PREDICTORS AND HOSPITAL OUTCOMES OF ATRIAL FIBRILLATION IN PATIENTS HOSPITALIZED WITH DIABETIC KETOACIDOSIS

Objectives: The aim of this study was to evaluate the temporal trends of transcatheter aortic valve replacement (TAVR) in severe aortic stenosis (AS) patients with atrial fibrillation (AF) and to compare the in-hospital outcomes between TAVR and surgical aortic valve replacement (SAVR) in patients with AF.Background: Data comparing TAVR to SAVR in severe AS patients with AF are lacking.Methods: National inpatient sample database in the United States from 2012 to 2016 were queried to identify hospitalizations for severe aortic stenosis patients with AF who underwent isolated aortic valve replacement. A propensity score-matched analysis was used to compare in-hospital outcomes for TAVR vs. SAVR for AS patients with AF.Results: The analysis included 278,455 hospitalizations, of which 124,910 (44.9%) were comorbid with AF. Before matching, TAVR had higher in-hospital mortality than SAVR (3.1 vs. 2.2%, p < 0.001); however, there was a declining trend during the study period (Ptrend < 0.001). After matching, TAVR and SAVR had similar in-hospital mortality (2.9 vs. 2.9%, p < 0.001) and stroke. TAVR was associated with lower rates of acute kidney injury, new dialysis, cardiac complications, acquired pneumonia, sepsis, mechanical ventilation, tracheostomy, non-routine discharge, and shorter length of stay; however, TAVR was associated with more pacemaker implantation and higher cost. Of the patients receiving TAVR, the presence of AF was associated with an increased rate of complications and increased medical resource usage compared to those without AF.Conclusions: In-hospital mortality and stroke for TAVR and SAVR in AF, AS are similar; however, the in-hospital mortality in TAVR AF is declining and associated with more favorable in-hospital outcomes.

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Chagas disease and SARS-CoV-2 coinfection does not lead to worse in-hospital outcomes: results from the Brazilian COVID-19 Registry

10.1101/2021.03.22.21254078 ◽

2021 ◽

Author(s):

Israel Molina Romero ◽

Milena Soriano Marcolino ◽

Magda Carvalho Pires ◽

Lucas Emanuel Ferreira Ramos ◽

Rafael Tavares Silva ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Chagas Disease ◽

Hospital Staff ◽

Study Data ◽

C Reactive Protein ◽

Hospital Outcomes ◽

Public Health Burden ◽

Protein Levels ◽

Reactive Protein

Objective: Chagas disease (CD) continues to be a major public health burden in Latina America, where co-infection with SARS-CoV-2 can occur. However, information on the interplay between COVID-19 and Chagas disease is lacking. Our aim was to assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Methods: Patients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio. Results: Of the 7,018 patients who had confirmed infection with SARS-CoV-2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p<0.05 for both). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups. Conclusions: In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation.

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Racial Disparities in In-hospital Adverse Events Among Patients with Atrial Fibrillation Implanted with a Watchman Left Atrial Appendage Occlusion Device: A United States National Perspective

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.120.009691 ◽

2021 ◽

Author(s):

Muhammad Zia Khan ◽

Muhammad Bilal Munir ◽

Douglas Darden ◽

Deepak Kumar Pasupula ◽

Sudarshan Balla ◽

...

Keyword(s):

United States ◽

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Appendage ◽

Hospital Outcomes ◽

Prolonged Length ◽

Left Atrial Appendage Occlusion ◽

Procedural Complications ◽

Race Ethnicity ◽

White Patients

Background - Left atrial appendage occlusion using a Watchman device has shown promise in reducing stroke risk in selected atrial fibrillation patients. Limited data exist on differences in characteristics and in-hospital outcomes of Watchman recipients in the United States based on race/ethnicity. Methods - Data were extracted from the National Inpatient Sample database for calendar years 2015-2018. The study sample was stratified into four groups (White, Black, Hispanic and Other races). Baseline characteristics, procedural complications and key in-hospital outcomes were then assessed. We also analyzed the independent association of race/ethnicity with key in-hospital outcomes including major complications, prolonged hospital stay and increased hospitalization cost. Results - A total of 34,960 Watchman recipients were included in the final analysis. Black and Hispanic patients had higher prevalence of heart failure, hypertension, obesity and renal failure when compared to White patients. The crude rate of overall procedural complications was also higher in Blacks, Hispanics and patients of Other race when compared to White patients (15.2%, 12.4% and 14.1% vs. 9.9%, p < 0.01). After multivariable adjustment, compared to White patients, Blacks, Hispanics and patients of Other race experienced a higher likelihood of a major complication from the procedure (adjusted odds ratio [aOR] 1.223; 95% confidence interval (CI) 0.986-1.517, aOR 1.296; 95% CI 1.075-1.561 and aOR 1.924; 95% CI 1.569-2.360, respectively) and prolonged length of stay > 1-day (aOR 1.631; 95% CI 1.431-1.859, aOR 1.239; 95% CI, 1.110-1.383 and aOR 1.619; 95% CI 1.403-1.869, respectively). Conclusions - Non-White patients undergoing Watchman implantation had higher prevalence of key co-morbidities and also experienced increased Watchman related adverse events including procedural complications and prolonged length of stay, even after adjustment for potential confounders. Further research is needed to identify etiologies behind differential outcomes among non-White patients after Watchman implantation.

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