scholarly journals Distressed Communities Index in Patients Undergoing Transcatheter Aortic Valve Implantation in an Affluent County in New York

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Thomas Bilfinger ◽  
Allison Nemesure ◽  
Robert Pyo ◽  
Jonathan Weinstein ◽  
Giridhar Korlipara ◽  
...  
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Medical Center ◽  
Well Being ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Significant Difference ◽  
Zip Code

Background. The clinical impact of the distressed communities index (DCI), a composite measure of economic well-being based on the U.S. zip code, is becoming increasingly recognized. Ranging from 0 (prosperous) to 100 (distressed), DCI’s association with cardiovascular outcomes remains unknown. We aimed to study the association of the DCI with presentation and outcomes in adults with severe symptomatic aortic stenosis (AS) undergoing transcatheter aortic valve intervention (TAVR) in an affluent county in New York. Methods. The study population included 286 patients with severe symptomatic AS or degeneration of a bioprosthetic valve who underwent TAVR with a newer generation transcatheter heart valve (THV) from December 2015 to June 2018 at an academic tertiary medical center. DCI for each patient was derived from their primary residence zip code. Patients were classified into DCI deciles and then categorized into 4 groups. The primary and secondary outcomes of interest were 30-day, 1-year, and 3-year mortality, respectively. Results. Among 286 patients studied, 26%, 28%, 28%, and 18% were categorized into DCI groups 1–4, respectively (DCI <10: n = 73; DCI 10–20: n = 81; DCI 20–30: n = 80; DCI >30: n = 52). Patients in group 4 were younger with worse kidney function compared to patients in groups 1 and 2. They also had smaller aortic annuli and were more likely to receive a smaller THV. No significant difference in hospital length of stay or distribution of in-hospital, 30-day, 1-year, and 3-year mortality was demonstrated. Conclusions. While the DCI was associated with differences in the clinical and anatomic profile, it was not associated with differences in clinical outcomes in this prospective observational study of adults undergoing TAVR suggesting that access to care is the likely discriminator.

scholarly journals Association of body mass index with morbidity in patients hospitalised with COVID-19

2021 ◽  
Vol 8 (1) ◽  
pp. e000970
Author(s):  
Maria Plataki ◽  
Di Pan ◽  
Parag Goyal ◽  
Katherine Hoffman ◽  
Jacky Man Kwan Choi ◽  
...  
Keyword(s):  
Body Mass Index ◽  
New York ◽  
Body Mass ◽  
Regression Models ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Linear Regression Models ◽  
Discharge Disposition ◽  
Home Discharge ◽  
Significant Difference

PurposeTo evaluate the association between body mass index (BMI) and clinical outcomes other than death in patients hospitalised and intubated with COVID-19.MethodsThis is a single-centre cohort study of adults with COVID-19 admitted to New York Presbyterian Hospital-Weill Cornell Medicine from 3 March 2020 through 15 May 2020. Baseline and outcome variables, as well as lab and ventilatory parameters, were generated for the admitted and intubated cohorts after stratifying by BMI category. Linear regression models were used for continuous, and logistic regression models were used for categorical outcomes.ResultsThe study included 1337 admitted patients with a subset of 407 intubated patients. Among admitted patients, hospital length of stay (LOS) and home discharge was not significantly different across BMI categories independent of demographic characteristics and comorbidities. In the intubated cohort, there was no difference in in-hospital events and treatments, including renal replacement therapy, neuromuscular blockade and prone positioning. Ventilatory ratio was higher with increasing BMI on days 1, 3 and 7. There was no significant difference in ventilator free days (VFD) at 28 or 60 days, need for tracheostomy, hospital LOS, and discharge disposition based on BMI in the intubated cohort after adjustment.ConclusionsIn our COVID-19 population, there was no association between obesity and morbidity outcomes, such as hospital LOS, home discharge or VFD. Further research is needed to clarify the mechanisms underlying the reported effects of BMI on outcomes, which may be population dependent.

Abstract 179: Short Length of Stay After Elective Transfemoral Transcatheter Aortic Valve Replacement is Not Associated With Increased Early or Late Readmission Risk

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Maneesh Sud ◽  
Feng Qui ◽  
Peter C Austin ◽  
Dennis T Ko ◽  
David Wood ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Hospital Length ◽  
Short Length ◽  
Hospital Length Of Stay ◽  
Transcatheter Aortic Valve ◽  
Readmission Risk

Background: Elderly patients undergoing transcatheter aortic valve replacement (TAVR) are at risk of hospital readmission post-procedure. It is not known if the index hospital length of stay, and specifically early discharge after TAVR is associated with an increased risk of readmission. We hypothesized a non-linear relationship whereby both short and long lengths of stay were associated with increased readmission risk. Methods: We performed a retrospective multi-center cohort analysis of patients undergoing elective transfemoral TAVR and surviving to discharge between Jan 2007 and March 2014. The exposure variable was hospital length of stay measured from the procedure date to the date of discharge and modeled as a continuous variable in a multivariable cause-specific Cox regression. Main outcome measures were 30-day and 1-year all-cause readmissions. Results: The study population consisted of 709 patients with a median length of stay of 6 days (interquartile range: 4-8 days). At 30-days and 1-year, 13.5% (n=96) and 44.0% (n=312) of patients were readmitted, respectively. Although length of stay was not associated with 30-day all-cause readmissions (p=0.92), there existed a significant association with 1-year readmission (p=0.01) after adjustment for baseline clinical variables. The association between length of stay and 1-year readmission was linear (p=0.55 for non-linearity) with no evidence supporting an increased readmission risk for shorter length of stays. Conclusions: Among elderly survivors of elective transfemoral TAVR, a short length of stay was not associated with an increased readmission risk within 30 days or 1 year. The 1-year readmission risk increased with longer length of stay.

scholarly journals Utilization, Costs, and Outcomes of Conscious Sedation Versus General Anesthesia for Transcatheter Aortic Valve Replacement

2021 ◽  
Author(s):  
Howard C. Herrmann ◽  
David J. Cohen ◽  
Rebecca T. Hahn ◽  
Vasilis C. Babaliaros ◽  
Xiao Yu ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Conscious Sedation ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Intermediate Risk ◽  
Transcatheter Aortic Valve ◽  
Risk Patients

Background: The potential advantages for conscious sedation (CS) as compared to general anesthesia (GA) have not been evaluated in studies with core laboratory echocardiographic assessments and monitored end points. We compared CS versus GA for SAPIEN 3 transcatheter aortic valve replacement in patients at intermediate- and low-surgical risk. Methods: This analysis included patients in the PARTNER 2 (Placement of Aortic Transcatheter Valve Trial) intermediate-risk registry and the PARTNER 3 randomized low-risk study. CS was compared to GA with respect to death, stroke, bleeding, paravalvular regurgitation, length of stay, and costs. Outcomes were assessed by a core echocardiographic laboratory, and clinical events were independently adjudicated. Results: Baseline characteristics were similar between the CS and GA groups. Postprocedure hospital length of stay was significantly shorter for CS versus GA both in intermediate-risk patients (4.4±0.2 and 5.2±0.2 days, respectively, P <0.01) and low-risk patients (2.7±0.1 and 3.4±0.2 days, respectively, P <0.001). There were no significant differences between CA and GA patients in either the 30-day or 1-year rates of death, stroke, rehospitalization, or paravalvular aortic regurgitation ≥moderate. In the intermediate-risk cohort, adjusted 30-day health care costs were $3833 lower per patient in the CS group. Conclusions: The selective use of CS is associated with shorter procedure times, shorter intensive care unit and hospital length of stay, lower costs, and no difference in clinical outcomes to 1 year, including ≥moderate paravalvular regurgitation. Our data demonstrate similar safety profiles with both approaches and support the continued use of CS for most patients undergoing the procedure. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT03222128 and NCT02675114.

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