CABG procedures suggests that while postoperative VTE after CABG is rare, it is associated with increased morbidity and mortality. Randomized controlled trials are needed to identify optimal strategies for VTE prophylaxis in these patients.
Panhwar MS; Ginwalla M; Kalra A; Gupta T; Kolte D; Khera S; Bhatt DL; Sabik JF 3rd
Journal of the American Heart Association
2019
2019-10
Copyright © 2019. Published by Elsevier Inc.
journalArticle
<a href="http://doi.org/10.1161/JAHA.119.013246" target="_blank" rel="noreferrer noopener">10.1161/JAHA.119.013246</a>
PMID: 31533551
Aortic valve replacement in bioprosthetic failure:Insights from the society of thoracic surgeons national database.
BACKGROUND: To determine the current nationwide trends and outcomes of reoperative surgical aortic valve replacement (SAVR) performed for degenerated bioprosthesis. METHODS: The study was conducted using data from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database. All patients who had isolated reoperative SAVR for a degenerated aortic bioprosthesis between January 2012 and December 2016 were included. Patients who had other concomitant cardiac surgery procedures or active endocarditis were excluded. Trend analyses were conducted to track changes during this time period. RESULTS: The number of patients undergoing SAVR for bioprosthetic failure increased substantially between 2012 and 2014 (782 in 2012 to 844 in 2013 and 900 in 2014; relative change = +7.25%); this trend reversed significantly between 2015 and 2016 (decreased to 873 in 2015 and 840 in 2016; relative change = -3.4%, P= 0.005). Patients were older in 2012-2014 (65.80 ± 13.52 years) compared with 2015-2016 (64.45 ± 12.91 years; P= 0.001). Mean STS-predicted mortality risk score decreased from 4.55% in 2012-2014 to 4.25% in 2015-2016 (P = 0.001). There was no difference in post-operative stroke (1.80% vs. 1.80%, P= 0.87), renal failure requiring dialysis (2.7% vs. 2.8%, P= 0.69), or operative mortality (3.5% vs. 4.0%, P= 0.36) after reoperative SAVR in 2012-2014 and 2015-2016, respectively. CONCLUSIONS: The number of patients undergoing SAVR for degenerated bioprosthesis is decreasing in U.S, particularly among older and high-risk patients. These trends may reflect the adoption of valve-in-valve transcatheter aortic valve replacement for degenerated bioprosthesis after its FDA approval in 2015.
Kalra A; Raza S; Hussain M; Shorbaji K; Delozier S; Deo VS; Khera S; Kleiman NS; Reardon MJ; Kolte D; Gupta T; Mustafa RR; Bhatt DL; Sabik JF 3rd
The Annals of thoracic surgery
2019
2019-09-23
Copyright © 2019. Published by Elsevier Inc.
journalArticle
<a href="http://doi.org/10.1016/j.athoracsur.2019.08.023" target="_blank" rel="noreferrer noopener">10.1016/j.athoracsur.2019.08.023</a>
PMID: 31557477
The changing landscape of aortic valve replacement in the usa.
Adolescent; Female; Humans; Male; Adult; Aged; Treatment Outcome; Risk Factors; United States; Aged 80 and over; Aortic Valve; Aortic Valve Stenosis; Transcatheter Aortic Valve Replacement
AIMS: The aim of this study was to analyse the real-world national data on parallel utilisation of transcatheter (TAVR) and surgical (SAVR) aortic valve replacement. METHODS AND RESULTS: We queried an all-payer, administrative United States in-patient database to identify all AVR hospitalisations in patients aged ≥18 years from January 2012 to December 2016 and examined the temporal changes in the number of AVR procedures and in-hospital mortality. A total of 463,675 AVRs were performed - 363,275 (78.4%) SAVR and 100,400 (21.6%) TAVR. AVR linearly increased (from 78,985 in 2012 to 103,415 in 2016; +30.9%; ptrend<0.001) largely due to a marked increase in TAVR (from 7,655 to 33,545; +338%; ptrend<0.001), whereas the absolute number of SAVRs remained relatively stable (from 71,330 to 69,870; -1%; ptrend<0.001). The number of TAVRs increased in all pre-specified age groups (<75, 75-79, 80-85, and ≥85 years; ptrend<0.001 for all). In contrast, the number of SAVRs increased modestly in patients aged <75 years (ptrend<0.001) and declined in those aged 75-79 years, 80-84 years, or ≥85 years (ptrend<0.001 for all). Age- and sex-adjusted in-hospital mortality after isolated (aOR 1.00 [0.95-1.05]; ptrend=0.96) or combined SAVR (aOR 1.01 [0.97-1.05]; ptrend=0.66) remained unchanged during the study period, whereas in-hospital mortality after TAVR declined (aOR 0.75 [0.70-0.79]; ptrend<0.001). Similar trends in in-hospital mortality were seen in the age subgroups. CONCLUSIONS: The number of AVRs markedly increased in the USA from 2012 to 2016, mainly due to the widespread adoption of TAVR, whereas the number of SAVRs remained relatively stable. In-hospital mortality after TAVR declined, whereas that after SAVR has remained unchanged.
Gupta T; Kolte D; Khera S; Goel K; Villablanca PA; Kalra A; Abbott JD; Elmariah S; Fonarow GC; Rihal CS; Garcia MJ; Weisz G; Bhatt DL
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
2019
2019-12-06
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.4244/EIJ-D-19-00381" target="_blank" rel="noreferrer noopener">10.4244/EIJ-D-19-00381</a>
PMID: 31403460