Abstract 19212: Racial Differences in Clinical Outcomes and Resource Utilization Associated With Heart Failure Hospitalizations in the United States: A Nationwide Analysis From 2011-2012

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Nilay Kumar ◽  
Rohan Khera ◽  
Neetika Garg
Keyword(s):  
Heart Failure ◽  
Native Americans ◽  
Hospital Mortality ◽  
Racial Differences ◽  
Resource Utilization ◽  
The United States ◽  
Primary Diagnosis ◽  
Hospital Charges ◽  
Nationally Representative ◽  
Racial Ethnic

Background and objectives: Heart failure (HF) incidence is higher among Blacks compared to Whites. There is a paucity of recent data on racial differences in in-hospital mortality and resource utilization in a nationally representative, multiracial cohort of HF hospitalizations. Hypothesis: There are significant racial-ethnic differences in HF hospitalization outcomes. Methods: We used the 2011-2012 Nationwide/National Inpatient Sample to identify hospitalizations with a primary diagnosis of HF using relevant ICD-9 codes. Outcomes of interest were in-hospital mortality, length of stay (LOS) and mean inflation adjusted charges. The effect of race on outcomes was ascertained using logistic or linear regression. Results: 375,740 primary HF hospitalizations representing 1.8 million hospitalizations nationwide were included. Mean age was 72.6 (SD 14.6) years and 50.1% were females. After adjusting for age, sex, hypertension, diabetes, APR-DRG mortality risk and socioeconomic status, in-hospital mortality was significantly lower for Blacks (OR 0.69, 95% CI 0.64 - 0.74; p<0.001), Hispanics (OR 0.82, 95% CI 0.75 - 0.91; p<0.001) and Asians or Pacific Islanders (OR 0.85, 95% CI 0.73 - 0.99; p=0.04) compared to Whites. Average inflation adjusted charges were significantly higher for all minorities compared to Whites except for Native Americans for whom charges were significantly lower than Whites (p<0.05 for Black, Hispanic, Asian, NA or Others vs. Whites). LOS was modestly higher for Blacks or Other races vs. Whites (p=0.01 B vs. W and Others vs. W) and lower for Native Americans vs. Whites (p<0.001). Conclusions: Blacks, Hispanics and Asians hospitalized for HF are significantly less likely to die in the hospital compared to Whites. Hospital charges for racial-ethnic minorities are significantly higher compared to Whites. The reasons for racial differences in HF hospitalization outcomes require further investigation.

scholarly journals Mortality and Associated Comorbidities Among Patients Hospitalized for Deep Vein Thrombosis and Pulmonary Embolism in the United States: Results from a Nationally Representative Database

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 39-40
Author(s):  
Ashwin Gupta ◽  
Jonathan R Day ◽  
Michael B. Streiff ◽  
Clifford Takemoto ◽  
Kyungsuk Jung ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Research Funding ◽  
The United States ◽  
Primary Diagnosis ◽  
Hospital Charges ◽  
Admission Diagnosis ◽  
Vein Thrombosis ◽  
All Cause Mortality ◽  
Nationally Representative ◽  
Deep Vein

Introduction Venous thromboembolism (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [PE]) is a cause of significant morbidity and mortality. Over the last decade, there has been an increase in awareness and major advances in early diagnosis and treatment of VTE. This study sought to estimate the mortality and associated diagnoses in hospitalized patients with a primary diagnosis of DVT or PE using a nationally representative database. Methods The 2017 Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) was used for analysis. The NIS uses a stratified probability sample of 20% of all inpatient discharges, representing over 97% of the US population. Sampling weights were applied to hospital discharges for DVT and PE using applicable ICD-10 codes to generate nationally representative estimates. Pearson's chi-squared test and the Mann-Whitney U test were used for comparisons to assess statistical significance. Results Of the nearly 36 million hospital admissions in 2017, 579,860 had DVT included in the index list of diagnoses during the hospitalization, and 105,635 had DVT as the primary admission diagnosis. Within the primary DVT admissions (median age (interquartile range (IQR)): 64 years (51-77)), 102,505 were acute DVT, and 3,130 were chronic DVT. There were 376,140 admissions with PE as one of all diagnoses and 188,245 with PE as the primary admission diagnosis. Among primary PE admissions (median age (IQR): 64 years (52-75)), 16,205 (8.6%) were saddle PE (Figure 1a). Overall, there were 826,155 people diagnosed with PE or DVT as one of any diagnoses, and 129,845 were diagnosed with both DVT and PE. Mortality The all-cause mortality in admissions with a primary diagnosis of DVT (0.8%) was significantly lower than for all other NIS admissions at 1.96% (p&lt;0.001) (Figure 1a). Among primary DVT admissions who had in-hospital mortality, the median age (IQR) at death was 72 years (61-82), which was comparable to 73 years (61-83) for all other NIS hospitalizations. The median (IQR) length of stay (LOS) of primary DVT admissions who had in-hospital mortality was 5 days (3-10). For primary PE admissions, the all-cause mortality (3.0%) was significantly higher than all other NIS admissions (p&lt;0.001). Among the PE admissions, mortality in those with saddle PE (4.2%) was significantly higher than all other PE cases (p&lt;0.001) (Figure 1b). The median (IQR) age at death for PE patients was 71 years (60-81) and was comparable to all other NIS hospitalizations. The median (IQR) LOS for deaths in PE admissions was 3 days (1-7). Besides the known cardiovascular disease risk factors such as hypertension, obesity, smoking, Type 2 diabetes mellitus, and hyperlipidemia, the most common diagnoses in those who died with DVT or PE as a primary diagnosis were acute kidney failure, cancer, and chronic kidney disease (CKD) (Table 1). Health Care Utilization The median (IQR) hospital charges for DVT and PE admissions were $27,476 ($15,053-$54,874) and $29,158 ($17,471-$52,636) respectively. These were comparable to all NIS hospitalizations at $26,841 ($12,969-$54,568). For hospitalizations for DVT and PE resulting in death, the median (IQR) hospital charges were $60,689 ($24,775-$137,830), and $55,218.50 ($29,373-$106,313) respectively which were comparable to all NIS deaths at $56,107 ($23,117-$131,768). Discussion/Conclusions In the United States, DVT or PE was listed as one of the discharge diagnoses in approximately 825,000 admissions in 2017 and was the primary reason for admission in 300,000 cases (0.8% of all admissions). PE was seen more often as a primary cause for hospitalization, while DVT was more often seen as a comorbidity. The all-cause mortality among admissions for PE was greater than that for DVT. The subset of PE patients with saddle embolism had the highest mortality rate of all admissions for VTE. Besides cardiovascular risk factors, cancer, acute kidney failure, and CKD were among the most common comorbidities seen in admissions with PE and DVT that had in-hospital mortality. Disclosures Streiff: Bayer: Consultancy, Speakers Bureau; Portola: Consultancy; Boehringer-Ingelheim: Research Funding; NHLBI: Research Funding; PCORI: Research Funding; NovoNordisk: Research Funding; Sanofi: Research Funding; Dispersol: Consultancy; BristolMyersSquibb: Consultancy; Janssen: Consultancy, Research Funding; Pfizer: Consultancy, Speakers Bureau. Takemoto:Novartis: Other: DSMB Aplastic Anemia Trial; Genentech: Membership on an entity's Board of Directors or advisory committees.

Heart Failure Related Hospitalizations Are Associated with Increased Morbidity and Mortality in Pediatric Oncology Patients

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4482-4482
Author(s):  
Britton Keeshan ◽  
Kimberly Y Lin ◽  
Matthew J O'Connor ◽  
Jill P Ginsberg ◽  
Richard Aplenc ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Pediatric Oncology ◽  
Multivariable Analysis ◽  
The United States ◽  
Morbidity And Mortality ◽  
Hospital Charges ◽  
Oncology Patients ◽  
Patients With Heart Failure ◽  
Inpatient Database

Abstract Introduction: Cardiomyopathy is a well-described complication of cancer therapy in pediatric patients. However, the prevalence and outcomes of heart failure related hospitalizations in these patients are unknown. We hypothesize that while heart failure related hospitalizations are uncommon in pediatric oncology patients, they are likely associated with increased morbidity and mortality. Methods: We performed retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database, a nationwide database of pediatric hospitalizations in the United States, for oncology patients with and without heart failure for years 2000, 2003, 2006, and 2009. Results: Heart failure was identified in 914 of 259,432 (0.4%) pediatric oncology admissions. Patients with heart failure were more likely to be non-white (52.2 vs 43%, p<0.001), less likely to be in the highest income bracket (23.9 vs 27.5%, p=0.014), more likely to have leukemia (40.7 vs 31.3%, p<0.001), and more likely to undergo bone marrow transplantation on admission (5.0 vs 1.6%, p<0.001). Several morbidities were significantly more common in patients with heart failure including respiratory failure [16.4% vs 1.3%, odds ratio (OR) 14.6, 95% CI 12.2-17.4), sepsis (21.9% vs 7.2%, OR 3.6, 95% CI 3.1-4.3), stroke (1.5% vs 0.6%, OR 2.5, 95% CI 1.5-4.3), and renal failure (11.7% vs 1.2%, OR 10.9, 95% CI 8.9-13.3). Length of stay (LOS) and hospital charges were also significantly greater in oncology patients with heart failure patients compared to those without; median LOS 9 (IQR 4-25) vs 4 days (IQR 2-6); median hospital charges $58,023 (IQR 18,835-169,826) vs $18,161 (IQR 8,860-39,640); p<0.001 for both. Hospital mortality was significantly greater in oncology patients with heart failure compared to those without (13.3% vs 1.3%; OR 11.5, 95% CI 9.5-14.0). On multivariable analysis, heart failure was independently associated with hospital mortality in pediatric oncology patients (OR 2.21, 95% CI 1.63-3.00). Conclusion: Heart failure is an uncommon but serious complication in hospitalized pediatric oncology patients. The presence of heart failure was associated with increased morbidities, resource utilization, and mortality. Further study is needed for the prevention and treatment of heart failure in this population. Disclosures Aplenc: Sigma Tau: Honoraria.

Abstract 18891: Racial Differences in End-of-life Care Associated With Heart Failure Hospitalizations in the United States: A Population-based Analysis From 2011-2012

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Nilay Kumar ◽  
Rohan Khera ◽  
Neetika Garg
Keyword(s):  
Parenteral Nutrition ◽  
Hospital Mortality ◽  
End Of Life ◽  
Racial Differences ◽  
The United States ◽  
Hospital Death ◽  
The Us ◽  
Eol Care ◽  
To Receive ◽  
Racial Ethnic

Background and objectives: Racial disparities in healthcare delivery constitute a major public health problem in the US. There are few studies evaluating the effect of race on utilization of end-of-life (EOL) procedures in HF hospitalizations in the US. Hypothesis: Utilization of EOL procedures differs significantly between racial-ethnic groups independent of socioeconomic status (SES) or probability of in-hospital death. Methods: We used the 2011-2012 Nationwide/National Inpatient Sample to identify primary HF hospitalizations. EOL procedures of interest were intubation, tracheostomy and prolonged mechanical ventilation, hemodialysis, cardiopulmonary resuscitation, gastrostomy, enteral or parenteral nutrition. Relevant ICD-9 codes were used. We used residential ZIP code as a proxy for SES. Multivariate logistic models were used to evaluate racial differences in EOL care while adjusting for SES and probability of in-hospital mortality. Results: 375,740 hospitalizations representing 1.8 million hospitalizations nationwide were included in the study. Mean age was 72.6 (SD 14.6) years and 50.1% were women. Overall 7.81% were intubated, 0.69% underwent tracheostomy, and 6.55% underwent hemodialysis, 0.55% underwent CPR, 0.22% had a gastrostomy and 0.45% received enteral or parenteral nutrition. Blacks, Hispanics, Asians or Pacific Islanders and Other races were more likely to receive EOL procedures compared to Whites after adjusting for SES and probability of in-hospital death. (Fig) Use of any EOL procedure was associated with higher age and sex adjusted odds of in-hospital mortality (OR 6.54, 6.09 - 7.04; p<0.001) and average charges ($76,917 vs. 35,841, p<0.001). Conclusions: Racial-ethnic minorities hospitalized for HF are significantly more likely to receive aggressive EOL care compared to Whites. The reasons for racial differences in utilization of EOL care in HF should be investigated in future studies.

scholarly journals Hepatitis C as a Prognostic Indicator among Noncirrhotic Patients Hospitalized with Alcoholic Hepatitis

2013 ◽  
Vol 27 (11) ◽  
pp. 639-642 ◽  
Author(s):  
Paul J Thuluvath ◽  
Eric Ahn ◽  
Geoffrey C Nguyen
Keyword(s):  
Hepatitis C ◽  
Hospital Mortality ◽  
Resource Utilization ◽  
Alcoholic Hepatitis ◽  
The United States ◽  
Hcv Infection ◽  
Hospital Charges ◽  
Hospital Resource ◽  
End Point ◽  
The Impact

OBJECTIVE: A nationwide analysis of alcoholic hepatitis (AH) admissions was conducted to determine the impact of hepatitis C virus (HCV) infection on short-term survival and hospital resource utilization.METHODS: Using the Nationwide Inpatient Sample, noncirrhotic patients admitted with AH throughout the United States between 1998 and 2006 were identified with diagnostic codes from theInternational Classification of Diseases, Ninth Revision. The in-hospital mortality rate (primary end point) of AH patients with and without co-existent HCV infection was determined. Hospital resource utilization was assessed as a secondary end point through linear regression analysis.RESULTS: From 1998 to 2006, there were 112,351 admissions for AH. In-hospital mortality was higher among patients with coexistent HCV infection (41.1% versus 3.2%; P=0.07). The adjusted odds of in-hospital mortality in the presence of HCV was 1.48 (95% CI 1.10 to 1.98). Noncirrhotic patients with AH and HCV also had longer length of stay (5.8 days versus 5.3 days; P<0.007) as well as greater hospital charges (US$25,990 versus US$21,030; P=0.0002).CONCLUSIONS: Among noncirrhotic patients admitted with AH, HCV infection was associated with higher in-hospital mortality and resource utilization.

Abstract 16794: Characteristics, Trends, Outcomes, and Costs of Stimulant-Related Acute Heart Failure Hospitalizations in the United States

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Suchith Shetty ◽  
Aaqib h Malik ◽  
Abbas Ali ◽  
Ying Chi Yang ◽  
Alexandros BRIASOULIS ◽  
...  
Keyword(s):  
United States ◽  
Heart Failure ◽  
Resource Utilization ◽  
The United States ◽  
Primary Diagnosis ◽  
Medical Advice ◽  
Against Medical Advice ◽  
Stimulant Use ◽  
Significant Burden ◽  
Discharge Against Medical Advice

Introduction: Heart failure hospitalizations remains significant burden on the health care system. Simulants including cocaine and methamphetamine are amongst the most used illegal substances in the United States. The information regarding stimulant related heart failure hospitalizations is scarce. Hypothesis: We sought to evaluate the characteristics and trends of stimulants-related heart failure hospitalizations in the United States and their associated outcomes and resource utilization. Methods: Using the National Inpatient Sample (NIS), we identified patients with a primary diagnosis of heart failure hospitalization. These hospitalizations were further divided into those with and without a concomitant diagnosis of stimulant (cocaine or amphetamine) dependence or abuse. Survey specific techniques were employed to compare trends in baseline characteristics, complications, procedures, outcomes and resource utilization between the two cohorts. Results: We identified 9,932,753 hospitalizations (weighted) with a primary diagnosis of heart failure, of those 138,438 (1.39%) had a diagnosis of active stimulant use. The proportion of stimulant related ACHF hospitalization is on the rise (1.1% to 1.9%) as the mean age of these stimulant related ACHF hospitalizations (from 49.9 to 52 years). Stimulant related ACHF hospitalization mostly affects African Americans and the proportion of ACHF is highest amongst the age group of 30-39 years. It is associated with increased incidence of in-hospital complications but lower mortality and length of stay. These patients have more than 7-fold higher discharge against medical advice. Conclusions: Stimulant related heart failure hospitalizations have been increasing. Evaluation of in-hospital outcomes is limited by a high proportion of patients leaving against medical advice.

scholarly journals National Trends in the Burden of Atrial Fibrillation During Hospital Admissions for Heart Failure

2021 ◽  
Author(s):  
Samuel W. Reinhardt ◽  
Fouad Chouairi ◽  
P. Elliott Miller ◽  
Katherine A. A. Clark ◽  
Bradley Kay ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Hospital Mortality ◽  
Hospital Admissions ◽  
The United States ◽  
Hospital Charges ◽  
Future Research ◽  
Reduced Ejection Fraction ◽  
Over Time

Background Heart failure (HF) and atrial fibrillation (AF) frequently coexist and may be associated with worse HF outcomes, but there is limited contemporary evidence describing their combined prevalence. We examined current trends in AF among hospitalizations for HF with preserved (HFpEF) ejection fraction or HF with reduced ejection fraction (HFrEF) in the United States, including outcomes and costs. Methods and Results Using the National Inpatient Sample, we identified 10 392 189 hospitalizations for HF between 2008 and 2017, including 4 250 698 with comorbid AF (40.9%). HF hospitalizations with AF involved patients who were older (average age, 76.9 versus 68.8 years) and more likely White individuals (77.8% versus 59.1%; P <0.001 for both). HF with preserved ejection fraction hospitalizations had more comorbid AF than HF with reduced ejection fraction (44.9% versus 40.8%). Over time, the proportion of comorbid AF increased from 35.4% in 2008 to 45.4% in 2017, and patients were younger, more commonly men, and Black or Hispanic individuals. Comorbid hypertension, diabetes mellitus, and vascular disease all increased over time. HF hospitalizations with AF had higher in‐hospital mortality than those without AF (3.6% versus 2.6%); mortality decreased over time for all HF (from 3.6% to 3.4%) but increased for HF with reduced ejection fraction (from 3.0% to 3.7%; P <0.001 for all). Median hospital charges were higher for HF admissions with AF and increased 40% over time (from $22 204 to $31 145; P <0.001). Conclusions AF is increasingly common among hospitalizations for HF and is associated with higher costs and in‐hospital mortality. Over time, patients with HF and AF were younger, less likely to be White individuals, and had more comorbidities; in‐hospital mortality decreased. Future research will need to address unique aspects of changing patient demographics and rising costs.

Abstract P2: Medical Resource Utilization and Costs Following Hospitalization of Patients with Chronic Heart Failure in the United States

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Caroline Korves ◽  
Adi Eldar-Lissai ◽  
Doug Rodermund ◽  
Elyse Swallow ◽  
Alice Kate Cummings ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Sick Leave ◽  
Resource Utilization ◽  
Indirect Costs ◽  
The United States ◽  
Data Availability ◽  
Index Hospitalization ◽  
Medical Resource ◽  
Medical Resource Utilization

Background: The study objective was to determine medical resource utilization and direct and indirect costs following hospitalization with chronic heart failure (HF). Methods: Patients (Pts) with ≥1 hospitalization with a chronic HF claim (ICD-9 428.22, 428.32 or 428.42) were identified in a US commercial insurance claims database from 2004-2008. Pts were observed from beginning of first hospitalization (index hospitalization) for chronic HF until disenrollment or end of data availability. Inpatient, outpatient, and prescription drug data were used to estimate per patient per month (PPPM) utilization rates. Costs (2009 USD) were calculated per hospitalization and PPPM for patients ≤65 years, and included insurers’ reimbursement, patient out-of-pocket (OOP) and sick leave. Results: There were 7,814 pts (mean age 73.2 years, 55.7% (4,355/7,814) male) meeting inclusion criteria. Mean HF hospitalization length of stay increased from 6.7 days at index hospitalization to 8.2 days at fourth re-hospitalization. Rate of HF-related re-hospitalization remained over 0.045 PPPM throughout 24 months of follow-up, accounting for the majority of all-cause hospitalizations. Rate of all-cause and HF-related outpatient visits peaked at 4.0 and 0.59 visits PPPM, respectively, within the three months after index hospitalization. Index hospitalization was most expensive (Table). Patient OOP costs accounted for less than 10% of direct costs (Table) and sick leave costs were less than $1,800 at any hospitalization. During the study period, outpatient cardiovascular drugs accounted for a small proportion of total pharmacy costs; average PPPM cost varied from $88 to $124, less than 1% of the average cost of a HF-related hospitalization. Conclusions: Treating chronic HF pts is resource intensive. The greatest burden occurs within the three months after index hospitalization and pts continue to be burdened after hospitalization by high inpatient and outpatient visit rates. Index hospitalization HF-related re-hospitalization 1st 2nd 3rd 4th Total direct medical costs $31,998 $22,047 $23,946 $24,839 $24,517 Reimbursement by insurers $31,023 $21,521 $23,103 $23,781 $23,971 Patient out-of-pocket $975 $526 $843 $1,058 $546 Indirect costs (sick leave) $1,194 $1,194 $1,281 $1,703 $1,764 Total $33,192 $23,241 $25,227 $26,542 $26,281

Abstract WP340: Prevalence and Influence of Chronic Obstructive Pulmonary Disease on Stroke Outcomes in Hospitalized Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Oladimeji Akinboro ◽  
Odunayo Olorunfemi ◽  
Stanley Holstein ◽  
Daniel Pomerantz ◽  
Stephen Jesmajian ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Mortality ◽  
The United States ◽  
Mortality Rates ◽  
Chronic Obstructive ◽  
Stroke Patients ◽  
Obstructive Pulmonary Disease ◽  
Index Stroke ◽  
Nationally Representative ◽  
Shared Risk

Background: COPD recently overtook stroke as the third leading cause of death in the United States. Intriguingly, smoking is an important shared risk factor for both stroke and COPD; COPD patients have baseline cerebral hypoxia and hypercapnia that could potentially exacerbate vascular brain injury; and stroke patients with COPD are at higher risk of aspiration than those without COPD. Yet, relatively little is known about the prevalence of COPD among stroke patients or its impact on outcomes after an index stroke. Objective: To assess prevalence of COPD among hospitalized stroke patients in a nationally representative sample and examine the effect of COPD with risk of dying in the hospital after a stroke. Methods: Data were obtained for patients, 18 years and older, from the National Inpatient Sample from 2004-2009 (n=48,087,002). Primary discharge diagnoses of stroke were identified using ICD-9 diagnosis codes 430-432 and 433-436, of which a subset with comorbid COPD were defined with secondary ICD-9 diagnoses codes 490-492, 494, and 496. In-hospital mortality rates were calculated, and independent associations of COPD with in-hospital mortality following stroke were evaluated with logistic regression. All analysis were survey-weighted. Results: 11.71% (95% CI 11.48-11.94) of all adult patients hospitalized for stroke had COPD. The crude and age-adjusted in-hospital mortality rates for these patients were 6.33% (95% CI 6.14-6.53) and 5.99% (95% CI 4.05-7.94), respectively. COPD was independently and modestly associated with overall stroke mortality (OR 1.03, 95% CI 1.01-1.06; p=0.02). However, when analyzed by subtype, greater risks of mortality were seen in those with intracerebral hemorrhage (OR 1.12, 95% CI 1.03-1.20; p<0.01), and ischemic stroke (OR 1.08; 95% CI 1.03-1.13, p<0.01), but not subarachnoid hemorrhage (OR 0.98, 95% CI 0.85-1.13; p=0.78). There were no statistically significant interactions between COPD and age, gender, or race. Conclusion: 12% of hospitalized stroke patients have COPD. Presence of COPD is independently associated with higher odds of dying during ischemic stroke hospitalization. Prospective studies are needed to identify any modifiable risk factors contributing to this deleterious relationship.

Abstract P44: Does Race Influence Disability and Hospital Disposition After Cerebral Hemorrhage? Results From a Community Wide Stroke Registry

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Dilip K Pandey ◽  
Venkatesh Aiyagari
Keyword(s):  
Hospital Mortality ◽  
Racial Differences ◽  
The United States ◽  
Term Treatment ◽  
Severe Disability ◽  
Stroke Registry ◽  
Discharge Disposition ◽  
Long Term Treatment ◽  
Mortality Incidence

Background: Compared to Non-Hispanic whites (NHW), intracerebral hemorrhage (ICH) has a higher incidence among African Americans (AA) where it also occurs at a younger age. Previous studies have concluded that there are no racial differences in hospital mortality after ICH, but the influence of race on disability and discharge disposition after ICH has not been studied. Methods: The Illinois Capture-Stroke registry is a prospectively collected database of patients admitted with a stroke to 56 acute care hospitals in Illinois. We performed a retrospective analysis of the association between race, and in-hospital mortality, modified Rankin Scale (mRS) score at discharge and discharge disposition in 804 patients with ICH enrolled in the registry between 2005 and 2007. Results: We studied 530 NHW and 175 AA patients with radiologically proven ICH. Compared to NHW, AA patients were younger (mean age NHW: 73±14 vs AA: 58±12 yrs, p <0.001) and had a higher incidence of hypertension, smoking and coronary artery disease. Although there was no racial difference in hospital mortality, incidence of moderate to severe disability (mRS 4-5) was significantly higher in NHW (69%) compared to AA (55%). Among patients <65 years old, a trend (p=0.102) towards a higher disability in NHW was observed (60% in NHW vs. 45% in AA). In this age group, 41% of NHW and 33% of AA were discharged to rehabilitation facilities while 37% of NHW and 44% of AA were discharged home. Conclusion: A very large proportion of patients with ICH are discharged from hospitals with moderate or severe disability. Compared to NHW, a higher proportion of younger AA patients are discharged home after ICH. The long term outcomes of survivors after ICH in the United States is not well studied, and the influence of racial and socioeconomic factors on long-term treatment and outcome after ICH needs to be explored.

Abstract 45: Thrombolytic Treatment for In-Hospital Ischemic Strokes in United States

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Tenbit Emiru ◽  
Malik M Adil ◽  
Adnan I Qureshi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Clinical Characteristics ◽  
The United States ◽  
Treated Group ◽  
Hospital Charges ◽  
Thrombolytic Treatment

BACKGROUND: Despite the recent emphasis on protocols for emergent triage and treatment of in-hospital acute ischemic stroke, there is little data on rates and outcomes of patients receiving thrombolytics for in-hospital ischemic strokes. OBJECTIVE: To determine the rates of in-hospital ischemic stroke treated with thrombolytics and to compare outcomes with patients treated with thrombolytics on admission. DESIGN/METHODS: We analyzed a seven-year data (2002-2009) from the National Inpatient Survey (NIS), a nationally representative inpatient database in the United States. We identified patients who had in-hospital ischemic strokes (defined by thrombolytic treatment after one day of hospitalization) and those who received thrombolytics on the admission day. We compared demographics, baseline clinical characteristics, in hospital complications, length of stay, hospitalization charges, and discharge disposition, between the two patient groups. RESULT: A total of 18036 (21.5%) and 65912 (78.5%) patients received thrombolytics for in-hospital and on admission acute ischemic stroke, respectively. In hospital complications such as pneumonia (5.0% vs. 3.4%, p=0.0006), deep venous thrombosis (1.9% vs. 0.6%, p<0.0001) and pulmonary embolism (0.8% vs. 0.4%, p=0.01) were significantly higher in the in-hospital group compared to on admission thrombolytic treated group. Hospital length of stay and mean hospital charges were not different between the two groups. Patients who had in-hospital strokes had had higher rates of in hospital mortality (12.1% vs. 10.6%, p=0.02). In a multivariate analysis, in-hospital thrombolytic treated group had higher in-hospital mortality after adjustment for age, gender and baseline clinical characteristics (odds ratio 0.84, 95% confidence interval 0.74-0.95, p=0.008). CONCLUSION/RELEVANCE: In current practice, one out of every five acute ischemic stroke patients treated with thrombolytics is receiving treatment for in-hospital strokes. The higher mortality and complicated hospitalization in such patients needs to be recognized.

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