CRT-800.53 Association Between Preexisting Valvular Heart Disease and Takotsubo Cardiomyopathy among Hospitalized Patients in the United States

Background: The pathogenesis of Takotsubo Cardiomyopathy (TTCM) remains poorly understood. Several case reports have described the occurrence of TTCM in patients with preexisting valvular heart disease (VHD). We sought to examine the association between preexisting VHD and TTCM in hospitalized patients. Methods: Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), all hospitalizations between 2007 and 2011 with preexisting diagnosis of VHD and admitting diagnosis of TTCM were extracted using ICD-9 CM codes. We compared patients admitted for TTCM who had preexisting VHD to those without. We excluded patients below the age of 18 as well as those diagnosed with TTCM who later underwent percutaneous coronary intervention (PCI). Multivariate logistic regression was used to assess the independent effect of preexisting VHD on both occurrence of TTCM and clinical outcomes (length of stay (LOS), stroke and in-hospital mortality). Results: In our study, 613 (0.06%) out of the 1,084,719 hospitalized patients with preexisting VHD, had TTCM, compared to 13,381 (0.04%) out of the 31,460,000 with no preexisting VHD (p<0.0001). In adjusted models, patients with preexisting VHD had a lower risk of being hospitalized for TTCM in the index hospital admission (adjusted odds ratio (aOR) =0.83, 95% confidence interval (CI) =0.77-0.90), independent of potential demographic, comorbid and lifestyle confounders. However, preexisting VHD was significantly associated with longer LOS (aOR=2.59, 95% CI=1.95-3.23), increased stroke rate (aOR=2.49, 95% CI=1.75-3.54) and higher in-hospital mortality (aOR=1.48, 95% CI=1.05-2.09). Conclusion: In this large, nationwide study, preexisting VHD was associated with worse clinical outcomes in patients hospitalized for TTCM. Our results can guide future clinical decision-making regarding prompt risk factor identification for poor prognosis in TTCM patients. Future prospective studies are needed to further evaluate this association.

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Abstract 163: High Burden of Valvulopathy in Heart Failure: A Moving Target

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.9.suppl_2.163 ◽

2016 ◽

Vol 9 (suppl_2) ◽

Author(s):

Enoch Agunanne ◽

Aamer Abbas ◽

Debabrata Mukherjee

Keyword(s):

United States ◽

Heart Failure ◽

Heart Disease ◽

Valvular Heart Disease ◽

Heart Diseases ◽

Medical Center ◽

Care Facility ◽

The United States ◽

Study Objective ◽

Valvular Heart Diseases

Background: The lifetime risk of developing Heart Failure (HF) is 20% for Americans ≥40 years of age. In the United States, greater than 650,000 new HF cases are diagnosed annually. About 5.1 million persons in the United States have clinically manifest HF. Additionally, HF has high absolute mortality rates of approximately 50% within 5 years of diagnosis. HF carries substantial health and economic burden. It is the primary diagnosis in >1 million hospitalizations annually. Patients hospitalized for HF are at high risk for all-cause re hospitalization. The total cost of HF care in the United States exceeds $30 billion annually. Objective: The study objective was to investigate the prevalence of valvular heart disease among patients hospitalized for HF in a largely Hispanic population. Methods: This is a retrospective study with aims inclusive of: analyzing the hospitalization and 4 months, 6 months, 2 year- re-hospitalization rates of HF in University Medical Center between Oct 2010 and Oct 2013; evaluating the association between valvular heart disease and hospitalizations for HF. Inclusion criteria were: admission/re hospitalizations with HF (with reduced, preserved and borderline EF). Echocardiographic determination of at least moderate valvular disease was utilized in this study as significant. Exclusion criteria were: patients lost to follow-up, death in hospital, transfer to another acute care facility, and discharge against medical advice. Demographics were also collected. Results: Hospitalizations involving 195 patients (120 men and 75 women) were randomly analyzed. The racial spread showed 77.4% (151 of 195) Hispanics and 22.6% (44 of 195) non-Hispanics. Out of the 195 index hospitalizations, the 4 month, 6 months and 2 years rehospitalization visits were 17.4% (34 of 195), 22.5% (44 of 195) and 38.5% (75 of 195) respectively. The prevalence of significant valvular heart disease was 45.9% (90 of 195), while the prevalence of no valvular heart disease was 54.1% (105 of 195) (p < 0.05). Conclusion: Multiple, prior studies have shown that valvular heart diseases have a comparatively low association with clinical Heart Failure. This study raises a valid point that in some population groups (the Hispanic), the burden of valvular heart disease may be greater than has been published in other groups. This calls for more studies, and has lots of potential implications in Heart Failure management.

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PCV24 INCREMENTAL DIRECT HEALTHCARE EXPENDITURES OF VALVULAR HEART DISEASE IN THE UNITED STATES

Value in Health ◽

10.1016/j.jval.2019.04.460 ◽

2019 ◽

Vol 22 ◽

pp. S122

Author(s):

P. Mallow ◽

J. Chen ◽

M. Moore ◽

C. Gunnarsson ◽

J. Rizzo

Keyword(s):

United States ◽

Heart Disease ◽

Valvular Heart Disease ◽

The United States ◽

Healthcare Expenditures

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Nonrheumatic valvular heart disease in the United States

American Heart Journal ◽

10.1016/0002-8703(93)90198-i ◽

1993 ◽

Vol 125 (3) ◽

pp. 915-918 ◽

Cited By ~ 2

Author(s):

Richard F. Gillum

Keyword(s):

United States ◽

Heart Disease ◽

Valvular Heart Disease ◽

The United States

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Anticoagulation for valvular heart disease in community-based practice

Thrombosis and Haemostasis ◽

10.1160/th09-07-0450 ◽

2010 ◽

Vol 103 (02) ◽

pp. 329-337 ◽

Cited By ~ 2

Author(s):

Al Ozonoff ◽

Lori Henault ◽

Elaine Hylek ◽

Adam Rose

Keyword(s):

United States ◽

Heart Disease ◽

Incidence Rate ◽

Valvular Heart Disease ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

The United States ◽

Major Haemorrhage ◽

Target Range ◽

Community Based

SummaryLittle is known about patients who receive oral anticoagulation for valvular heart disease (VHD) in community-based practice. It was this study’s objective to describe the characteristics, management, and outcomes of patients anticoagulated for VHD, compared to patients anticoagulated for atrial fibrillation (AF). We used a nationally-representative cohort of community-based anticoagulation care in the United States. Data collected included indications for therapy, demographics, selected comorbid conditions, international normalised ratio (INR) target ranges, INR control, and clinical outcomes. We identified 1,057 patients anticoagulated for VHD (15.6% of the overall cohort) and 3,396 patients anticoagulated for AF (50.2%). INR variability was similar between the two groups (0.64 vs. 0.69, p = 0.80). Among patients with aortic VHD, for whom a standard (2–3) target INR range is recommended, 461 (84%) had a high target range (2.5–3.5), while 95 (16%) had a standard target range. VHD patients had a higher rate of major haemorrhage compared to AF patients (3.57 vs. 1.78 events per 100 patient-years, incidence rate ratio 2.02, 95% CI 1.33 – 3.06). The rate of stroke/systemic embolus was similar between groups (0.67 vs. 0.97 events per 100 patient-years, incidence rate ratio 0.71, 95% CI 0.32 – 1.57). In our community-based study, approximately 15.6% of patients receiving warfarin were anticoagulated for VHD. VHD patients achieved similar anticoagulation control to patients with AF, as measured by INR variability. Nevertheless, the rate of major haemorrhage was elevated among VHD patients compared to AF patients; this finding requires further investigation.Disclaimer: The opinions expressed in this manuscript do not necessarily represent the views or policies of the United States Department of Veterans Affairs.

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Hospitalizations for Valvular Heart Disease in Chronic Dialysis Patients in the United States

Nephron ◽

10.1159/000064476 ◽

2002 ◽

Vol 92 (1) ◽

pp. 43-50 ◽

Cited By ~ 18

Author(s):

Kevin C. Abbott ◽

Lawrence Y. Agodoa

Keyword(s):

United States ◽

Heart Disease ◽

Valvular Heart Disease ◽

The United States ◽

Chronic Dialysis ◽

Dialysis Patients

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Heart disease, cancer, and trauma injury top the list of the 15 most costly medical conditions in the United States

PsycEXTRA Dataset ◽

10.1037/e556482006-014 ◽

2003 ◽

Keyword(s):

United States ◽

Heart Disease ◽

The United States ◽

Medical Conditions ◽

Trauma Injury

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Faculty Opinions recommendation of Hospitalized patients with 2009 H1N1 influenza in the United States, April-June 2009.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1167967.630070 ◽

2009 ◽

Author(s):

Kayvon Modjarrad

Keyword(s):

United States ◽

H1n1 Influenza ◽

The United States ◽

Hospitalized Patients ◽

2009 H1n1

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Current knowledge of Chagas-related heart disease among pediatric cardiologists in the United States

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01924-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sanchi Malhotra ◽

Imran Masood ◽

Noberto Giglio ◽

Jay D. Pruetz ◽

Pia S. Pannaraj

Keyword(s):

United States ◽

Differential Diagnosis ◽

Heart Disease ◽

Chagas Disease ◽

Latin American ◽

Current Knowledge ◽

Parasitic Infection ◽

The United States ◽

Cardiac Complications ◽

The U.S

Abstract Background Chagas disease is a pathogenic parasitic infection with approximately 8 million cases worldwide and greater than 300,000 cases in the United States (U.S.). Chagas disease can lead to chronic cardiomyopathy and cardiac complications, with variable cardiac presentations in pediatrics making it difficult to recognize. The purpose of our study is to better understand current knowledge and experience with Chagas related heart disease among pediatric cardiologists in the U.S. Methods We prospectively disseminated a 19-question survey to pediatric cardiologists via 3 pediatric cardiology listservs. The survey included questions about demographics, Chagas disease presentation and experience. Results Of 139 responses, 119 cardiologists treat pediatric patients in the U.S. and were included. Most providers (87%) had not seen a case of Chagas disease in their practice; however, 72% also had never tested for it. The majority of knowledge-based questions about Chagas disease cardiac presentations were answered incorrectly, and 85% of providers expressed discomfort with recognizing cardiac presentations in children. Most respondents selected that they would not include Chagas disease on their differential diagnosis for presentations such as conduction anomalies, myocarditis and/or apical aneurysms, but would be more likely to include it if found in a Latin American immigrant. Of respondents, 87% agreed that they would be likely to attend a Chagas disease-related lecture. Conclusions Pediatric cardiologists in the U.S. have seen very few cases of Chagas disease, albeit most have not sent testing or included it in their differential diagnosis. Most individuals agreed that education on Chagas disease would be worth-while.

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