scholarly journals Outcomes and resource utilization of atrial fibrillation hospitalizations with type 2 myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R.W Ariss ◽  
A.M Minhas ◽  
S Nazir ◽  
C Meenakshisundaram ◽  
M.M Ali ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Resource Utilization ◽  
Neurological Disorders ◽  
Hospital Costs ◽  
Nursing Facility ◽  
Icd 10

Abstract Background Patients with atrial fibrillation (AF) are often elderly and have higher rates of comorbidities which may predispose them to an increased risk of myocardial oxygen demand-supply mismatch. Scarce data exist on the prognostic impact of type 2 myocardial infarction (MI) in AF. Purpose To examine the association of type 2 MI with outcomes and resource utilization in primary AF hospitalizations. Methods We utilized the Nationwide Readmission Database 2018 to identify primary AF hospitalizations with and without type 2 MI. The International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes I48.0, I48.1, I48.2, I48.91 were utilized to identify primary AF hospitalizations within the United States. Of these, AF hospitalizations complicated by type 2 MI were identified using ICD-10 code I21.A1. Comorbidities and outcomes were identified using the corresponding ICD-10 codes. Complex samples multivariable logistic and linear regression models were used to determine the association between type 2 MI and outcomes (in-hospital mortality, index length of stay [LOS], hospital costs, discharge to nursing facility, and 30-day all-cause readmissions). Predictors of in-hospital mortality in AF with type 2 MI were also determined. Results Of 382,896 primary AF hospitalizations included in this study, 7,375 (1.9%) had type 2 MI. Compared to AF hospitalization without type 2 MI, those with type 2 MI are older (74.5 vs. 70.7-years-old) and have higher prevalence of chronic pulmonary disease, dyslipidemia, diabetes mellitus, hypertension, heart failure, peripheral vascular disease, chronic kidney disease, neurological disorders, deficiency anemia, coagulopathy, valvular disease, prior myocardial infarction, prior coronary artery bypass grafting, prior percutaneous coronary intervention, and prior cerebrovascular accident (P for all <0.001). AF with type 2 MI is associated with significantly higher in-hospital mortality (1.3% vs. 0.5%; P<0.001), LOS (4.1 vs. 3.3 days; P<0.001), hospital costs ($10,293.6 vs. $8,820.3; P<0.001), discharges to nursing facility (18.1% vs. 10.2%; P<0.001), and 30-day all-cause readmissions (18.5% vs. 13.5%; P=0.001) compared to AF hospitalizations without type 2 MI (Table 1). Heart failure, chronic kidney disease, neurological disorders, and age (per year) were identified as independent predictors of in-hospital mortality among AF patients with type 2 MI (Figure 1). Conclusion In this large nationwide analysis, type 2 MI in the setting of AF hospitalization is associated with higher in-hospital mortality and increased resource utilization compared to AF hospitalizations without type 2 MI. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Patient characteristics and clinical outcomes of type 2 myocardial infarction in patients with acute ischemic stroke in the united states

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
R W Ariss ◽  
S Nazir ◽  
A M Minhas ◽  
G V Moukarbel ◽  
H Jneid
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Kidney Disease ◽  
Neurological Disorders ◽  
Functional Outcomes ◽  
Hospital Costs ◽  
The United States ◽  
Nursing Facility

Abstract Background Type 2 myocardial infarction (MI) due to supply-demand mismatch may occur as a sequala of acute ischemic stroke (AIS). However, scarce data exits on the patient profiles and the prognostic impact of type 2 MI on outcomes of AIS. Purpose To determine the risk profiles and examine the association of type 2 MI with outcomes and resource utilization in primary AIS hospitalizations. Methods We utilized the Nationwide Readmission Database from October 1st, 2017 to December 31st, 2018 to identify primary AIS hospitalizations with and without type 2 MI in the United States. The International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes I63.x were utilized to identify patients with AIS. Complex samples multivariable logistic and linear regression models were used to determine the predictors of type 2 MI and the association with outcomes (in-hospital mortality, poor functional outcomes [defined as a composite of mortality or discharge to hospice or to a long-term facility], index length of stay, hospital costs, discharge to nursing facility, and 30-day all-cause readmissions). Results Of 587,550 AIS hospitalizations included in this study, 4,182 (0.71%) had type 2 MI. Compared to AIS hospitalization without type 2 MI, those with type 2 MI were older (73 years vs. 70 years; P<0.001), more likely to be females (52% vs. 49.7%; P<0.001), and had a higher prevalence of heart failure (32% vs. 15.5%; P<0.001), atrial fibrillation (38.5% vs. 24.2%; P<0.001), prior myocardial infarction (8.8% vs. 7.7%; P<0.001), valvular heart disease (17% vs. 9.8%; P<0.001), peripheral vascular disease (12.2% vs. 9.2%; P<0.001), chronic kidney disease (24.4% vs. 16.7%; P<0.001), neurological disorders (49.3% vs. 34.6%; P<0.001), drug abuse (4.9% vs. 4.1%; P=0.04), chronic liver disease (2.6% vs. 1.7%; P<0.001), chronic lung disease (18.1% vs. 15.8%; P<0.001), anemia (4.3% vs. 2.8%; P<0.001), and weight loss (9.7% vs. 4.4%; P<0.001). Compared with their counterparts without type 2 MI, AIS with type 2 MI had significantly higher in-hospital mortality, poor functional outcomes, hospital costs, rate of discharge to nursing facility, length of stay, and rate of 30-day all-cause readmissions (Table 1). Heart failure, weight loss, neurological disorders, drug abuse, valvular heart disease, atrial fibrillation, chronic kidney disease, and age (per year) were identified as independent predictors of type 2 MI among AIS hospitalizations (Figure 1). Conclusion Patients with AIS complicated by type 2 MI have a high prevalence of underlying cardiovascular disease. In addition, type 2 MI in patients hospitalized with AIS is associated with poor prognosis and higher resource utilization. FUNDunding Acknowledgement Type of funding sources: None.

P1954Prognostic value of the CHADS2 score for adverse cardiovascular events in acute myocardial infarction patients without atrial fibrillation: J-MINUET Substudy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Motozato ◽  
K Sakamoto ◽  
K Tsujita ◽  
K Nakao ◽  
Y Ozaki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiovascular Events ◽  
Chads2 Score ◽  
Intermediate Point ◽  
Significant Difference

Abstract Background The CHADS2score has mainly been used to predict the likelihood of cerebrovascular accidents in patients with atrial fibrillation. However, increasing attention is being paid to this scoring system for risk stratification of patients with coronary artery disease. We investigated the value of the CHADS2 score in predicting cardiovascular events in Japanese acute myocardial infarction (AMI) patients without atrial fibrillation. Methods To elucidate the prognostic value of CHADS2score in AMI patients, we analysed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3,283 AMI patients, who were hospitalized within 48-hours of onset from July 2012 to March 2014. We calculated the CHADS2 scores for 3,044 patients without clinical evidence of atrial fibrillation. The presence of heart failure was substituted by Killip classification>2 on admission. Clinical follow-up data was obtained for 3 years. In addition to the in-hospital mortality,we evaluated cardiovascular events, defined as all cause deathor non-fatal MI during 3-year follow up periods. Results In this study, enrolled patients were classified into low- (point 0–1), intermediate- (point 2–3), and high-score (point 4–6) groups by calculating CHADS2 score. Overall patients with low, intermediate and high score were divided into 1,395, 1,393 and 256 patients, respectively. In-hospital mortality among low, intermediate, and high score groups were 2.8%, 7.4% and 14.8%, respectively (P<0.001). The incidence of cardiovascular eventsamong low, intermediate, and high score groups were 7.8%, 16.3%, 29.3%, respectively (P<0.001). Kaplan-Meier analysis showed a significant difference between the groups (Figure). The event rates were significantly higher in both high score and intermediate score group than in low score group (P<0.001). Multivariate Cox hazard analysis identified CHADS2 score (per 1 point) as an independent predictor of cardiovascular events in addition to chronic kidney disease and lower body mass index. (hazard ratio, 1.344; 95% CI, 1.239–1.459; P<0.001). Among the factors constituting CHADS2 score, heart failure and age were identified as independent predictors for in-hospital mortality. With respect to the cardiovascular event during 3 years, heart failure, age, and previous stroke were revealed as significant independent predictors. Conclusion This large cohort study indicated that the CHADS2 score is useful for the prediction of in-hospital mortality and the cardiovascular events during 3-year follow up in Japanese AMI patients without atrial fibrillation.

Outcomes and Resource Utilization of Atrial Fibrillation Hospitalizations With Type 2 Myocardial Infarction

2021 ◽  
Author(s):  
Robert W. Ariss ◽  
Abdul Mannan Khan Minhas ◽  
Salik Nazir ◽  
Chandramohan Meenakshisundaram ◽  
Muhammad Mobeen Ali ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Resource Utilization

1975-P: Effects of Bariatric Surgery on the Incidence of Heart Failure and Atrial Fibrillation in Patients with Type 2 Diabetes and Obesity: A Nationwide, Matched, Observational Cohort Study

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1975-P
Author(s):  
GUDRUN HÖSKULDSDOTTIR ◽  
NAVEED SATTAR ◽  
MERVETE MIFTARAJ ◽  
INGMAR NASLUND ◽  
JOHAN R. OTTOSSON ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Cohort Study ◽  
Observational Cohort Study ◽  
Observational Cohort ◽  
Diabetes And Obesity

scholarly journals Catheter ablation can improve survival with the reduction of heart failure in frail patients with atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Joung ◽  
P.S Yang ◽  
J.H Sung ◽  
E Jang ◽  
H.T Yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Catheter Ablation ◽  
Real World ◽  
Background Characteristics ◽  
Risk Of Death ◽  
Frail Patients ◽  
Korean National Health Insurance

Abstract Background It is unclear whether catheter ablation is beneficial in frail patients with AF. Purpose This study aimed to evaluate whether catheter ablation reduces death and other outcomes in real-world frail patients with atrial fibrillation (AF). Methods Out of 801,710 patients with AF in the Korean National Health Insurance Service database from 2006 to 2015, 1,411 frail patients underwent AF ablations. The Hospital Frailty Risk Score were calculated retrospectively. Inverse probability of treatment weighting (IPTW) was used to categorize ablation and non-ablation frail groups. Results After IPTW, the two cohorts had similar background characteristics. During a median follow-up of 4.7 years (interquartile range: 2.2–7.8), the risk of death in frail patients with ablations was reduced by 65% compared to frail patients without ablations (2.0 and 6.4 per 100 person-years, respectively; hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.25–0.50; P&lt;0.001). Ablations were related with a lower incidence and risk of heart failure admission (1.8 and 3.1 per 100 person-years, respectively; HR 0.66, 95% CI 0.44–0.98; P=0.042) and acute myocardial infarction (0.2 and 0.6 per 100 person-years, respectively; HR 0.30, 95% CI 0.15–0.62; P=0.001). However, the risk of stroke did not change after ablation. Conclussion Ablation may be associated with lower incidences of death, heart failure, and acute myocardial infarction in real-world frail patients with AF, supporting the role of AF ablation in these patients. The effect of frailty risk on the outcome of ablation should be evaluated in further studies. Funding Acknowledgement Type of funding source: None

scholarly journals JDP2, a Novel Molecular Key in Heart Failure and Atrial Fibrillation?

2021 ◽  
Vol 22 (8) ◽  
pp. 4110
Author(s):  
Gerhild Euler ◽  
Jens Kockskämper ◽  
Rainer Schulz ◽  
Mariana S. Parahuleva
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Cardiac Dysfunction ◽  
Therapeutic Target ◽  
Close Correlation ◽  
Disease Development ◽  
Major Life ◽  
Life Threatening ◽  
Current Therapies

Heart failure (HF) and atrial fibrillation (AF) are two major life-threatening diseases worldwide. Causes and mechanisms are incompletely understood, yet current therapies are unable to stop disease progression. In this review, we focus on the contribution of the transcriptional modulator, Jun dimerization protein 2 (JDP2), and on HF and AF development. In recent years, JDP2 has been identified as a potential prognostic marker for HF development after myocardial infarction. This close correlation to the disease development suggests that JDP2 may be involved in initiation and progression of HF as well as in cardiac dysfunction. Although no studies have been done in humans yet, studies on genetically modified mice impressively show involvement of JDP2 in HF and AF, making it an interesting therapeutic target.

scholarly journals Trends in mortality, co-morbidity and treatment after acute myocardial infarction in patients with rheumatoid arthritis 1998–2013

2020 ◽  
Vol 9 (8) ◽  
pp. 931-938 ◽  
Author(s):  
Mattias Skielta ◽  
Lars Söderström ◽  
Solbritt Rantapää-Dahlqvist ◽  
Solveig W Jonsson ◽  
Thomas Mooe
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Congestive Heart Failure ◽  
Cox Regression Analysis ◽  
Co Morbidity ◽  
One Year ◽  
Over Time

Aims: Rheumatoid arthritis may influence the outcome after an acute myocardial infarction. We aimed to compare trends in one-year mortality, co-morbidities and treatments after a first acute myocardial infarction in patients with rheumatoid arthritis versus non-rheumatoid arthritis patients during 1998–2013. Furthermore, we wanted to identify characteristics associated with mortality. Methods and results: Data for 245,377 patients with a first acute myocardial infarction were drawn from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions for 1998–2013. In total, 4268 patients were diagnosed with rheumatoid arthritis. Kaplan-Meier analysis was used to study mortality trends over time and multivariable Cox regression analysis was used to identify variables associated with mortality. The one-year mortality in rheumatoid arthritis patients was initially lower compared to non-rheumatoid arthritis patients (14.7% versus 19.7%) but thereafter increased above that in non-rheumatoid arthritis patients (17.1% versus 13.5%). In rheumatoid arthritis patients the mean age at admission and the prevalence of atrial fibrillation increased over time. Congestive heart failure decreased more in non-rheumatoid arthritis than in rheumatoid arthritis patients. Congestive heart failure, atrial fibrillation, kidney failure, rheumatoid arthritis, prior diabetes mellitus and hypertension were associated with significantly higher one-year mortality during the study period 1998–2013. Conclusions: The decrease in one-year mortality after acute myocardial infarction in non-rheumatoid arthritis patients was not applicable to rheumatoid arthritis patients. This could partly be explained by an increased age at acute myocardial infarction onset and unfavourable trends with increased atrial fibrillation and congestive heart failure in rheumatoid arthritis. Rheumatoid arthritis per se was associated with a significantly worse prognosis.

Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.L Xu ◽  
J Luo ◽  
H.Q Li ◽  
Z.Q Li ◽  
B.X Liu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Natural Science ◽  
Funding Source ◽  
Onset Atrial Fibrillation ◽  
New Onset

Abstract Background New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF following AMI and HF hospitalization. Methods This retrospective cohort study was conducted between February 2014 and March 2018, using data from the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry, where all participants did not have a documented AF history. Patients with AMI who discharged alive and had complete echocardiography and follow-up data were analyzed. The primary outcome was HF hospitalization, which was defined as a minimum of an overnight hospital stay of a participant who presented with symptoms and signs of HF or received intravenous diuretics. Results A total of 2075 patients were included, of whom 228 developed NOAF during the index AMI hospitalization. During up to 5 years of follow-up (median: 2.7 years), 205 patients (9.9%) experienced HF hospitalization and 220 patients (10.6%) died. The incidence rate of HF hospitalization among patients with NOAF was 18.4% per year compared with 2.8% per year for those with sinus rhythm. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 2.30–4.28; p&lt;0.001). Consistent result was observed after accounting for the competing risk of all-cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30; p&lt;0.001) or performing a propensity score adjusted multivariable model (HR: 3.28, 95% CI: 2.39–4.50; p&lt;0.001). Furthermore, the risk of HF hospitalization was significantly higher in patients with persistent NOAF (HR: 5.81; 95% CI: 3.59–9.41) compared with that in those with transient NOAF (HR: 2.61; 95% CI: 1.84–3.70; p interaction = 0.008). Conclusion NOAF complicating AMI is strongly associated with an increased long-term risk of heart. Cumulative incidence of outcome Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. National Natural Science Foundation of China, 2. Natural Science Foundation of Shanghai

Patient Characteristics and Outcomes of Type 2 Myocardial Infarction During Heart Failure Hospitalizations in the United States

2021 ◽  
Author(s):  
Salik Nazir ◽  
Abdul Mannan Khan Minhas ◽  
Ishan S. Kamat ◽  
Robert W. Ariss ◽  
George V. Moukarbel ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Patient Characteristics ◽  
The United States

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

2021 ◽  
pp. 088506662110614
Author(s):  
Mohinder R. Vindhyal ◽  
Liuqiang (Kelsey) Lu ◽  
Sagar Ranka ◽  
Prakash Acharya ◽  
Zubair Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Congestive Heart Failure ◽  
Hospital Mortality ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Cross Sectional ◽  
Increased Risk ◽  
Icd 10 ◽  
Nationwide Readmission Database

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

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