Bariatric surgery decreases the number of future hospital admissions for diastolic heart failure in subjects with severe obesity. Retrospective analysis of the US national inpatient sample (NIS) database.

Author(s):  
David Romero Funes ◽  
David Gutierrez Blanco ◽  
Cristina Botero-Fonnegra ◽  
Liang Hong ◽  
Emanuele Lo Menzo ◽  
...  
Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 1231-P
Author(s):  
IRIAGBONSE R. ASEMOTA ◽  
HAFEEZ SHAKA ◽  
MUHAMMAD USMAN ALMANI ◽  
EMMANUEL AKUNA ◽  
EHIZOGIE EDIGIN

2019 ◽  
Vol 25 (5) ◽  
pp. 166-167 ◽  
Author(s):  
Abdisamad M Ibrahim ◽  
Cameron Koester ◽  
Mohammad Al-Akchar ◽  
Nitin Tandan ◽  
Manjari Regmi ◽  
...  

This study aimed to evaluate the accuracy of the HOSPITAL Score (Haemoglobin level at discharge, Oncology at discharge, Sodium level at discharge, Procedure during hospitalization, Index admission, number of hospital admissions, Length of stay) LACE index (Length of stay, Acute/emergent admission, Charlson comorbidy index score, Emerency department visits in previous 6 months) and LACE+ index in predicting 30-day readmission in patients with diastolic dysfunction. Heart failure remains one of the most common hospital readmissions in adults, leading to significant morbidity and mortality. Different models have been used to predict 30-day hospital readmissions. All adult medical patients discharged from the SIU School of Medicine Hospitalist service from 12 June 2016 to 12 June 2018 with an International Classification of Disease, 10th Revision, Clinical Modification diagnosis of diastolic heart failure were studied retrospectively to evaluate the performance of the HOSPITAL Score, LACE index and LACE+ index readmission risk prediction tools in this patient population. Of the 730 patient discharges with a diagnosis of heart failure with preserved ejection fraction (HFpEF), 692 discharges met the inclusion criteria. Of these discharges, 189 (27%) were readmitted to the same hospital within 30 days. A receiver operating characteristic evaluation showed C-statistic values to be 0.595 (95% CI 0.549 to 0.641) for the HOSPITAL Score, 0.551 (95% CI 0.503 to 0.598) for the LACE index and 0.568 (95% CI 0.522 to 0.615) for the LACE+ index, indicating poor specificity in predicting 30-day readmission. The result of this study demonstrates that the HOSPITAL Score, LACE index and LACE+ index are not effective predictors of 30-day readmission for patients with HFpEF. Further analysis and development of new prediction models are needed to better estimate the 30-day readmission rates in this patient population.


Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael W Foster ◽  
Sara E Badenhausen ◽  
Colleen Tewksbury ◽  
Noel N Williams ◽  
J Eduardo Rame ◽  
...  

Introduction: Heart failure patients with severe obesity endure significant morbidity and frequent hospitalizations. Bariatric surgery is proven to provide durable weight loss for those with severe obesity, but the clinical impact and safety of these procedures among patients with heart failure has not been well-demonstrated. Methods: We conducted a medical record query of patients who have a previous diagnosis of heart failure (HFpEF and HFrEF) and underwent subsequent Roux-En-Y gastric bypass or laparoscopic sleeve gastrectomy at a high-volume metabolic and bariatric surgery center. We compared clinical, demographic, and echocardiographic data captured just prior to the bariatric procedure to the most recent data available in the medical record for each patient. Results: There were 50 patients (88% had HFpEF) included in this study. Time from HF diagnosis to most recent follow-up ranged from 0.2 to 20.3 years (median 6.7 years) and there was no recorded mortality. The median time from HF diagnosis to surgery was 2.3 years and median time from surgery to recent follow-up was 2.9 years. Post-operative median decrease in BMI was 8.8 kg/m 2 , HF hospitalizations were 0.4 per patient year (PPY) to 0.15 PPY, p=0.008, and median NYHA Class was II pre-op and I post-op, p=0.048). LVEF, LVESD, and LVEDD were not significantly changed post-operatively (Table 1). Conclusion: Weight loss following bariatric surgery for patients with HF led to improvements in NYHA Class, fewer hospitalizations for HF, and was not associated with perioperative mortality. It is reasonable to consider bariatric surgery for this patient population, but further prospective investigation is warranted.


Author(s):  
Menatalla Mekhaimar ◽  
Soha Dargham ◽  
Mohamed El-Shazly ◽  
Jassim Al Suwaidi ◽  
Hani Jneid ◽  
...  

Abstract We aimed to study the cardiovascular and economic burden of diabetes mellitus (DM) in patients hospitalized for heart failure (HF) in the US and to assess the recent temporal trend. Data from the National Inpatient Sample were analyzed between 2005 and 2014. The prevalence of DM increased from 40.4 to 46.5% in patients hospitalized for HF. In patients with HF and DM, mean (SD) age slightly decreased from 71 (13) to 70 (13) years, in which 47.5% were males in 2005 as compared with 52% in 2014 (p trend < 0.001 for both). Surprisingly, the presence of DM was associated with lower in-hospital mortality risk, even after adjustment for confounders (adjusted OR = 0.844 (95% CI [0.828–0.860]). Crude mortality gradually decreased from 2.7% in 2005 to 2.4% in 2014 but was still lower than that of non-diabetes patients’ mortality on a yearly comparison basis. Hospitalization for HF also decreased from 211 to 188/100,000 hospitalizations. However, median (IQR) LoS slightly increased from 4 (2–6) to 4 (3–7) days, so did total charges/stay that jumped from 15,704 to 26,858 USD (adjusted for inflation, p trend < 0.001 for both). In total, the prevalence of DM is gradually increasing in HF. However, the temporal trend shows that hospitalization and in-hospital mortality are on a descending slope at a cost of an increasing yearly expenditure and length of stay, even to a larger extent than in patient without DM.


2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Christine K Kha ◽  
Ellyn Phan ◽  
Nicole Simon

Abstract Diabetic ketoacidosis (DKA) is an acute life-threatening complication of diabetes mellitus. It is responsible for greater than 100,000 hospital admissions per year in the US (1). There are few studies regarding the relationship between drug usage and acute diabetic complications (2). Since 2001, cannabis usage among US adults have more than doubled, as state legal restrictions have eased and attitudes towards cannabis have become more permissive. Cannabis is the most commonly used illicit drug in the US (3). Some studies suggested cannabis usage was associated with improvement in insulin sensitivity and pancreatic beta cell function. Other research demonstrated cannabis usage may contribute to diabetes-related hospitalizations. A retrospective analysis was performed at an urban teaching hospital to examine the relationship between cannabis usage and risk for DKA upon presentation. From March 2017 to February 2019, all non-pregnant patients aged 18 years and older, and who met criteria for DKA admission upon medical records review, were included in the study. Demographics, vitals, biochemistry, and toxicology were evaluated. Overall, 188 admissions for DKA were identified in a total of 130 patients, and 43% (81/188) were readmissions by 23 patients. Illicit substance usage was addressed by history in 72% (135/188) of all admissions, among which 24% (33/135) reported cannabis usage. 36% (67/188) of all admissions, 73% (24/33) of the self-reported cannabis usage group, and 46% (37/81) of the readmissions, underwent general toxicology screening that did not include detection for cannabis. 11% (20/188) of all admissions, 24% (8/33) of the self-reported cannabis usage group, and 16% (13/81) of the readmissions, completed toxicology screening specifically for cannabis. All of the self-reported cannabis usage admissions (33/33) and readmissions (81/81) presented with additional aggravating factors for DKA such as medication noncompliance, polysubstance abuse, and infection. Finally, 20 of the overall 130 patients admitted during this timeframe presented with new onset DKA, where none reported cannabis usage, 20% (4/20) completed general toxicology screening, and none underwent cannabis specific toxicology screening. From the observational retrospective analysis at this hospital, there is a need for awareness about substance abuse screening, especially in adults with a history of recurrent hospital admissions for DKA. Knowledge among health care providers and patient education regarding the effect of cannabis usage on metabolic factors and its diabetes complications, including diabetes self-management at time of drug usage, can be further explored in prospective studies. References: (1) Umpierrez (2006) Diabetes Care, 29(12), 2755-2757. (2) Brown et al., (2017) JAMA, 317(2), 207. (3) Haffajee et al., (2018) NEJM, 379(6), 501-504.


Nutrients ◽  
2021 ◽  
Vol 13 (9) ◽  
pp. 3150
Author(s):  
Enrica Migliore ◽  
Amelia Brunani ◽  
Giovannino Ciccone ◽  
Eva Pagano ◽  
Simone Arolfo ◽  
...  

Bariatric surgery (BS) confers a survival benefit in specific subsets of patients with severe obesity; otherwise, effects on hospital admissions are still uncertain. We assessed the long-term effect on mortality and on hospitalization of BS in patients with severe obesity. This was a retrospective cohort study, including all patients residing in Piedmont (age 18–60 years, BMI ≥ 40 kg/m2) admitted during 2002–2018 to the Istituto Auxologico Italiano. Adjusted hazard ratios (HR) for BS were estimated for mortality and hospitalization, considering surgery as a time-varying variable. Out of 2285 patients, 331 (14.5%) underwent BS; 64.4% received sleeve gastrectomy (SG), 18.7% Roux-en-Y gastric bypass (RYGB), and 16.9% adjustable gastric banding (AGB). After 10-year follow-up, 10 (3%) and 233 (12%) patients from BS and non-BS groups died, respectively (HR = 0.52; 95% CI 0.27–0.98, by a multivariable Cox proportional-hazards regression model). In patients undergoing SG or RYGB, the hospitalization probability decreased significantly in the after-BS group (HR = 0.77; 0.68–0.88 and HR = 0.78; 0.63–0.98, respectively) compared to non-BS group. When comparing hospitalization risk in the BS group only, a marked reduction after surgery was found for all BS types. In conclusion, BS significantly reduced the risk of all-cause mortality and hospitalization after 10-year follow-up.


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