Abstract 223: Non-Cardiac Comorbidities in Predictive Models for Valvular Heart Disease Interventions

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Benjamin Wessler ◽  
Christine Lundquist ◽  
Gowri Raman ◽  
Jennifer Lutz ◽  
Jessica Paulus ◽  
...  
Keyword(s):  
Heart Disease ◽  
Predictive Models ◽  
Valvular Heart Disease ◽  
De Novo ◽  
Predictive Analytics ◽  
Model Performance ◽  
Median Number ◽  
Valve Surgery ◽  
Comorbid Condition ◽  
Comorbid Conditions

Background: Interventions for patients with valvular heart disease (VHD) now include both surgical and percutaneous procedures. As a result, treatments are being offered to increasingly complex patients with a significant burden of non-cardiac comorbid conditions. There is a major gap in our understanding of how various comorbidities relate to prognosis following interventions for VHD. Here we describe how comorbidities are handled in clinical predictive models for patients undergoing interventions for VHD. Methods: We queried the Tufts Predictive Analytics and Comparative Effectiveness (PACE) Clinical Prediction Model (CPM) Registry to identify de novo CPMs for patients undergoing VHD interventions. We systematically extracted information on the non-cardiac comorbidities contained in the CPMs and also measures of model performance. Results: From January 1990- May 2012 there were 12 CPMs predicting measures of morbidity or mortality for patients undergoing interventions for VHD. There were 2 CPMs predicting outcomes for isolated aortic valve replacement, 3 CPMs predicting outcomes for isolated mitral valve surgery, and 7 models predicting outcomes for a combination of valve surgery subtypes. Ten out of twelve (83%) of the CPMs for patients undergoing interventions for VHD predicted mortality. The median number of non-cardiac comorbidities included in the CPMs was 4 (range 0-7). All of the CPMs predicting mortality included at least 1 comorbid condition. The top 3 most common comorbidities included in these CPMs were, renal dysfunction (10/12, 83%), prior CVA (7/12, 58%) and measures of BMI/BSA (7/12, 58%). Diabetes was present in only 25% (3/12) of the models and chronic lung disease in only 17% (2/12). Conclusions: Non-cardiac comorbidities are frequently found in CPMs predicting morbidity and mortality following interventions for VHD. There is significant variation in the number and type of specific comorbid conditions included in these CPMs. More work is needed to understand the directionality, magnitude, and consistency of effect of these non-cardiac comorbid conditions for patients undergoing interventions for VHD.

Acupuncture in Patients with Valvular Heart Disease and Prosthetic Valves

2003 ◽  
Vol 21 (3) ◽  
pp. 87-91 ◽  
Author(s):  
Anthony Stellon
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Acupuncture Treatment ◽  
Laboratory Data ◽  
Median Number ◽  
Prophylactic Antibiotics ◽  
Blood Cultures ◽  
Prosthetic Valves ◽  
Small Cohort

Endocarditis has been reported in patients with valvular heart disease who have undergone acupuncture treatment, although most have been associated with the use of semi-permanent needles. This has led reviewers to suggest that acupuncture may not only be contraindicated in such patients but that prophylactic antibiotics should be given. This study investigated the use of acupuncture treatment in patients with proven valvular heart disease and observed whether endocarditis developed in such patients. All patients in a single-handed GP practice with proven valvular heart disease, including those with prosthetic valves, were identified over a ten-year period. Those who had undergone acupuncture treatment underwent a clinical examination and diagnostic tests, which focused on the signs, symptoms and laboratory criteria for the diagnosis of endocarditis and included a transthoracic echocardiogram. Autopsy findings were reviewed in any patient who died. Based on these clinical and laboratory data, using the modified Duke's criteria for the diagnosis of endocarditis, patients were identified as having definite or possible endocarditis, or the diagnosis was rejected. All patients underwent brief acupuncture with no skin disinfectant and no prophylactic antibiotics were given. Semi-permanent needles were avoided. Thirty-six patients with valvular heart disease underwent a total of 479 acupuncture treatments over a ten-year period. The median number of treatments was 9 (range 1 – 72), with a follow-up after treatment of 5.75 years (range 0.5 – 10 years). Definite endocarditis was not found in any patient, but two patients had possible endocarditis, eventually discounted by both negative blood cultures and echocardiography. In conclusion, brief acupuncture was safe in this small cohort of valvular heart disease patients and no case of endocarditis was detected over a ten-year period.

Abstract 129: Clinical Predictive Models for Valvular Heart Disease: A Systematic Review of the Literature

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Benjamin S Wessler ◽  
Muhammad Ajlan ◽  
Christine Lundquist ◽  
Zuhair Natto ◽  
Jessica Paulus ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heart Disease ◽  
Predictive Models ◽  
Valvular Heart Disease ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Surgical Interventions ◽  
Percutaneous Interventions ◽  
C Statistic ◽  
Original Report

Objectives: Pre-procedure risk assessment is central to clinical decision making for patients with advanced valvular heart disease (VHD) and treatments are increasingly being offered to patients with elevated pre-procedure risk. While there are numerous clinical predictive models (CPMs) available for patients with VHD, the relative performance of these CPMs is largely unknown. Here we describe the performance of CPMs available for patients with VHD with specific attention to whether CPMs have been externally validated. Methods: To identify CPMs for patients with VHD, we conducted a systematic review of the Tufts PACE CPM Registry, a comprehensive database of cardiovascular CPMs. For each identified CPM for patients with VHD, we performed a complete citation search using Scopus to identify any external validations of these models published in other articles. We extracted information on CPM performance in both the original report and also the external validations. For external validations we calculated the relative percent decrease in discrimination. Results: We identified 41 CPMs predicting outcomes for patients with VHD. 33 (81%) predict outcomes following surgical intervention, 5 (12%) predict outcomes following percutaneous interventions, and 3 (7%) predict outcomes in the absence of intervention. Only 30/41 (73%) of the CPMs report a c-statistic. The median reported c- statistic was 0.77 [IQR, 0.04] for CPMs predicting outcomes following surgical interventions, 0.68 [IQR, 0.04] for CPMs for percutaneous interventions, and 0.83 [IQR, 0.07] for CPMs predicting outcomes in the absence of intervention. While a total of 69 external validations of these CPMs have been published, only 21 (51%) of the CPMs have ever been externally validated. For external validations that report c- statistics, we noted a median percent decrement in discrimination of -27.6% [IQR, -37.4] ( Figure) . Conclusion: While there are numerous CPMs for patients with VHD, performance is often incompletely reported and half of these CPMs have never been externally validated. The CPMs that have been externally validated generally show substantially worse discrimination in external datasets compared to the derivation datasets.

Mitral valve surgery and maternal and fetal outcome in valvular heart disease

2003 ◽  
Vol 81 (2) ◽  
pp. 151-156 ◽  
Author(s):  
M. Malhotra ◽  
J.B. Sharma ◽  
P. Arora ◽  
S. Batra ◽  
S. Sharma ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Valvular Heart Disease ◽  
Fetal Outcome ◽  
Mitral Valve Surgery ◽  
Valve Surgery

scholarly journals Comorbidities with Congenital Heart Disease among Hospitalized Children in a Specialized Cardiac Hospital in Bangladesh

2017 ◽  
Vol 9 (2) ◽  
pp. 83-89
Author(s):  
Shahina Akhter Mita ◽  
Md Salim ◽  
Md Ataul Haque ◽  
Abdullah Shahriar ◽  
Md Nazneen Umme Zakia ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Septal Defect ◽  
Complex Congenital Heart Disease ◽  
Comorbid Condition ◽  
Comorbid Conditions ◽  
Transposition Of Great Arteries ◽  
Different Types ◽  
Valvular Lesion

Background: Congenital heart diseases (CHD) when associated with any comorbid condition may complicate the outcome of management. So to find out and treat comorbidities before definite treatment is essential for better outcome. Methods: This observational cross sectional study was conducted in the inpatient Department of Paediatric Cardiology at National Institute of Cardiovascular Diseases, Dhaka, during the period of January 2014 to January 2015 to identify the comorbid conditions of congenital heart disease.Results: A total of 794 children with different types of congenital heart disease were enrolled during the study period. Among them, 48.6% were simple CHD and 51.4% were complex CHD. Among simple CHD, ventricular septal defect (VSD) was commonest (27.2%), Tetralogy of Fallot (TOF) occupied the second position (20.5%). One child presented with Ectopia cardis. Among complex CHD most common anomalies were VSD with either atrial septal defect (ASD) or patent ductus arteriosus (PDA) or valvular lesion. Next common anomalies were TOF with PDA or ASD &/or pulmonary valvular abnormalities. Double outlet of right ventricle (DORV) with shunt and transposition of great arteries (TGA) with shunt also occur frequently. AV canal defect with or without valvular lesion presented in significant number. Among them 616 (77.6%) had different types of comorbid conditions. Among comorbidities, respiratory and acquired cardiac comorbidities were common (37.9% & 34.1% respectively). Other congenital or genetic comorbidities were in 11.2%. Multisystem involvement was in 9.8% cases.Conclusion: Pneumonia and heart failure were the most frequent comorbid condition among both simple and complex congenital heart disease. They were common among acyanotic heart disease. But cyanotic spell, acute stroke syndrome and brain abscess were common among cyanotic heart disease. Among genetic comorbidities Down’s syndrome occupied the major part.Cardiovasc. j. 2017; 9(2): 83-89

scholarly journals Type of Valvular Heart Disease Requiring Surgery in the 21st Century: Mortality and Length-of-Stay Related to Surgery

2013 ◽  
Vol 7 (1) ◽  
pp. 104-109 ◽  
Author(s):  
Konstantinos Dean Boudoulas ◽  
Yazhini Ravi ◽  
Daniel Garcia ◽  
Uksha Saini ◽  
Gbemiga G. Sofowora ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Length Of Stay ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Valvular Heart Disease ◽  
Aortic Insufficiency ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Surgical Mortality

Aim: While the incidence of rheumatic heart disease has declined dramatically over the last half-century, the number of valve surgeries has not changed. This study was undertaken to define the most common type of valvular heart disease requiring surgery today, and determine in-hospital surgical mortality and length-of-stay (LOS) for isolated aortic or mitral valve surgery in a United States tertiary-care hospital. Methods: Patients with valve surgery between January 2002 to June 2008 at The Ohio State University Medical Center were studied. Patients only with isolated aortic or mitral valve surgery were analyzed. Results: From 915 patients undergoing at least aortic or mitral valve surgery, the majority had concomitant cardiac proce-dures mostly coronary artery bypass grafting (CABG); only 340 patients had isolated aortic (n=204) or mitral (n=136) valve surgery. In-hospital surgical mortality for mitral regurgitation (n=119), aortic stenosis (n=151), aortic insufficiency (n=53) and mitral stenosis (n=17) was 2.5% (replacement 3.4%; repair 1.6%), 3.9%, 5.6% and 5.8%, respectively (p=NS). Median LOS for aortic insufficiency, aortic stenosis, mitral regurgitation, and mitral stenosis was 7, 8, 9 (replacement 11.5; repair 7) and 11 days, respectively (p<0.05 for group). In-hospital surgical mortality for single valve surgery plus CABG was 10.2% (p<0.005 compared to single valve surgery). Conclusions: Aortic stenosis and mitral regurgitation are the most common valvular lesions requiring surgery today. Surgery for isolated aortic or mitral valve disease has low in-hospital mortality with modest LOS. Concomitant CABG with valve surgery increases mortality substantially. Hospital analysis is needed to monitor quality and stimulate improvement among Institutions.

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