Abstract 308: Effect of Watchman Implantation in Atrial Fibrillation Patients on Healthcare Utilization: Insights From National Readmission Database 2016-2017

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Moghniuddin Mohammed ◽  
Sagar Ranka ◽  
Madhu Reddy
Keyword(s):  
Atrial Fibrillation ◽  
Healthcare Utilization ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Index Procedure ◽  
Post Procedure ◽  
Binomial Regression ◽  
Watchman Device ◽  
Rate Ratios ◽  
National Readmission Database

Background: Prior studies have shown that WATCHMAN device can be an alternative for anticoagulation in atrial fibrillation (AF) patients for stroke reduction. Its impact on healthcare utilization in AF population remains unknown. Methods: We queried the 2016-2017 National Readmission Database for all adult AF patients undergoing WATCHMAN procedure using ICD10 codes. All patients discharged alive from February to November were included (N = 13192), and their bleeding/thrombosis related admissions pre- and post-index procedure were recorded. Hierarchical longitudinal negative binomial regression was done to calculate incidence rate ratios (IRR) of admissions pre- and post-procedure with patient and hospital as level 2 and 3 variables, respectively. Person-time was included as an offset variable to account for variation in pre and post-procedure time contribution by each patient. A second model was created that included a blanking period of 2 months post-procedure to account for continued anticoagulation after the procedure. For this analysis, patients who received the procedure in October and November (N = 3265) and also patients who died within 2 months of the procedure (N = 49) were excluded. Results: For 13192 patients, the mean age was 77 years and 39% were female. Overall, we found a decrease of ~23% in all-cause readmissions after the procedure (IRR = 0.77; 95% CI = 0.74-0.81; p<0.001). A much greater decrease in thrombosis related admissions of ~69% (IRR = 0.31, p<0.001) and bleeding related admissions of 46% (IRR=0.54, p<0.001) were noted. When applying the 2-month blanking period after the index procedure, we observed an even greater decrease in all-cause readmissions of ~37% post-procedurally. Similarly, there was a decrease of ~75% and ~74% in thrombosis- and bleeding-related admissions respectively (Figure 1). Conclusions: AF patients undergoing WATCHMAN procedure have a significantly lower readmission rate, especially for thromboembolic/bleeding related readmissions. Thus, there is a trend towards decrease in healthcare utilization post-procedurally. Further studies are needed to confirm and evaluate the reasons for these findings.

Effect of environmental conditions on injury rates at a Colorado ski resort

2019 ◽  
Vol 26 (4) ◽  
pp. 324-329
Author(s):  
Lauren A Pierpoint ◽  
Zachary Y Kerr ◽  
Gary Grunwald ◽  
Morteza Khodaee ◽  
Tessa Crume ◽  
...  
Keyword(s):  
Environmental Conditions ◽  
Negative Binomial ◽  
Injury Rate ◽  
Negative Binomial Regression ◽  
Injury Rates ◽  
Ski Resort ◽  
Average Temperature ◽  
Binomial Regression ◽  
Rate Ratios ◽  
Packed Powder

ObjectiveTo determine the effect of daily environmental conditions on skiing and snowboarding-related injury rates.MethodsInjury information was collected from a mountainside clinic at a large Colorado ski resort for the 2012/2013 through 2016/2017 seasons. Daily environmental conditions including snowfall, snow base depth, temperature, open terrain and participant visits were obtained from historical resort records. Snowpack and visibility information were obtained for the 2013/2014 through 2014/2015 seasons and included in a subanalysis. Negative binomial regression was used to estimate injury rate ratios (IRRs) and 95% CIs.ResultsThe overall injury rate among skiers and snowboarders was 1.37 per 1000 participant visits during 2012/2013 through 2016/2017. After adjustment for other environmental covariates, injury rates were 22% higher (IRR=1.22, 95% CI 1.14 to 1.29) on days with <2.5 compared with ≥2.5 cm of snowfall, and 14% higher on days with average temperature in the highest quartile (≥−3.1°C) compared with the lowest (<−10.6°C; IRR=1.14, 95% CI 1.03 to 1.26). Rates decreased by 8% for every 25 cm increase in snow base depth (IRR=0.92, 95% CI 0.88 to 0.95). In a subanalysis of the 2013/2014 and 2014/2015 seasons including the same covariates plus snowpack and visibility, only snowpack remained significantly associated with injury rates. Rates were 71% higher on hardpack compared with powder days (IRR=1.71, 95% CI 1.18 to 2.49) and 36% higher on packed powder compared with powder days (IRR 1.36, 95% CI 1.12 to 1.64).ConclusionsEnvironmental conditions, particularly snowfall and snowpack, have a significant impact on injury rates. Injury prevention efforts should consider environmental factors to decrease injury rates in skiers and snowboarders.

Effects of consultant residence out-of-hours on acute paediatric admissions

2020 ◽  
Vol 105 (7) ◽  
pp. 661-663 ◽  
Author(s):  
Robert Scott-Jupp ◽  
Emily Carter ◽  
Nick Brown
Keyword(s):  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Time Of Day ◽  
Short Stay ◽  
Night Time ◽  
Out Of Hours ◽  
Duration Of Stay ◽  
Binomial Regression ◽  
Rate Ratios ◽  
Short Stay Patients

Acute paediatric units require round-the-clock skilled resident medical cover. Fully trained doctors remaining resident on-site at night and weekends may improve care at these times, but costs are higher. In compensation, more senior doctors may be less likely to admit children.MethodsIn a unit providing 24-hour, 7-day acute services, out-of-hours resident cover has been divided between level 2/3 trainees and consultants. Between 2007 and 2017, night and weekend day shifts were identified as resident consultant or non-resident consultant. Admission numbers (duration of stay of ≥4 hours) were obtained from hospital activity databases. Analyses were undertaken on total admissions and stratified by time of day and duration of stay of >12 or < 12 hours. Incidence rate ratios (IRRs) were derived using negative binomial regression .ResultsFor all out-of-hours and short-stay patients, children were significantly more likely to be admitted when there was no resident consultant: IRRs 1.07 (95% CI 1.04 to 1.09) and 1.09 (95% CI 1.02 to 1.18), respectively. There was no difference between rates stratified into long stay at night or weekend days: IRRs 1.01 (95% CI 0.96 to 1.07) and 1.03 (95% CI 0.99 to 1.18) respectively .ConclusionA resident consultant presence was associated with reduced total, night-time and short-stay admissions.

Abstract 16194: Prior Atrial Fibrillation and WCD-detected Arrhythmic Outcomes - Data From the WEARIT-II Prospective Registry

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ido Goldenberg ◽  
Arwa Younis ◽  
Scott McNitt ◽  
Helmut U Klein ◽  
Ilan Goldenberg ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Atrial Arrhythmia ◽  
Rank Test ◽  
Cumulative Probability ◽  
Icd Implantation ◽  
Kaplan Meier ◽  
Binomial Regression ◽  
History Of

Introduction: The Wearable Cardioverter Defibrillator (WCD) is utilized in patients with assumed but not yet confirmed risk for sudden cardiac death (SCD). Many of these patients also present with a history of atrial fibrillation (AF). However, the rate of WCD-detected ventricular or atrial arrhythmia events in this specific high-risk cohort is not well understood. Methods: In WEARIT-II, the cumulative probability of any sustained or non-sustained VT/VF (WCD-treated and non-treated), and atrial/supraventricular arrhythmias during WCD use was assessed using the Kaplan-Meier method, with comparisons by the log-rank test. The incidence of ventricular and atrial arrhythmia events were expressed as events per 100 patient-years, and were analyzed by negative binomial regression. Results: The WEARIT-II trial enrolled 2000 patients, 557 (28%) of whom had AF prior to enrollment. The cumulative probability of any sustained or non-sustained WCD-detected VT/VF during WCD use was significantly higher among patients with a history of AF than in patients without AF (6% vs. 3%, p=0.001, Figure). Similarly, the recurrent rate of any sustained or non-sustained VT/VF was significantly higher in patients with prior AF vs. no prior AF (131.5 events per 100 patient-years vs. 22.7 events per 100 patient-years, p=0.001). Patients with prior AF also had a significantly higher burden of WCD-detected atrial arrhythmias/SVT (64 events per 100 patient-years vs 13.7 events per 100 patient-years, p<0.001). Conclusions: Our results demonstrate that patients with a history of AF wearing the WCD for risk assessment have a higher incidence of ventricular arrhythmias that may facilitate the decision making for ICD implantation.

Injuries and Illnesses Among American Red Cross Responders—United States, 2008–2012

2014 ◽  
Vol 8 (5) ◽  
pp. 404-410 ◽  
Author(s):  
Kimberly Brinker ◽  
Catherine A. Head ◽  
Candice Y. Johnson ◽  
Renée H. Funk
Keyword(s):  
Negative Binomial ◽  
Occupational Injury ◽  
Occupational Injuries ◽  
Negative Binomial Regression ◽  
Red Cross ◽  
American Red Cross ◽  
Binomial Regression ◽  
Level 3 ◽  
Rate Ratios ◽  
Adjusted Model

ABSTRACTObjectiveOccupational injury and illness rates for volunteer responders have not been well documented. We analyzed data specific to volunteers from the American Red Cross (ARC).MethodsData collected by the ARC between 2008 and 2012 were analyzed to identify disaster factors associated with responder injuries and illnesses. We focused on disaster-relief operation (DRO) level (indicating operational costs, ranging from 3 [lower] to 5+ [higher]); disaster type; region; and year. We calculated injury and illness rates and estimated rate ratios (RR) with 95% CI, using negative binomial regression. Also, we analyzed a total of 113 disasters.ResultsHurricanes had the highest rates of injuries (14/1000 responders) and illnesses (18/1000 responders). In the adjusted model for injuries, RRs were higher for DRO levels 4 (3.6 [CI, 2.0–6.7]) and 5+ (4.9 [CI, 2.2–11.0]) than for level 3. In the adjusted model for illnesses, RRs also were higher for DRO levels 4 (4.4 [CI, 2.6–7.3]) and 5+ (8.6 [CI, 4.1–17.7]) than for level 3.ConclusionsHigher DRO levels were a significant predictor of greater rates of occupational injuries and illnesses. Careful selection of responders, including volunteers, has been warranted for deployments to such disasters. (Disaster Med Public Health Preparedness. 2014;0:1-7)

Abstract P330: Chronic Kidney Disease is Associated With Short-Term Risk of Hospitalization Among Older Adults

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Eugenia Wong ◽  
Shoshana H Ballew ◽  
Natalie Daya ◽  
Junichi Ishigami ◽  
Casey M Rebholz ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Kidney Disease ◽  
African American ◽  
Kidney Disease ◽  
Incidence Rate ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Serum Cystatin C ◽  
Binomial Regression ◽  
Rate Ratios

Background: Chronic kidney disease (CKD) is now staged by estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (ACR). Risks of cardiovascular disease, dialysis, and mortality are well described, but risks of hospitalization at older age have not been explored to the same depths. Hypothesis: CKD stages will be associated with risk of all-cause hospitalizations. Methods: The analysis was conducted on 5669 white and African-American participants of the ARIC Visit 5 (2011-2013) cohort (mean age, 76 y; female, 57%; African-American, 23%). CKD was staged according to KDIGO 2012 criteria with eGFR from serum cystatin C (eGFRcys) and ACR. The primary outcome of all-cause hospitalization risk was analyzed by using negative binomial regression to estimate incidence rate ratios (IRR), adjusted for demographics, behaviors, and comorbidities. Results: Over a median follow-up period of 3.5 years (by December 31 st , 2015), 6124 hospitalizations occurred over 19788 person-years (Crude Incidence Rate, 309 per 1000 person-years). Risk of hospitalization increased markedly with lower eGFRcys and higher albuminuria ( Table 1 ). Other baseline comorbidities were also associated with hospitalization risk (IRR [95% CI] for heart failure, coronary heart disease (CHD), stroke, cancer were 1.7 [1.4-2.0], 1.5 [1.3-1.7], 1.3 [1.1-1.6], and 1.2 [0.9-1.5]). Conclusions: Among older adults, both low eGFR and high ACR are strongly related to risk of hospitalization. These findings provide insight for risk stratification and prevention of CKD at older ages. Table 1. Risk of hospitalization by CKD stages defined by eGFR and ACR

scholarly journals Pitching Behaviors in Youth Baseball: Comparison With the Pitch Smart Guidelines

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110501
Author(s):  
Justin J. Greiner ◽  
Cameron A. Trotter ◽  
Brian E. Walczak ◽  
Scott J. Hetzel ◽  
Geoffrey S. Baer
Keyword(s):  
Negative Binomial ◽  
Negative Binomial Regression ◽  
High Volume ◽  
Cross Sectional Study ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Baseball Players ◽  
Binomial Regression ◽  
Youth Baseball ◽  
Rate Ratios

Background: The Pitch Smart guidelines aim to limit youth baseball pitching behaviors associated with overuse injuries. Despite many youth baseball leagues being compliant with the guidelines, during tournaments, pitch count restrictions or guidelines are often not followed. Purpose: To perform a quantitative analysis of pitch counts in youth baseball players and evaluate compliance with regard to the Pitch Smart guidelines in the tournament setting. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included in the analysis were 100 youth baseball teams that competed in the 8-and-under to 14-and-under age divisions during the 2019 tournament season. Pitching data were compared with the Pitch Smart guidelines. Violations were identified as (1) exceeding maximum daily pitch count, (2) inadequate rest between pitching events, and (3) pitching more than 1 event on the same day. Pitcher and game factors were analyzed for possible relationships to guideline violations using mixed-effects negative binomial regression models, with comparisons of violations using rate ratios (RRs). Results: Analysis included 1046 pitchers and 2439 games. There were 1866 total Pitch Smart guideline violations, with 48.6% of pitchers having at least 1 violation. Inadequate rest was the most common reason for violation, with noncompliance occurring in 43.3% of pitchers. The highest rate of any violation (0.32 per appearance) occurred in the 8-and-under age division. High-volume pitchers had increased violation rates in each category compared with low-volume pitchers ( P < .001). Violation rates were increased more than twice the rate when pitchers participated in ≥5 consecutive games without a rest day when compared with a single game (RR, 2.48; P < .001). Conclusion: Noncompliance with Pitch Smart guidelines in tournament settings occurred in more than 90% of teams and almost half of all pitchers. Factors associated with noncompliance included younger pitcher age, high-volume pitching, and pitching in multiple consecutive games. Education of tournament directors, coaches, parents, and athletes regarding pitching guidelines is warranted in order to limit the risk of injury.

scholarly journals Socio-Economic Patterns of COVID-19 During the Pandemic in Italy

2021 ◽  
Author(s):  
Alberto Mateo-Urdiales ◽  
Massimo Fabiani ◽  
Aldo Rosano ◽  
Maria Fenicia Vescio ◽  
Martina Del Manso ◽  
...  
Keyword(s):  
Retrospective Cohort ◽  
Regression Models ◽  
Negative Binomial ◽  
Case Fatality ◽  
Negative Binomial Regression ◽  
Epidemiological Surveillance ◽  
Association Measure ◽  
Binomial Regression ◽  
Region Of Residence ◽  
Rate Ratios

Objective: To investigate the association between deprivation and COVID-19 outcomes in Italy during pre-lockdown, lockdown and post-lockdown periods.Design: Retrospective cohort study.Setting: All municipalities in Italy with less than 50,000 population.Participants: 38,534,169 citizens and 222,875 COVID-19 cases reported to the Italian epidemiological surveillance were assigned to quintiles based on the deprivation index of their municipality of residence.Interventions: The COVID-19 pandemic during pre-lockdown, lockdown and post-lockdown from the 20th of February to the 15th of October of 2020.Main outcome measures: Multilevel negative binomial regression models, adjusting for age, sex, population-density and region of residence were conducted to evaluate the association between deprivation and COVID-19 incidence, case-hospitalisation rate and case-fatality. The association measure was the rate ratio.Results: During pre-lockdown, lockdown and post-lockdown, the incidence rate ratios (IRR) with 95% confidence interval (CI) in the most deprived quintile with respect to the least deprived quintile were 1.17 (95% CI 0.98 to 1.41), 1.14 (1.03 to 1.27) and 1.47 (1.32 to 1.63), respectively. In those three periods, the case-hospitalization IRR were 0.68 (0.51 to 0.92), 0.89 (0.72 to 1.11) and 0.99 (0.81 to 1.22) and the case-fatality IRR were 0.92 (0.75 to 1.13), 0.95 (0.85 to 1.07) and 1.02 (0.73 to 1.41), respectively.Conclusions: During lockdown and post-lockdown, but not during pre-lockdown, a higher incidence of cases was observed in the most deprived municipalities compared with the least deprived ones. No differences in case-hospitalisation and case-fatality according to deprivation were observed in any period under study.

scholarly journals Is area deprivation associated with greater impacts of COVID-19 in care homes across England? A preliminary analysis of COVID-19 outbreaks and deaths

2021 ◽  
pp. jech-2020-215039 ◽  
Author(s):  
Anders Malthe Bach-Mortensen ◽  
Michelle Degli Esposti
Keyword(s):  
Negative Binomial ◽  
Care Home ◽  
Negative Binomial Regression ◽  
Population Characteristics ◽  
Care Homes ◽  
Future Research ◽  
Area Deprivation ◽  
Binomial Regression ◽  
Index Of Multiple Deprivation

IntroductionThe COVID-19 pandemic has disproportionately impacted care homes and vulnerable populations, exacerbating existing health inequalities. However, the role of area deprivation in shaping the impacts of COVID-19 in care homes is poorly understood. We examine whether area deprivation is linked to higher rates of COVID-19 outbreaks and deaths among care home residents across upper tier local authorities in England (n=149).MethodsWe constructed a novel dataset from publicly available data. Using negative binomial regression models, we analysed the associations between area deprivation (Income Deprivation Affecting Older People Index (IDAOPI) and Index of Multiple Deprivation (IMD) extent) as the exposure and COVID-19 outbreaks, COVID-19-related deaths and all-cause deaths among care home residents as three separate outcomes—adjusting for population characteristics (size, age composition, ethnicity).ResultsCOVID-19 outbreaks in care homes did not vary by area deprivation. However, COVID-19-related deaths were more common in the most deprived quartiles of IDAOPI (incidence rate ratio (IRR): 1.23, 95% CI 1.04 to 1.47) and IMD extent (IRR: 1.16, 95% CI 1.00 to 1.34), compared with the least deprived quartiles.DiscussionThese findings suggest that area deprivation is a key risk factor in COVID-19 deaths among care home residents. Future research should look to replicate these results when more complete data become available.

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