The American journal of cardiology
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Observational Study
Impact of Sex on Survival and Neurologic Outcomes in Adults With In-Hospital Cardiac Arrest.
Data regarding the impact of sex on clinical outcomes in adults with in-hospital cardiac arrest (IHCA) have yielded conflicting results. We aimed to study the impact of female sex on mortality and poor neurologic outcomes in adults with IHCA. The study population included 680 consecutive patients hospitalized with IHCA who underwent ACLS-guided resuscitation from 2012 to 2018 at an academic tertiary medical center. ⋯ With respect to outcomes, women were noted to have significantly higher rates of in-hospital mortality (87.5% vs 78.0%; p = 0.001) and lower rates of favorable neurologic outcome (10.0% vs 15.8%, p = 0.030) compared with men. In multivariable analyses, female sex was independently associated with nearly two-fold higher rates of in-hospital mortality [odds ratio (OR) 1.93, 95% confidence interval (CI) 1.22-3.04, p = 0.005] and a trend toward lower rates of favorable neurologic outcome (OR 0.63, 95% CI 0.38-1.04, p = 0.071). In conclusion, in this prospective, contemporary registry of adults with IHCA, female sex was independently associated with nearly twofold higher rates of in-hospital mortality and a trend toward lower rates of favorable neurologic outcomes.
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Multicenter Study Comparative Study
Stroke and Systemic Embolism and Other Adverse Outcomes of Heart Failure With Preserved and Reduced Ejection Fraction in Patients With Atrial Fibrillation (from the COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation [CODE-AF]).
It is unknown whether heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) carry a similar risk of stroke or systemic embolism (SE) and other outcomes in patients with nonvalvular atrial fibrillation (AF). A prospective, multicenter outpatient registry with echocardiographic data which enrolled 10,589 patients from June 2016 to May 2019 was analyzed. In this registry, 935 (8.8%) patients had HF, and the proportions of patients with HFpEF and HFrEF were 43.2% and 56.8%, respectively. ⋯ The risk of stroke/SE in the HFpEF group compared with that in the no-HF group was consistently increased even in patients on oral anticoagulation therapy (adjusted HR 2.55, 95% CI 1.31 to 4.96). There was a correlation between larger left atrial size and risk of stroke/SE (adjusted HR 1.53, 95% CI 1.03 to 2.29), but not between reduced left ventricular ejection fraction and this risk. In conclusion, these results suggest that strict oral anticoagulation therapy helps reduce the risk of stroke/SE in patients with nonvalvular AF and HFpEF, especially in those with a larger left atrial size.
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Management of ST-elevation myocardial infarction complicated by cardiogenic shock (STEMI-CS) has evolved in the last decade. There is paucity of data on readmissions in this study population. We aimed to assess the burden, major etiologies, and resource utilization for 30-day readmissions among patients with STEMI and CS. ⋯ Congestive heart failure was the single most common reason for 30-day readmission. Patients discharged to skilled nursing facility, patients with private insurance and higher socioeconomic status were less likely to be readmitted. Moreover, readmissions among STEMI-CS patients contribute to significant resource utilization.
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Pacemakers with sleep apnea monitor (SAM) provide an easy tool to assess obstructive sleep apnea over long periods of time. The link between respiratory disturbances at night and the incidence of acute decompensated heart failure (ADHF) is not well established. We aimed at (1) determining the ability of SAM pacemakers to evaluate the extent of left ventricular overload and (2) assess the impact of respiratory disturbances at night on the occurrence of ADHF over 1-year of follow-up. ⋯ Patients with >12.5% of nights with RDI >20AH/h tended to have more ADHF during follow-up (log-rank p = 0.067). In conclusion, a high burden of apneas/hypopneas at night is associated with elevated NT-proBNP and PCWP values and an increased risk of ADHF over 1 year. These patients might benefit from early tailored clinical management.
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Multicenter Study Observational Study
Frequency of Cardiovascular Events and In-hospital Mortality With Opioid Overdose Hospitalizations.
The United States is in the kernel of cataclysmic opioid misuse epidemic with over 33,000 deaths per year from both prescription and illegal opioids use. One of the most common pernicious effects of opioids is on the cardiovascular system. The purpose of this analysis was to determine the incidence of opioid overdose associated cardiovascular events and its impact on short-term outcomes. ⋯ This study group also demonstrated longer length of stay and higher cost of hospitalization associated with opioid overdose and associated cardiovascular outcome. In conclusion, opioid overdose is associated with higher rates of cardiovascular events, particularly ischemic events and cardiac arrhythmias. These adverse events eventually lead to higher mortality rates and more resource utilization.