scholarly journals Contemporary predictors of readmission outcomes in patients with infective endocarditis: analysis from a national readmission database

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Khayata ◽  
A Addoumieh ◽  
S Alkharabsheh ◽  
P Collier ◽  
A Klein ◽  
...  
Keyword(s):  
Substance Abuse ◽  
Hepatitis C ◽  
Infective Endocarditis ◽  
Opioid Abuse ◽  
Index Admission ◽  
Secondary Outcome ◽  
Cocaine Use ◽  
The Us ◽  
Readmission Risk ◽  
National Readmission Database

Abstract Background/Introduction Infective endocarditis (IE) remains a serious illness that is associated with remarkable morbidity and mortality in the United States (US). There are limited studies that investigated predictors of 30-day readmission risk in this population. Purpose We aimed to perform a contemporary analysis to investigate predictors of 30-day readmission in IE patients in the US. Methods We used the 2017 national readmission database to identify index admissions among adults (age ≥18) with the diagnosis of IE. Appropriate International Statistical Classification (ICD-10) codes were used to identify patients with IE. Primary outcome of interest was 30-day readmission, and hospital cost was the secondary outcome. Results Out of 49,692 admissions for IE, 5,743 (11.6%) patients were readmitted within 30 days. Patients who had 30-day readmission were younger (55±20 vs 61±19 years, P<0.001), 44.8% were females (P=0.08), 27.9% had diabetes mellitus (DM), 56.8% had hypertension, 37.9% had heart failure (HF), 31.3% had chronic kidney disease (CKD), 12.2% had end stage renal disease, and 47.8% had Medicare insurance. Patients who had readmissions within 30 days were more likely to have non-elective index admission (96.9% vs 93.4%, P<0.001), more likely to have hepatitis C (19.5% vs 12.2%, P<0.001), human immunodeficiency virus (HIV) (1.7% vs 1.2%, P<0.001), substance abuse (8.6% vs 5.4%, P<0.001), opioid abuse (24% vs 14.7%, P<0.001), and cocaine use (7.4% vs 4.3%, P<0.001). Overall, 5,393 (10.9%) patients died during index admission. Median cost for readmissions within 30 days was $83,217 [$41,457-$165,487], compared to the index admission cost of $90,257 [$41,945- $208,851] (P<0.001). After adjusting for age, DM, HF, and CKD, substance abuse (odds ratio (OR): 1.19 [1.07–1.33]; P 0.001), opioid abuse (OR: 1.37, [1.26- 1.48]; P<0.001), cocaine use (OR: 1.33 [1.18- 1.48]; P<0.001), HIV (OR: 1.25 [1.01–1.56]; P=0.04), and hepatitis C (OR: 1.34 [1.24–1.45]; P<0.001) correlated with higher odds of readmissions within 30 days (Figure 1). Conclusion Approximately 1 in 4 patients admitted for IE in the US had a history of opioid abuse and almost one fifth had hepatitis C. The 30-day readmission rate remains significant in IE with high financial burden on the health system. Both opioid abuse and hepatitis C were among the highest predictors of readmission within 30 days. Identifying modifiable predictors of readmission in this population may reduce readmission risk and healthcare cost. Figure 1 Funding Acknowledgement Type of funding source: None

National estimates of case‐mix, mortality, and economic outcomes among inpatient HIV/AIDS mono‐infection and hepatitis C co‐infection cases in the US

2018 ◽  
Vol 25 (5) ◽  
pp. 806-821
Author(s):  
Timothy Pham ◽  
R. Chris Rathbun ◽  
Shellie Keast ◽  
Nancy Nesser ◽  
Kevin Farmer ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Economic Outcomes ◽  
Case Mix ◽  
The Us ◽  
National Estimates ◽  
Hiv Aids

scholarly journals Sustained Virologic Response Rates of Direct Acting Antivirals in HIV Coinfected Hepatitis C Patients and Its Effect on Liver Fibrosis

2020 ◽  
Vol 3 (2) ◽  
pp. 01-07
Author(s):  
Dora Lebron
Keyword(s):  
Hepatitis C ◽  
Real World ◽  
Sustained Virologic Response ◽  
Virologic Response ◽  
Hiv Care ◽  
Secondary Outcome ◽  
Direct Acting Antivirals ◽  
Fibrosis Regression ◽  
Direct Acting ◽  
End Stage

Background: Hepatitis C virus (HCV) is an important cause of chronic hepatitis with necroinflammation and fibrosis resulting in end stage liver disease and hepatocellular carcinoma. Direct acting antivirals (DAAs) are newer agents that directly interfere with the HCV lifecycle and result in high rates of sustained virologic response (SVR). We evaluated if treatment with DAAs in a real-world setting is as successful in HCV/HIV coinfected patients as it is in HCV monoinfected patients, and if some degree of fibrosis regression can be observed after completion of therapy in both groups. Methods: We retrospectively reviewed data from HCV monoinfected and HCV/HIV coinfected patients who received treatment from 2014-2016 at the East Carolina University Infectious Diseases clinic. The primary outcome was to compare completion and sustained virologic response (SVR) rate at either 12 or 24 weeks between HCV monoinfected patients and HCV/HIV coinfected patients. The secondary outcome was to assess regression of fibrosis at either 12 or 24 weeks after completion of therapy, defined as one METAVIR stage improvement in their FibroSure™, a noninvasive biochemical test to estimate the stage of fibrosis. Results: There were 41 patients in each group. Compared to the coinfected group, patient no show rate was higher in the monoinfected group (p=0.0346). In the HCV monoinfected group, 25 (93%) achieved either SVR 12 or 24. Two patients were non-compliant and had detectable viral load on evaluation at week 12. In the HCV/HIV coinfected group, 37 patients achieved SVR (p=0.0039). One patient in the coinfected group did not complete therapy but achieved SVR. In terms of fibrosis, 12/18 (67%) in the monoinfected group demonstrated improvement in at least 1 Metavir stage and 6/18 (33%) had no change. In the coinfected group, 8/16 (50%) patients demonstrated an improvement in FibroSure™ stage, 5/16 (31%) had no change, and 3/16 (19%) had worsening fibrosis according to FibroSure™ stage, (p=0.4867). Conclusions: In this small, real-world cohort, HCV/HIV coinfected patients treated with DAAs had higher completion and SVR rates than HCV monoinfected patients. Treatment failures in the monoinfected group were all linked to non-adherence, whereas, more coinfected patients achieved SVR, likely related to the fact that they were regularly engaged in routine HIV care. Fibrosis regression based on FibroSure™ was observed more in monoinfected patients than those with coinfection. Although not statistically significant, at least 50% of the patients in each group had regression of fibrosis.

scholarly journals Clinical and morphological characteristics of infective endocarditis

2020 ◽  
Vol 98 (2) ◽  
pp. 115-121
Author(s):  
V. I. Ulanova ◽  
V. I. Mazurov ◽  
V. A. Zinzerling
Keyword(s):  
Staphylococcus Aureus ◽  
Hepatitis C ◽  
Infective Endocarditis ◽  
Drug Dependence ◽  
Drug Users ◽  
Clinical Course ◽  
Morphological Characteristics ◽  
Hepatitis C Virus Infection ◽  
Morphological Picture ◽  
Drug Dependent

The aim of the study was to identify the features of the clinical course and morphogenesis of infective endocarditis (IE) in HIVinfected injecting drug users with concomitant hepatitis C virus infection in comparison with the clinical and morphological picture of endocarditis in persons without drug dependence. It was found that the causative agent of IE in HIV-infected patients was staphylococcus aureus (71.8%), and in persons without drug dependence in the etiology of the disease the conditionally pathogenic flora prevailed. In HIV-infected drug-dependent patients, the tricuspid valve was affected (82.7%), and in persons without drug dependence — isolated aortic valve damage (40%) and combined mitral and aorticvalve lesions (36.4%). Purulent sepsis complications in drug-dependent patients with IE are less common than in patients without drug dependence due to immunosuppression, which is present in HIV-infected persons.

The Feasibility of Virtual VitalTalk Workshops in Japanese: Can Faculty Members in the US Effectively Teach Communication Skills Virtually to Learners in Japan?

2021 ◽  
pp. 104990912110444
Author(s):  
Kaori Ito ◽  
Takeshi Uemura ◽  
Misuzu Yuasa ◽  
Eriko Onishi ◽  
Youkie Shiozawa ◽  
...  
Keyword(s):  
Training Program ◽  
Communication Skills ◽  
Communication Training ◽  
Faculty Members ◽  
Secondary Outcome ◽  
Virtual Communication ◽  
Serious Illness ◽  
The Us ◽  
Before And After ◽  
The Mean

Background: VitalTalk is an established training program for serious illness conversations in the US. Previously, this training course has been provided in-person in Japanese, but never virtually. Objectives: To evaluate the feasibility of a virtually administered VitalTalk workshop in Japanese. Setting/Subjects: We conducted a virtual workshop which consisted of 2 days (3 hours per day) of synchronous sessions and preceding asynchronous modules. Five VitalTalk faculty members in the US facilitated 4 workshops for 48 physicians from 33 institutions across Japan. Learners completed surveys before and after the workshop. Measurements: To evaluate the feasibility, learners were asked for their satisfaction with the workshop and the virtual format as primary outcomes and their self-assessed preparedness in serious illness communication as the secondary outcome. Each question employed a 5-point Likert scale. Results: All learners (n = 48, male 79%) participated in the survey. The mean score of the learners’ satisfaction was 4.69 or higher in all questions. The mean score of the virtual format’s satisfaction was 4.33 or higher in all questions. The mean score of self-reported preparedness on the 11 questions were between 2.30 and 3.34 before the workshop, all of which significantly increased to 3.08 through 3.96 after the workshop (p < 0.01 in all questions). Conclusion: Learners in Japan perceived the virtual format of our VitalTalk workshop as satisfactory, and their self-reported preparedness improved significantly after the workshop. VitalTalk faculty members in the US were able to provide virtual communication training to physicians in Japan.

Abstract TP418: Impact of Substance Use Disorder on Stroke Outcomes

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Thomas Lawler ◽  
Jessica Lee
Keyword(s):  
Substance Use ◽  
Ischemic Stroke ◽  
Infective Endocarditis ◽  
Control Group ◽  
Stroke Patients ◽  
Drug Induced ◽  
Health Crisis ◽  
Stroke Outcomes ◽  
The Us ◽  
Illicit Substances

Background: Substance abuse is a major health crisis in the US, with an estimated 20 million people suffering from substance use disorders (SUD). In addition to rising rates of SUD, Kentucky is located in the northern region of the stroke belt and has one of the highest rates of stroke hospitalizations in the US. Substance use may cause stroke by various mechanisms, including vasoconstriction, endothelial dysfunction, drug-induced vasculopathies, advanced rates of atherosclerosis, and infective endocarditis. We sought to examine the relationship between SUD and stroke outcomes. Methods: This is a single center, retrospective chart review of adults age >18 years with a diagnosis of ischemic or hemorrhagic stroke, and SUD based on either urine drug testing or medical record history, admitted between 12/6/2015 and 5/10/2019. We collected length of stay (LOS), admission/discharge NIHSS, discharge modified Rankin Scores, ICH scores, and discharge status and compared them to controls of ischemic stroke without SUD. Results: A total of 197 cases were identified [M=147 (74.6%)]. The most common illicit substances identified by testing were stimulants (42.6%, n=84), opioids (32.5%, n=64), and benzodiazepines (28.4%, n=56). Nearly all subjects had multiple substances present on screening. 13.8% (n=27) and 5.6% (n=11) received thrombolysis with either IV alteplase or mechanical thrombectomy, respectively. Compared to a control group of 176 ischemic stroke patients that did not test positive for illicit substances, cases (n= 139, ischemic stroke + SUD) were younger (mean=54.94+/-12.01 vs 66.15 +/- 14.38 yrs , p=0.0137), had a longer LOS (n=139, mean=8.44+/-10.84 vs 5.06 +/- 5.74, p=0.0006), higher admission NIHSS (mean=9.87+/-9.08, p=0.00012), and higher discharge NIHSS (mean=6.51+/-7.13 vs 4.19 +/- 5.73 , p=0.000512). Conclusion: Patients with SUD and stroke had longer LOS and worse discharge NIHSS compared to ischemic stroke patients without SUD. This could be due to the different mechanisms that cause strokes in substance users or could be a reflection of the effects of specific substances present at the time of admission. Future directions will include evaluating a hemorrhagic control population and examining a subpopulation of infective endocarditis.

Risk factors for 30-day readmissions in patients with tumor lysis syndrome and solid malignancies: Analysis from the National Readmission Database.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18863-e18863
Author(s):  
Estefania Gauto ◽  
Miguel Salazar ◽  
Shristi Upadhyay ◽  
Binav Baral ◽  
Maryam Zia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Readmission Rate ◽  
Tumor Lysis Syndrome ◽  
Index Admission ◽  
Tumor Lysis ◽  
Solid Malignancy ◽  
Solid Malignancies ◽  
Health Care Burden ◽  
National Readmission Database

e18863 Background: Tumor lysis syndrome (TLS) is a well-known potentially fatal complication of chemotherapy and an oncologic emergency. It is most prevalent in hematologic malignancies, but there are case reports and clinical series of occurrence after the treatment of solid tumors. Hospital readmissions are indicators of quality of care and cost control. We aim to look at the prevalence of readmissions after an initial episode of TLS in patients with solid malignancies and their financial burden on the United States healthcare system. Methods: We conducted a retrospective analysis of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an initial “index” admission of TLS (ICD10 code E88.3) with a concomitant diagnosis of solid malignancy. We aimed to identify the 30-day readmission rate, mortality, healthcare-related utilization resources, and independent predictors of readmission by performing a COX regression analysis. Results: A total of 874 patients with solid tumors were admitted with TLS in 2017. The 30-day readmission rate was 20.4%. The main causes for readmission were sepsis, recurrent malignant lesions, metastasis to CNS, bleeding, acute kidney failure (AKI). Compared to initial admissions, readmitted patients were less likely to have acute kidney failure (AKI) (64.6% vs 30.8%; P < 0.01), less likely to require mechanical ventilation (17.9% vs 5.7%; P < 0.01), less likely to suffer shock (7.3% vs 2.3%; P = 0.03) and ileus (4.8% vs 0.7%; P = 0.04). Readmission was associated with higher in-hospital mortality rate (0.1% vs. 1.5%; P < 0.01), more likely to have private insurance (29.9% vs 36.1%; P < 0.01), and more likely to be discharged home (26.2% vs 36.8%; P < 0.01). The total health care in-hospital economic burden of readmission was $14.9 million in total charges to patients and $4 million in total costs for hospitals. Independent predictors of readmission were prolonged length of stay (during index admission), tobacco abuse, VTE, thrombocytopenia, and admission to an urban hospital. We identified the following preventive factors for readmission: radiation therapy, admission to a smaller hospital, total parenteral nutrition during the index admission and a primary gynecologic malignancy. Conclusions: Readmissions after TLS in patients with solid malignancy are associated with a higher in-hospital mortality rate and pose an increased health care burden. We identified risk factors that, if targeted, could lead to reducing readmissions, health care burden, and patient morbidity.

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