scholarly journals TCT-128 Impact of Gender on Clinical Outcomes of Septal Myectomy Versus Alcohol Septal Ablation for Hypertrophic Cardiomyopathy in the United States

2019 ◽  
Vol 74 (13) ◽  
pp. B127
Author(s):  
Tarun Jain ◽  
Alejandro Lemor ◽  
Pedro Villablanca ◽  
Dee Dee Wang ◽  
Mayra Guerrero ◽  
...  
Keyword(s):  
United States ◽  
Hypertrophic Cardiomyopathy ◽  
Clinical Outcomes ◽  
The United States ◽  
Alcohol Septal Ablation ◽  
Septal Myectomy

Impact of age on outcomes in patients with hypertrophic cardiomyopathy: a nationwide inpatient database study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Jain ◽  
M.G Gupta ◽  
A.B Bansal ◽  
B.G Griffin ◽  
B.X Xu
Keyword(s):  
United States ◽  
Hypertrophic Cardiomyopathy ◽  
Elderly Patients ◽  
Odds Ratio ◽  
Age Groups ◽  
Pacemaker Implantation ◽  
The United States ◽  
Age Group ◽  
Alcohol Septal Ablation ◽  
Septal Myectomy

Abstract Background Hypertrophic cardiomyopathy (HCM) is an inherited cardiovascular condition, associated with increased risk of premature adverse events. Once considered a disease of the young, it is increasingly being recognized in septuagenarians and octogenarians, with a few small-scale studies indicating that the risk of adverse cardiovascular outcomes may be lower in the older population. Purpose There are limited data regarding the outcomes of elderly patients with HCM. We therefore investigated a nationwide cohort in the United States to evaluate the pattern of disease presentation and outcomes of HCM patients, with a focus on the geriatric population. Methods The Nationwide Inpatient Sample (NIS) was queried to identify patients who were admitted for any cause with a concomitant diagnosis of HCM between 2011 and 2014 using ICD-9 (International Classification of Diseases-9th Edition-Clinical Modification) diagnosis code 425.1. All patients were further sub-categorized based on their age into those less than 65 years of age (representative of younger population), 66–75 years, 76–85 years and more than or equal to 86 years. We performed the Chi-squared tests for categorical variables and Mann–Whitney U tests for continuous variables. Multiple logistic regression was performed to assess the predictors of mortality. A two-tailed p-value of <0.05 was considered to be significant. Results We identified 120,805 patients who were admitted with a diagnosis of HCM, of whom 46.4% were in the <65 age group, 21.5% were in the 66–75 age group, 20.5% were in the 76–85 age group, and 11.5% were in the >86 age group. The proportion of patients with ventricular fibrillation was lower (1.8% vs 1.0% vs 0.5% vs 0.1%, p<0.01), whereas the proportion of patients undergoing permanent pacemaker placement was higher (1.2% vs 2.3% vs 3.7% vs 3.6%, p<0.01) in successive age groups. The proportion of people undergoing operative procedures including septal myectomy (SM) (5.4% vs 4.5% vs 1.8% vs 0.2%, p-intervention <0.01) and alcohol septal ablation (ASA) (3.2% vs 3.3% vs 1.9% vs 1.0%, p-intervention <0.01) were lower in the advanced age groups when compared to the younger age groups. Pacemaker implantation (odds ratio (OR): 0.32, 95% confidence intervals (CIs): 0.20–0.50, p<0.01) and implantable cardioverter defibrillator (ICD) placement (OR: 0.059, 95% CI: 0.024–0.144, p<0.01) were found to be associated with decreased odds of in-hospital mortality across all age groups. Conclusion In a large nationwide cohort of HCM patients in the United States, a significant proportion of patients were septuagenarians and octogenarians. Fewer elderly patients with HCM underwent septal myectomy and alcohol septal ablation, while elderly patients underwent more pacemaker implants. A combination of reduced ventricular conduction abnormalities coupled with increased pacemaker implantation may be contributing to increased longevity in older HCM patients. Odds-ratio for predictors of mortality Funding Acknowledgement Type of funding source: None

scholarly journals A scoping review of female drowning: an underexplored issue in five high-income countries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kym Roberts ◽  
Ogilvie Thom ◽  
Susan Devine ◽  
Peter A. Leggat ◽  
Amy E. Peden ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
United Kingdom ◽  
New Zealand ◽  
Clinical Outcomes ◽  
Scoping Review ◽  
The United States ◽  
Clinical Treatment ◽  
High Income ◽  
Public Health Issue

Abstract Background Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. Methods A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. Results The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). Conclusion Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.

scholarly journals Adoption of Electronic Health Records and Perceptions of Financial and Clinical Outcomes Among Ophthalmologists in the United States

2018 ◽  
Vol 136 (2) ◽  
pp. 164 ◽  
Author(s):  
Michele C. Lim ◽  
Michael V. Boland ◽  
Colin A. McCannel ◽  
Arvind Saini ◽  
Michael F. Chiang ◽  
...  
Keyword(s):  
United States ◽  
Electronic Health Records ◽  
Clinical Outcomes ◽  
The United States ◽  
Health Records ◽  
Electronic Health

Recent Trends in Clinical Outcomes and Resource Utilization for Pulmonary Embolism in the United States

CHEST Journal ◽  
2009 ◽  
Vol 136 (4) ◽  
pp. 983-990 ◽  
Author(s):  
Brian Park ◽  
Louis Messina ◽  
Phong Dargon ◽  
Wei Huang ◽  
Rocco Ciocca ◽  
...  
Keyword(s):  
United States ◽  
Pulmonary Embolism ◽  
Clinical Outcomes ◽  
Resource Utilization ◽  
The United States ◽  
Recent Trends

Abstract 14301: Effects of Septal Reduction Therapy on Acute Cardiovascular Events and All-cause Mortality in Patients With Obstructive Hypertrophic Cardiomyopathy: Propensity Score-matched Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sae Morita ◽  
Yanling Zhao ◽  
Kohei Hasegawa ◽  
Muredach P Reilly ◽  
Mathew S Maurer ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
Propensity Score ◽  
New York State ◽  
Control Group ◽  
Short Term ◽  
Alcohol Septal Ablation ◽  
Septal Myectomy ◽  
All Cause Mortality ◽  
Obstructive Hypertrophic Cardiomyopathy ◽  
Matched Study

Introduction: Septal reduction therapy (SRT) - i.e., septal myectomy and alcohol septal ablation - has been used to treat medically-refractory obstructive hypertrophic cardiomyopathy (HOCM) for a few decades. However, the effects of SRT on the risk of acute cardiovascular (CV) events and all-cause mortality are largely unknown. Hypothesis: SRT is associated with a long-term decrease in acute CV events and a short-term increase in all-cause mortality in patients with HOCM. Methods: We performed a propensity score (PS)-matched study using all-payer databases that capture all hospitalizations and outpatient visits in New York State. We identified patients with HOCM who underwent SRT between January 1, 2007 and December 31, 2014 (i.e., the SRT group) and those who have never had SRT but had at least one hospitalization for HOCM during the same period (i.e., the control group). We performed 1:1 PS matching using age, sex, race/ethnicity, source of payment, season and year of starting event follow-up (i.e., the day of SRT or the index hospitalization), and Elixhauser comorbidity measures. The primary outcomes were (1) acute CV event (i.e., emergency department visit or unplanned hospitalization for CV disease) during 1-360 days and 361-720 days and (2) 7-, 15-, 30-, 180-, and 360-day all-cause mortality. We compared the risk of the outcome event using logistic regression models. Results: The analytic cohort consisted of 690 patients with HOCM (i.e., 345 PS-matched pairs). The SRT group had a lower risk of acute CV event during 361-720 days (OR 0.44; 95% CI, 0.20-0.97; P=0.04) but a higher risk of 7-day mortality (11 vs. 2 in the control group; P=0.03). The SRT group had a non-significant trend towards lower all-cause mortality in longer terms ( Figure ). Conclusion: In this population-based PS-matched study of patients with HOCM, SRT was associated with a reduced risk of acute CV events in the second post-procedure year at the sacrifice of a short-term increase in all-cause mortality.

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