scholarly journals Capturing Intravenous Thrombolysis for Acute Stroke at the ICD‐9 to ICD‐10 Transition: Case Volume Discontinuity in the United States National Inpatient Sample

2021 ◽  
Author(s):  
Lily W. Zhou ◽  
Mina Allo ◽  
Michael Mlynash ◽  
Thalia S. Field
Keyword(s):  
Transition Period ◽  
Intravenous Thrombolysis ◽  
Resource Planning ◽  
The United States ◽  
National Inpatient Sample ◽  
Discharge Data ◽  
Period 2 ◽  
Significant Difference ◽  
Icd 10 ◽  
Slope Difference

Background Transition from International Classification of Diseases ( ICD ) Ninth and Tenth Revisions ( ICD‐9 and ICD‐10 ) for hospital discharge data was mandated for US hospitals on October 1, 2015. We examined the volume of patients receiving thrombolysis in ischemic stroke (IS) identified using ICD codes within this transition period in the 2015 to 2016 National Inpatient Sample, a weighted 20% sample of all inpatient US hospital discharges. Methods and Results During the ICD‐10 period, 2 case identification strategies were used. Codes for IS were combined with: (1) only the ICD‐10 code for thrombolytic given into a peripheral vein and (2) all new ICD‐10 codes mapped to the ICD‐9 code for all thrombolysis. On visual inspection there was an obvious discontinuity in the volume of patients with IS treated with IV thrombolysis corresponding to 3 time periods: ICD‐9 (study period 1), transition (period 2), and ICD‐10 (period 3). With Strategy 1, analysis using a linear spline with 2 knots shows that the volume of patients with IS treated with IV thrombolysis was significantly different between study periods 1 and 2 (slope difference −1880, 95% CI −2834 to −928, P =0.005), and periods 2 to 3 (slope difference 1980, 95% CI 1207–2754, P  = 0.002). With Strategy 2, volumes did not change significantly between periods 1 to 2, though there was a significant difference between periods 2 and 3 (slope difference 719, 95% CI 91–1347, P =0.034). Conclusions The significant discontinuity in thrombolysis volumes for IS during the transition period for ICD‐9 to ICD‐10 coding suggests that more rigorous validation of US administrative data during this time period may be necessary for research, resource planning, and quality assurance.

Abstract P12: Alteplase Reduces Mortality in Patients With Ischemic Stroke and Atrial Fibrillation: Analysis of the IAC Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shadi Yaghi ◽  
Eva Mistry ◽  
Adam H De Havenon ◽  
Christopher Leon Guerrero ◽  
Amre Nouh ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Infarct Volume ◽  
Intravenous Thrombolysis ◽  
The United States ◽  
Hemorrhagic Transformation ◽  
Stroke Patients ◽  
Increased Risk ◽  
Significant Difference

Background and Purpose: Multiple studies have established that intravenous thrombolysis with alteplase improves outcome after acute ischemic stroke. However, assessment of thrombolysis’ efficacy in stroke patients with atrial fibrillation (AF) has yielded mixed results. We sought to determine the association of alteplase with mortality, hemorrhagic transformation (HT), infarct volume, and mortality in patients with AF and acute ischemic stroke. Methods: We retrospectively analyzed consecutive acute ischemic stroke patients with AF included in the Initiation of Anticoagulation after Cardioembolic stroke (IAC) study, which pooled data from 8 comprehensive stroke centers in the United States. 1889 (90.6%) had available 90-day follow up data and were included. For our primary analysis we used a cohort of 1367/1889 (72.4%) patients who did not undergo mechanical thrombectomy (MT). Secondary analyses were repeated in the patients that underwent MT (n=522). Binary logistic regression was used to determine whether alteplase use was independently associated with risk of HT, final infarct volume, and 90-day mortality, respectively, adjusting for potential confounders. Results: In our primary analyses we found that alteplase use was independently associated with an increased risk for HT (adjusted OR 2.14, 95% CI 1.49 - 3.07, p <0.001) but overall reduced risk of 90-day mortality (adjusted OR 0.58, 95% CI 0.39 - 0.87, p = 0.009). Among patients undergoing MT, alteplase use was associated with a trend towards a reduction in 90-day mortality (adjusted OR 0.68 95% CI 0.45 - 1.04, p = 0.077). In the subgroup of patients prescribed DOAC treatment (n = 327; 24 received alteplase), alteplase treatment was associated with a trend towards smaller infarct size (< 10 mL), (adjusted OR 0.40, 95% CI 0.15 - 1.12, p = 0.082) without a significant difference in the odds of 90-day mortality (adjusted OR 0.51, 95% CI 0.12 - 2.13, p = 0.357) or hemorrhagic transformation (adjusted OR 0.27, 95% CI 0.03 - 2.07, p = 0.206). Conclusion: Thrombolysis with intravenous alteplase was associated with reduced 90-day mortality in AF patients with acute ischemic stroke not undergoing MT. Further study is required to assess the safety and efficacy of alteplase in AF patients undergoing MT and those on DOACs.

scholarly journals Access to Mechanical Thrombectomy for Ischemic Stroke in the United States

Stroke ◽  
2021 ◽  
Author(s):  
Hooman Kamel ◽  
Neal S. Parikh ◽  
Abhinaba Chatterjee ◽  
Luke K. Kim ◽  
Jeffrey L. Saver ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
The United States ◽  
Sensitivity Analyses ◽  
Stroke Severity ◽  
Discharge Data ◽  
Cerebral Vessel

Background and Purpose: Mechanical thrombectomy helps prevent disability in patients with acute ischemic stroke involving occlusion of a large cerebral vessel. Thrombectomy requires procedural expertise and not all hospitals have the staff to perform this intervention. Few population-wide data exist regarding access to mechanical thrombectomy. Methods: We examined access to thrombectomy for ischemic stroke using discharge data from calendar years 2016 to 2018 from all nonfederal emergency departments and acute care hospitals across 11 US states encompassing 80 million residents. Facilities were classified as hubs if they performed mechanical thrombectomy, gateways if they transferred patients who ultimately underwent mechanical thrombectomy, and gaps otherwise. We used standard descriptive statistics and unadjusted logistic regression models in our primary analyses. Results: Among 205 681 patients with ischemic stroke, 100 139 (48.7% [95% CI, 48.5%–48.9%]) initially received care at a thrombectomy hub, 72 534 (35.3% [95% CI, 35.1%–35.5%]) at a thrombectomy gateway, and 33 008 (16.0% [95% CI, 15.9%–16.2%]) at a thrombectomy gap. Patients who initially received care at thrombectomy gateways were substantially less likely to ultimately undergo thrombectomy than patients who initially received care at thrombectomy hubs (odds ratio, 0.27 [95% CI, 0.25–0.28]). Rural patients had particularly limited access: 27.7% (95% CI, 26.9%–28.6%) of such patients initially received care at hubs versus 69.5% (95% CI, 69.1%–69.9%) of urban patients. For 93.8% (95% CI, 93.6%–94.0%) of patients with stroke at gateways, their initial facility was capable of delivering intravenous thrombolysis, compared with 76.3% (95% CI, 75.8%–76.7%) of patients at gaps. Our findings were unchanged in models adjusted for demographics and comorbidities and persisted across multiple sensitivity analyses, including analyses adjusting for estimated stroke severity. Conclusions: We found that a substantial proportion of patients with ischemic stroke across the United States lacked access to thrombectomy even after accounting for interhospital transfers. US systems of stroke care require further development to optimize thrombectomy access.

In-hospital mortality in acute promyelocytic leukemia patients: A study of national inpatient sample.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18521-e18521
Author(s):  
Dipesh Uprety ◽  
Yazhini Vallatharasu ◽  
Amir Bista ◽  
Mamatha Gaddam ◽  
Andrew J Borgert ◽  
...  
Keyword(s):  
United States ◽  
Hospital Volume ◽  
Early Death ◽  
The United States ◽  
Promyelocytic Leukemia ◽  
Early Mortality ◽  
Matched Cohort ◽  
National Inpatient Sample ◽  
Inpatient Mortality ◽  
Icd 10

e18521 Background: Acute Promyelocytic Leukemia (APL), a subtype of acute myeloid leukemia, has excellent outcomes, but continues to show high rates of early mortality. An epidemiologic study utilizing SEER between 1992 & 2007 showed an early death rate of 17.3%. There is limited data on the incidence of inpatient mortality in APL patients in the United States and the factors that contribute to early death. Methods: National Inpatient Sample was utilized to identify adult patients (≥18 years) diagnosed with APL using International Classification of Diseases, 10th edition (ICD-10-CM) code C92.40. Since the United States transitioned from using ICD-9-CM to ICD-10-CM on October 2015, we included APL patients diagnosed between 2015 & 2016. Clinical, sociodemographic and hospital characteristic data were examined; hospital volume was divided into quartiles. The association between overall inpatient survival & receipt of chemotherapy was examined in a propensity score matched cohort of patients not discharged to another acute care facility. Statistical analyses were conducted utilizing SAS version 9.4. Results: In total, 433 APL patients were identified (median age 52 years, 52% males, 65% whites). The inpatient mortality rate was 9.93%. 59.5% (n = 258) of patients did not receive chemotherapy. On univariate-analysis, patients with younger age, black-race, transfer in from other hospital, elective admissions, private insurance, large bed size hospital & large hospital volume were more likely to receive chemo. In the matched-cohort, receipt of chemo was associated with decreased mortality (Hazard Ratio 0.27, 95% CI: 0.12-0.60). We ran additional mortality analysis landmarked at 3 days and 7 days: 75% of chemo patients receiving treatment within 3 days had survival advantage with chemo (HR: 0.35 [0.15-0.82]). 90% of chemo patients receiving treatment within 7 days didn’t show any difference in survival (HR: 0.49 [0.18-1.32]) but the sample size was small. Conclusions: Our study showed an early survival benefit when patient with APL received chemotherapy within 3 days of admission. Early recognition & prompt treatment initiation will help reduce the rate of early mortality in patients with APL.

Abstract 065: Hospital Teaching Status and TAVR Outcomes in the United States - Analysis of the National Inpatient Sample (NIS)

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Emmanuel Akintoye ◽  
Samson Alliu ◽  
Oluwole Adegbala ◽  
Haider Aldiwani ◽  
Mohamed Shokr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Kidney Injury ◽  
The United States ◽  
Teaching Hospitals ◽  
National Inpatient Sample ◽  
Mixed Effect ◽  
Significant Difference ◽  
Teaching Status ◽  
Risk Of Hemorrhage ◽  
The U.S

Background: Evidence suggest that medical service offerings vary by hospital teaching status. However, little is known about how these translate to patient outcomes. We therefore sought to evaluate this gap in knowledge in patients undergoing TAVR Methods: This study was conducted using the National Inpatient Sample (NIS) in the U.S (2011-2013). Teaching status was classified as teaching vs non-teaching and endpoints were clinical outcomes, length of stay and cost. Procedure-related complications were identified via ICD-9 coding and analysis was performed via mixed effect model Results: An estimated 17,020 TAVR procedures were performed in the U.S between 2011 and 2013, out of which 87% were in teaching hospitals. Mean (SD) age was 80 (8) and 47% were females. There was no significant difference between hospital teaching status with regards to procedure-related in-patient mortality, myocardial infarction, or other cardiac, vascular, neurological, respiratory complications, post-op DVT/PE, or sepsis (Fig 1). However, compared to non-teaching hospitals, teaching hospitals tend to have higher risk of acute kidney injury (OR: 1.47 [95% CI, 1.08-1.99]) but lower risk of hemorrhage requiring transfusion (OR: 0.67 [95% CI, 0.50-0.91]). The mean length of stay was higher in teaching hospitals (8.3 days) compared to non-teaching hospitals (7.5 days) (fig 2A), but median cost of hospitalization was higher in non-teaching hospitals (USD 59702 vs 49708) (fig 2B) Conclusion: We found that the risks of most TAVR-related complications (except for AKI and hemorrhage) are about the same in teaching compared to non-teaching hospitals. However, length of stay was higher in teaching hospitals while cost was higher in non-teaching hospitals

Anemia Is Associated With Poor Clinical Outcomes in Hospitalized Patients With Takotsubo Cardiomyopathy

Angiology ◽  
2021 ◽  
pp. 000331972199949
Author(s):  
Xiaojia Lu ◽  
Pengyang Li ◽  
Catherine Teng ◽  
Peng Cai ◽  
Bin Wang
Keyword(s):  
Takotsubo Cardiomyopathy ◽  
Kidney Injury ◽  
Length Of Hospital Stay ◽  
International Classification Of Diseases ◽  
The United States ◽  
Primary Diagnosis ◽  
National Inpatient Sample ◽  
Classification Of Diseases ◽  
Icd 10

The association between anemia and Takotsubo cardiomyopathy (TCM) has not been well studied. To assess the effect of anemia on patients hospitalized with TCM, we identified 4733 patients with a primary diagnosis of TCM from the 2016 to 2018 National Inpatient Sample (NIS) database (the United States) using the International Classification of Diseases, 10th edition, Clinical Modification ( ICD-10-CM) code. Of these, 603 (12.7%) patients had a comorbidity of anemia and 4130 did not. After propensity score matching, we compared the in-hospital outcomes between the 2 groups (anemia vs nonanemia, n = 594 vs 1137). Patients with TCM with anemia had significantly higher rates of in-hospital complications, including cardiogenic shock (11.4% vs 4.0%, P < .001), ventricular arrhythmia (6.6% vs 3.6%, P = .008), acute kidney injury (22.7% vs 13.1%, P < .001), acute respiratory failure (22.6% vs 13.1%, P < .001), longer length of hospital stay (5.6 ± 5.8 days vs 3.6 ± 3.6 days, P < .001), and higher total charges (US$79 586 ± 10 2436 vs US$50 711 ± 42 639, P < .001). In conclusion, patients with anemia who were admitted for TCM were associated with a higher incidence of in-hospital complications compared with those without anemia.

scholarly journals Causes of Hospitalization in the United States between 2005–2018

2021 ◽  
Author(s):  
Husam M Salah ◽  
Abdul Mannan Khan Minhas ◽  
Muhammad Shahzeb Khan ◽  
Ambarish Pandey ◽  
Erin D Michos ◽  
...  
Keyword(s):  
United States ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiac Arrhythmias ◽  
The United States ◽  
National Inpatient Sample ◽  
Discharge Data ◽  
High Burden ◽  
The Us ◽  
Common Causes

Abstract In this report, we identify the ten most common causes of hospitalizations in the United States (US) in 2005–2018 using the discharge data from the National Inpatient Sample database. We show that sepsis has been the leading cause of hospitalizations in the US followed by heart failure, which has consistently been within the three most common causes of hospitalizations since 2005. Additionally, we show a high burden of cardiovascular diseases as a cause of hospitalization over the study period with a consistent presence of cardiac arrhythmias as one of the top 10 causes of hospitalizations in the US and emergence of acute myocardial infarction as one of the top 10 causes after 2014.

scholarly journals Three easily-implementable changes reduce median door-to-needle time for intravenous thrombolysis by 23 minutes

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Demi Tran ◽  
Zhu Zhu ◽  
Mohammad Shafie ◽  
Hermelinda Abcede ◽  
Dana Stradling ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Intervention Group ◽  
Intravenous Thrombolysis ◽  
The United States ◽  
Quality Improvement Initiative ◽  
Great Effort ◽  
Post Intervention ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference ◽  
Post Intervention Group

Abstract Background The benefit of intravenous thrombolysis (IVT) for acute ischemic stroke is time dependent. Despite great effort, the median door-to-needle time (DNT) was 60 min at the United States stroke centers. We investigated the effect of a simple quality improvement initiative on DNT for IVT. Methods This is a single-center study of patients treated with IVT between 2013 and 2017. A simple quality improvement initiative was implemented in January 2015 to allow the Stroke team to manage hypertension in the emergency room, to make decision for IVT before getting blood test results unless patients were taking oral anticoagulants, and to give IVT in the CT suite. Baseline characteristics, DNT and outcomes at hospital discharge were compared between pre- and post-intervention groups. Results Ninety and 136 patients were treated with IVT in pre- and post-intervention groups, respectively. The rate of IVT was significantly higher in the post-intervention group (20% vs. 14.4%, p = 0.007). The median DNT with interquartile range (IQR) was reduced significantly by 23 min (63[53–81] vs. 40[29–53], p < 0.001) with more patients in the post-intervention group receiving IVT within 60 min (81.6% vs. 46.7%) and 45 min (64.0% vs.17.8%). There was no significant difference in symptomatic intracerebral hemorrhage rate (1.5% vs. 1.1%), modified Rankin Scale 0–1 (29.4% vs. 23.3%), and hospital mortality (7.4% vs. 6.7%) between the 2 groups. Conclusions Three easily-implementable quality improvement initiative increases IVT rate and reduces DNT significantly without increasing the rate of IVT-related complications in our comprehensive stroke center.

Abstract 15132: Inpatient Outcome of Infective Pericarditis in the United States: An Analysis From National Inpatient Sample 2016-2017

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bolun Liu ◽  
Bing Chen ◽  
Omid Behnamfar ◽  
Trisha Gomez ◽  
Ajoe Kattoor
Keyword(s):  
Cardiac Tamponade ◽  
Hemodynamic Instability ◽  
The United States ◽  
Primary Diagnosis ◽  
National Inpatient Sample ◽  
All Cause Mortality ◽  
Icd 10 ◽  
The Mean ◽  
Baseline Characteristics ◽  
Basic Characteristics

Introduction: Infective pericarditis is a relatively uncommon condition in the modern antibiotic era, has a high mortality rate (20-30%) and is associated with immunosuppression, alcohol use, illicit drug use, thoracic surgery. Outcomes data in the current era is unknown. We aim to analyze the baseline characteristics and outcomes of patients admitted in the hospital with infective pericarditis. Methods: We conducted a retrospective study using National Inpatient Sample (NIS) database from 2016 to 2017. Hospital visits with a primary diagnosis of infective pericarditis (ICD10, I30.1) during which a pericardial procedure was performed were identified using ICD-10-CM and ICD-10-PCS Codes. Our primary outcome was basic characteristics and in-hospital all-cause mortality. Multivariate regression model was used to adjust for the pericardial procedure approach, age, and cardiac tamponade. R (Version 3.6.1) was utilized for the analysis. Results: A total of 1010 weighted hospitalizations in adult patients with infective pericarditis were identified. The mean age was 56.7±1.1 years (woman - 41.4%). The baseline characteristics and comorbidities are described in table 1 and table 2. 60.5% of the patients underwent percutaneous pericardial drainage, 36.4% had open surgery, and 3.2% had VATs. The mean time from admission to a pericardial procedure is 1.7±0.2 days. In-hospital all-cause mortality was 2.27%. The mean length of stay was 7.59±0.43 days. The mean total cost was 22530±1193 US dollars. Among all hospitalizations, 61.8% of them were complicated by hemodynamic instability and 56.8% had cardiac tamponade. Compared to pericardiocentesis, patients who underwent pericardiotomy had a higher mortality (5% vs 0.8%, adjusted OR 8.03, P = 0.043). Conclusions: Our study demonstrates relatively low inpatient mortality with infective pericarditis compared to older studies. Around half of the patients had cardiac tamponade.

scholarly journals Three Easily-Implementable Changes Reduce Median Door-To-Needle Time for Intravenous Thrombolysis by 23 Minutes

2019 ◽  
Author(s):  
Demi Tran ◽  
Zhu Zhu ◽  
Mohammad Shafie ◽  
Hermelinda Abcede ◽  
Dana Stradling ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Intervention Group ◽  
Intravenous Thrombolysis ◽  
The United States ◽  
Quality Improvement Initiative ◽  
Great Effort ◽  
Post Intervention ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference ◽  
Post Intervention Group

Abstract Background: The benefit of intravenous thrombolysis (IVT) for acute ischemic stroke is time dependent. Despite great effort, the median door-to-needle time (DNT) was 60 minutes at the United States stroke centers. We investigated the effect of a simple quality improvement initiative on DNT for IVT. Methods: This is a single-center study of patients treated with IVT between 2013 and 2017. A simple quality improvement initiative was implemented in January 2015 to allow the Stroke team to manage hypertension in the emergency room, to make decision for IVT before getting blood test results unless patients were taking oral anticoagulants, and to give IVT in the CT suite. Baseline characteristics, DNT and outcomes at hospital discharge were compared between pre- and post-intervention groups. Results: Ninety and 136 patients were treated with IVT in pre- and post-intervention groups, respectively. The rate of IVT was significantly higher in the post-intervention group (20% vs. 14.4%, p=0.007). The median DNT with interquartile range (IQR) was reduced significantly by 23 minutes (63[53-81] vs. 40[29-53], p<0.001) with more patients in the post-intervention group receiving IVT within 60 minutes (81.6% vs. 46.7%) and 45 minutes (64.0% vs.17.8%). There was no significant difference in symptomatic intracerebral hemorrhage rate (1.5% vs. 1.1%), modified Rankin Scale 0-1 (29.4% vs. 23.3%), and hospital mortality (7.4% vs. 6.7%) between the 2 groups. Conclusions: Three easily-implementable quality improvement initiative increases IVT rate and reduces DNT significantly without increasing the rate of IVT-related complications in our comprehensive stroke center.

scholarly journals Three Easily-Implementable Changes Reduce Median Door-To-Needle Time for Intravenous Thrombolysis by 23 Minutes

2019 ◽  
Author(s):  
Demi Tran ◽  
Zhu Zhu ◽  
Mohammad Shafie ◽  
Hermelinda Abcede ◽  
Dana Stradling ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Intervention Group ◽  
Intravenous Thrombolysis ◽  
The United States ◽  
Functional Independence ◽  
Quality Improvement Initiative ◽  
Great Effort ◽  
Post Intervention ◽  
Significant Difference ◽  
Post Intervention Group

Abstract Background: The benefit of intravenous thrombolysis (IVT) for acute ischemic stroke is time dependent. Despite great effort, the median door-to-needle time (DNT) was 60 minutes at the United States stroke centers. We investigated the effect of a simple quality improvement initiative on DNT for IVT. Methods: This is a single-center study of patients treated with IVT between 2013 and 2017. A simple quality improvement initiative was implemented in January 2015 to allow the Stroke team to manage hypertension in the emergency room, to make decision for IVT before getting blood test results unless patients were taking oral anticoagulants, and to give IVT in the CT suite. Baseline characteristics, DNT and outcomes at hospital discharge were compared between pre- and post-intervention groups. Results: Ninety and 136 patients were treated with IVT in pre- and post-intervention groups, respectively. The rate of IVT was significantly higher in the post-intervention group (20% vs. 14.4%, p=0.007). The median DNT with interquartile range (IQR) was reduced significantly by 23 minutes (63[53-81] vs. 40[29-53], p<0.001) with more patients in the post-intervention group receiving IVT within 60 minutes (81.6% vs. 46.7%) and 45 minutes (64.0% vs.17.8%). There was no significant difference in symptomatic intracerebral hemorrhage rate (1.5% vs. 1.1%), functional independence at discharge (modified Rankin Scale 0-1, 29.4% vs. 23.3%), and hospital mortality (7.4% vs. 6.7%) between the 2 groups. Conclusions: Three easily-implementable quality improvement initiative increases IVT rate and reduces DNT significantly without increasing the rate of IVT-related complications in our comprehensive stroke center.

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