Abstract 11056: Hospitals Accepting Greater Proportions of High Risk Transfer-In STEMI Patients Do Not Have Higher Risk-Adjusted Hospital Mortality: A Report From the AHA Mission: Lifeline Program

Background: Mortality is an important quality measure for acute MI hospital care. There is concern that, despite risk adjustment, PCI receiving hospitals receiving a disproportionate volume of high risk STEMI transfers may have their reported mortality adversely affected. Methods: All STEMI patients from April 2011 to December 2013 in the ACTION Registry®-GWTG™ were included. High risk was defined as pts with either cardiogenic shock or cardiac arrest on admission. Hospitals were divided into tertiles based on the proportion of high risk STEMI patients who were transferred relative to the total number of STEMI patients treated. Adjusting for covariates in the ACTION mortality risk model, the differences in risk-adjusted in-hospital mortality in each tertile were determined before and after excluding high risk STEMI transfer pts. Results: Among 119,680 STEMI pts treated at 539 primary PCI hospitals, 37,028 (31%) pts were transfers, of whom 4,500 (4%) were high risk. The proportion of high risk STEMI transfers ranged from 0-12% across hospitals. Times from initial hospital presentation to PCI were similar across tertiles: Low 107 min; Middle, 100 min; High 106 min. The ACTION mortality risk model, which includes cardiogenic shock but not cardiac arrest, slightly underestimated mortality for high-risk STEMI transfer pts (observed in-hospital mortality rate: 26%, predicted mortality rate: 24%). While differences in observed hospital mortality were present among hospitals with a greater proportion of high-risk transfers, risk-adjusted mortality was unaffected by the inclusion or exclusion of high-risk transfer patients across all tertiles (TABLE). Conclusions: Receiving PCI hospitals accepting greater proportions of high risk STEMI transfer pts did not have a higher risk-adjusted in-hospital mortality when a clinical mortality risk model was used for risk adjustment.

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Clinical impact of implementing a rapid-response team based on the Modified Early Warning Score in wards that offer emergency department support

PLoS ONE ◽

10.1371/journal.pone.0259577 ◽

2021 ◽

Vol 16 (11) ◽

pp. e0259577

Author(s):

Lorena Micheline Alves Silva ◽

Diego Marques Moroço ◽

José Paulo Pintya ◽

Carlos Henrique Miranda

Keyword(s):

Emergency Department ◽

High Risk ◽

Mortality Rate ◽

Hospital Mortality ◽

Early Warning ◽

Rapid Response Team ◽

Rapid Response ◽

Early Warning Score ◽

Before And After ◽

Response Team

Background Emergency department (ED) crowding is a frequent situation. To decrease this overload, patients without a life-threating condition are transferred to wards that offer ED support. This study aimed to evaluate if implementing a rapid response team (RRT) triggered by the modified early warning score (MEWS) in high-risk wards offering ED support is associated with decreased in-hospital mortality rate. Methods A before-and-after cross-sectional study compared in-hospital mortality rates before and after implementation of an RRT triggered by the MEWS ≥4 in two wards of a tertiary hospital that offer ED support. Results We included 6863 patients hospitalized in these wards before RRT implementation from July 2015 through June 2017 and 6944 patients hospitalized in these same wards after RRT implementation from July 2018 through June 2020. We observed a statistically significant decrease in the in-hospital mortality rate after intervention, 449 deaths/6944 hospitalizations [6.47% (95% confidence interval (CI) 5.91%– 7.07%)] compared to 534 deaths/6863 hospitalizations [7.78% (95% CI 7.17–8.44)] before intervention; with an absolute risk reduction of -1.31% (95% CI -2.20 –-0.50). Conclusion RRT trigged by the MEWS≥4 in high-risk wards that offer ED support was found to be associated with a decreased in-hospital mortality rate. A further cluster-randomized trial should evaluate the impact of this intervention in this setting.

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The in-hospital outcomes of the use of microaxial left ventricular assist device vs intra-aortic ballon pump in acute myocardial infarction complicated by cardiogenic shock

European Heart Journal ◽

10.1093/ehjci/ehaa946.1850 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Jin ◽

Y Yang ◽

B Liu

Keyword(s):

Cardiac Arrest ◽

Blood Transfusion ◽

Length Of Stay ◽

Propensity Score ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Left Ventricular ◽

Bleeding Complications ◽

Categorical Variables ◽

Cardiac Complications

Abstract Purpose To compare the outcomes of patients with AMI underwent percutaneous coronary intervention (PCI) complicated by cardiogenic shock treated with IABP vs MLVAD. Methods The Nationwide Inpatient Sample (NIS) database is the largest inpatient registry in the U.S. We used NIS year 2009–2014 to identify adult patients admitted for AMI, who received PCI and complicated by cardiogenic shock. Based on the use of IABP or MLVAD, the study population was divided into 2 groups. To reduce selection bias, we performed propensity score matching using Kernell method. Patient characteristics, hospital characteristics, and comorbidities were matched. Logistic regression was used for categorical variables including in-hospital mortality, requirement of blood transfusion, sepsis, cardiac arrest and cardiac complications (including iatrogenic complications, hemopericardium, and cardiac tamponade). Poisson regression was used for continuous variables including length of stay and total cost. Results A total of 49837 patients were identified. With propensity score match, 34132 patients in IABP group were matched to 1430 patients in MLVAD group. Compared with MLVAD group, the IABP group had lower in-hospital mortality rates (28.29% vs 40.36%, OR 0.58 (0.42–0.81), p=0.002), lower rate of blood transfusion (9.63% vs 11.50%, OR 0.49 (0.27–0.88), p=0.017), and lower cost (47167 vs 70429 USD, p<0.001). IABP and MLVAD group had similar length of stay (8.9 versus 9.3 days, p=0.882), rates of cardiac complication (6.50% vs 7.24%, OR 0.56 (0.26–1.19), p=0.134), rates of sepsis (9.30% vs 14.98%, OR 0.66 (0.38–1.14), p=0.133), and rates of cardiac arrest (37.84% vs 41.05%, OR 0.70 (0.45–1.10), p=0.123). Conclusion In patients with AMI underwent PCI and complicated by cardiogenic shock, MLAVD compared with IABP was associated with higher risk of in-hospital mortality, requirement of blood transfusion indicating presence of major bleeding complications, and cost, although study interpretation is limited by retrospective observational design. Further research is warranted to elucidate the optimal MCSD in these patients. Funding Acknowledgement Type of funding source: None

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Abstract 11372: A Risk-Adjustment Model for Patients Presenting to Hospitals with Out-of-Hospital Cardiac Arrest and ST-Elevation Myocardial Infarction

Circulation ◽

10.1161/circ.144.suppl_2.11372 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Andy T Tran ◽

Anthony Hart ◽

John Spertus ◽

Philip Jones ◽

Bryan McNally ◽

...

Keyword(s):

Cardiac Arrest ◽

Hospital Mortality ◽

Risk Adjustment ◽

Quality Measures ◽

Coronary Intervention ◽

Spontaneous Circulation ◽

Logistic Regression Models ◽

Adjustment Model ◽

Risk Adjustment Model ◽

Hospital Cardiac Arrest

Background: Given the diversity of patients resuscitated from out-of-hospital cardiac arrest (OHCA) complicated by STEMI, adequate risk adjustment is needed to account for potential differences in case-mix to reflect the quality of percutaneous coronary intervention. Objectives: We sought to build a risk-adjustment model of in-hospital mortality outcomes for patients with OHCA and STEMI requiring emergent angiography. Methods: Within the Cardiac Arrest Registry to Enhance Survival, we included adult patients with OHCA and STEMI who underwent angiography within 2 hours from January 2013 to December 2019. Using pre-hospital patient and arrest characteristics, multivariable logistic regression models were developed for in-hospital mortality. We then described model calibration, discrimination, and variability in patients’ unadjusted and adjusted mortality rates. Results: Of 2,999 hospitalized patients with OHCA and STEMI who underwent emergent angiography (mean age 61.2 ±12.0, 23.1% female, 64.6% white), 996 (33.2%) died. The final risk-adjustment model for mortality included higher age, unwitnessed arrest, non-shockable rhythms, not having sustained return of spontaneous circulation upon hospital arrival, and higher total resuscitation time on scene ( C -statistic, 0.804 with excellent calibration). The risk-adjusted proportion of patients died varied substantially and ranged from 7.8% at the 10 th percentile to 74.5% at the 90 th percentile (Figure). Conclusions: Through leveraging data from a large, multi-site registry of OHCA patients, we identified several key factors for better risk-adjustment for mortality-based quality measures. We found that STEMI patients with OHCA have highly variable mortality risk and should not be considered as a single category in public reporting. These findings can lay the foundation to build quality measures to further optimize care for the patient with OHCA and STEMI.

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Musical Performance Anxiety and the High-risk Model of Threat Perception

Medical Problems of Performing Artists ◽

10.21091/mppa.2000.2013 ◽

2000 ◽

Vol 15 (2) ◽

pp. 65-71

Author(s):

Marcie Zinn ◽

Claudia McCain ◽

Mark Zinn

Keyword(s):

High Risk ◽

Negative Affect ◽

Social Desirability ◽

Pain Perception ◽

Risk Model ◽

Performance Anxiety ◽

Threat Perception ◽

Stage Fright ◽

Significant Difference ◽

Before And After

Fourteen music majors were tested using the high-risk model of threat perception (HRMTP), a biopsychosocial model designed to diagnose and guide treatment of stress-related somatic disorders. Regression analysis revealed that negative affect, social desirability, peripheral vasoconstriction, and “catastrophizing” predicted state anxiety scores after jury performance (p ≤ 0.041). A significant difference in hand temperature before and after jury performance was also found (p ≤ 0.01). Social desirability scores were inversely correlated with negative affect and catastrophizing scores (p ≤ 0.01). These results are consistent with predictions from the HRMTP, which predicts that people high in either overt or covert negative affect and catastrophizing are at greater risk for psychophysiological disorders than normals. The model also predicts that people who are high in social desirability (repressors) are likewise at risk because of inhibited pain perception. Since performance anxiety has been discussed by several authors as a psychophysiological event, implicating the role of the autonomic nervous system in the initiation and maintenance of stage fright, this model may provide a new pathway into the understanding of stage fright.

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Italian hospital mortality risk model vs additive and logistic EuroSCORE in coronary operations

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2008.10.031 ◽

2009 ◽

Vol 35 (2) ◽

pp. 379-380 ◽

Cited By ~ 1

Author(s):

Marco Ranucci

Keyword(s):

Hospital Mortality ◽

Mortality Risk ◽

Risk Model ◽

Logistic Euroscore ◽

Italian Hospital

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Using Machine Learning for Early Prediction of Cardiogenic Shock in Patients with Acute Heart Failure

10.21203/rs.3.rs-453102/v1 ◽

2021 ◽

Author(s):

Faisal Rahman ◽

Noam Finkelstein ◽

Anton Alyakin ◽

Nisha Gilotra ◽

Jeff Trost ◽

...

Keyword(s):

Heart Failure ◽

High Risk ◽

Cardiogenic Shock ◽

Risk Model ◽

Acute Decompensated Heart Failure ◽

Clinical Care ◽

Delayed Diagnosis ◽

Low Risk ◽

Cohort Identification ◽

High Risk Cohort

Abstract Objective: Despite technological and treatment advancements over the past two decades, cardiogenic shock (CS) mortality has remained between 40-60%. A number of factors can lead to delayed diagnosis of CS, including gradual onset and nonspecific symptoms. Our objective was to develop an algorithm that can continuously monitor heart failure patients, and partition them into cohorts of high- and low-risk for CS.Methods: We retrospectively studied 24,461 patients hospitalized with acute decompensated heart failure, 265 of whom developed CS, in the Johns Hopkins Healthcare system. Our cohort identification approach is based on logistic regression, and makes use of vital signs, lab values, and medication administrations recorded during the normal course of care. Results: Our algorithm identified patients at high-risk of CS. Patients in the high-risk cohort had 10.2 times (95% confidence interval 6.1-17.2) higher prevalence of CS than those in the low-risk cohort. Patients who experienced cardiogenic shock while in the high-risk cohort were first deemed high-risk a median of 1.7 days (interquartile range 0.8 to 4.6) before cardiogenic shock diagnosis was made by their clinical team. Conclusions: This risk model was able to predict patients at higher risk of CS in a time frame that allowed a change in clinical care. Future studies need to evaluate if CS analysis of high-risk cohort identification may affect outcomes.

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Abstract 16915: Mortality And Safety Outcomes of Various Catheter-based Treatment Modalities in Patients With High-risk Pulmonary Embolism: A Meta-analysis

Circulation ◽

10.1161/circ.132.suppl_3.16915 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Navkaranbir S Bajaj ◽

Rajat Kalra ◽

Sameer Ather ◽

Jason Guichard ◽

William J Lancaster ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Mortality Rate ◽

Hospital Mortality ◽

Heart Association ◽

Treatment Modalities ◽

Significant Heterogeneity ◽

Access Site ◽

Aspiration Thrombectomy ◽

Safety Outcomes

Background: Catheter-based treatments (CBTs) are diverse set of techniques aimed at relieving pulmonary arterial obstruction in patients with high-risk pulmonary embolism. Multiple modalities are currently available. The mortality and safety outcomes have not been studied among these different modalities. Hypothesis: We conducted this investigation to determine the mortality and safety of individual modalities. Methods: We searched SCOPUS since inception to November 2014 using predefined criteria. Studies including massive PE or a combination of massive and submassive PE, as defined by the American Heart Association, were included. In-hospital mortality rates and pooled safety complication rate (defined as a composite of peri- and post-procedural cardiac arrest, minor access site bleeding, major access site bleeding, and bleeding at other sites) were estimated using standard meta-analytic methods and compared among six different groups namely aspiration thrombectomy, intrapulmonary thrombolysis (IP), mechanical fragmentation (MF), rheolytic thrombectomy (RT), ultrasound-accelerated thrombolysis (USAT) and multiple simultaneous modalities. Results: In 54 eligible studies with 1,333 patients, 1,357 CBT procedures were performed. Patients undergoing USAT had the lowest in-hospital mortality rate whereas patients undergoing RT had the highest in-hospital mortality rate (p = 0.011, Table). Intrapulmonary thrombolysis had the highest pooled rate of safety outcome whereas MF had the lowest rate among various techniques (p = 0.034, Table). Conclusion: There is significant heterogeneity in mortality and safety outcomes between various CBT modalities. Our analysis is limited by variance in study quality and baseline characteristics. More investigation is required to determine the optimal type of CBT for high-risk PE.

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