Abstract P456: Myocardial Infarction in Patients With Intracerebral Hemorrhage. Prevalence and Impact on Outcome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Rauf Chaudhry ◽  
Hussan Gill ◽  
Saqib Chaudhry ◽  
Baljinder Singh ◽  
Harathi Bandaru ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intracerebral Hemorrhage ◽  
Nationwide Inpatient Sample ◽  
Hospital Charges ◽  
Discharge Disposition ◽  
International Classification Of Disease ◽  
Myocardial Infraction ◽  
Discharge Outcomes ◽  
Baseline Characteristics

Introduction/background: Comorbidities can potentially affect outcome of patients with intracerebral hemorrhage (ICH). It is unclear what the prevalence of acute myocardial infarction (AMI) and its impact on outcome are in patients with intracerebral hemorrhage. Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all intracerebral hemorrhage (ICH) patients. AMI was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, discharge disposition, length of stay and in-hospital charges) were compared between the two groups. Results: Of the 884379 patients with ICH, 27692 (3.13%) had in-hospital myocardial infraction. ICH patients with AMI order had lower proportion of females (47.8% versus 49.7%, P= 0.0028) and were older (69.7 years versus 67.2 years, P <.0001) compared to ICH patients without MI. The in-hospital mortality was higher (40.9% versus 25.5%, p≤.0001) among ICH patients with AMI in both univariate and multivariate analysis (OR = 1.22 (1.14 -1.31), P<.0001) after adjusting for potential confounders. ICH patients with MI had higher (72.4% versus 58.8%, P <.0001) proportion of moderate to severe disability at discharge compared to ones without. Similarly, mean length of in-hospital stay (12.4 days versus 8.94 days, P <.0001) and mean hospital charges ($129328 versus $ 81984.0, P <.0001) were also higher in ICH patients with MI Conclusions: While only 3.13% of patients with ICH have an AMI, there is a 22% increase in worse outcome among those patients with AMI and ICH.

Abstract P444: Myocardial Infarction and Subarachnoid Hemorrhage. Frequency and Impact on Outcome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Rauf Chaudhry ◽  
Hussan Gill ◽  
Saqib Chaudhry ◽  
Baljinder Singh ◽  
Harathi Bandaru ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Subarachnoid Hemorrhage ◽  
Fold Increase ◽  
Severe Disability ◽  
Hospital Charges ◽  
Neurogenic Pulmonary Edema ◽  
Systemic Complications ◽  
International Classification Of Disease ◽  
Myocardial Infraction ◽  
Increase Risk

Introduction/background: Subarachnoid hemorrhage is known to be associated with systemic complications including neurogenic pulmonary edema and Talkotsubo cardiomyopathy. We set to establish the frequency of myocardial infarction (MI) and its impact on outcome among patients with subarachnoid hemorrhage (SAH) Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all subarachnoid hemorrhage (ICH) patients. Myocardial infraction (MI) was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, moderate to severe disability at dischagre, length of stay and in-hospital charges) were compared between the two groups. Results: Of the 325923 patients with SAH, 12720 (3.90%) had in-hospital myocardial infraction. SAH patients with MI were older (64.6 years versus 59.0 years, P <.0001) compared to SAH patients without MI but there was no difference in-term of proportion of females between the two groups. The in-hospital mortality was also higher (49.8% versus 23.9%, p≤.0001) among patients with MI in both univariate and multivariate analysis (OR = 1.75 (1.59 -1.93), P<.0001) after adjusting for potential confounders. SAH patients with MI had higher (68.5% versus 40.9%, P <.0001) proportion of moderate to severe disability at discharge compared to ones without. Similarly, mean length of in-hospital stay (13.2 days versus 11.8 days, P <.0001) and mean hospital charges ($188845 versus $150062, P <.0001) were also higher in SAH patients with MI Conclusions: While MI was reported in only 3.9% of SAH cases it had a significant impact on outcome with a one fold increase in morality and about 75% increase risk of severe disability.

Abstract P454: Do Not Resuscitate Orders in Intracerebral Hemorrhage Patients. Impact on Mortality

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Rauf A Chaudhry ◽  
Hussan Gill ◽  
Saqib Chaudhry ◽  
Baljinder Singh ◽  
Harathi Bandaru ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
The Self ◽  
Racial Groups ◽  
Do Not Resuscitate ◽  
Code Status ◽  
International Classification Of Disease ◽  
Discharge Outcomes ◽  
Racial Ethnic ◽  
Dnr Orders

Introduction/background: Do not resuscitate (DNR) orders have been associated with higher mortality in hospitalized patients which the question if they these patients are victims of the self-fulfilling prophecy; that the odds of their survival is made worse by withholding aggressive treatment. In addition, previous reports show that racial and ethnic minorities tend to opt for more aggressive and lifesaving procedures as compared to Whites. Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all intracerebral hemorrhage (ICH) patients. DNR code status was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, length of stay) were compared between the two groups. DNR code status was compared between different racial groups. Results: Of the 884379 patients with ICH, 81968 (9.26%%) had DNR order. ICH patients with DNR order had higher proportion of females (55.1% versus 49.1%, P <.0001) and were older (74.2 years versus 66 years, P <.0001) compared to ICH patients without DNR. The in-hospital mortality was also higher (53.4% versus 23.3%, p≤.0001) among patients with DNR both univariate and multivariate analysis (OR = 3.24 (3.07 -3.41), p<.0001) after adjusting for potential confounders. Whites have a higher rate (11.5% versus 8.08%) of DNR order as compared to other racial/ethnic groups Conclusions: While there may be other explanations at play, the higher mortality and shorter LOS suggest that early DNR orders do lead to the self-fulfilling prophecy. The lower proportion of DNR orders among minorities suggest a sociocultural aspect in accepting the concept of DNR. These two facts raise concerns about what the real vs perceived meaning of DNR orders.

Abstract 17330: Predictors of Acute Myocardial Infarction During Pregnancy

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Byomesh Tripathi ◽  
Varun Kumar ◽  
Purnima Sharma ◽  
Shilpkumar Arora ◽  
Shikha Malhotra ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Nationwide Inpatient Sample ◽  
Electrolyte Imbalance ◽  
High Risk Population ◽  
International Classification Of Disease ◽  
Nationwide Inpatient Sample Database ◽  
Simple Logistic

Introduction: Risk stratification of the pregnant population is critical to improving outcomes associated with pregnancy-related Acute myocardial infarction (AMI). Methods: Pregnancy-related hospitalizations (antepartum as well as postpartum) and AMI were identified using appropriate International classification of disease-Ninth revision (ICD-9) codes from nationwide inpatient sample database (2005-2014). Simple logistic regression was used to calculate predictors of AMI during pregnancy. Results: We identified 3,786 cases of AMI from a total of 43,437,621 pregnancy related hospitalization during study period. Compared to pregnant women <20-year, we noted more than 10-fold risk of AMI among patients ≥ 40 years (OR 10.1, 95% CI 5.3-19.0, p<0.001). Other significant predictors of AMI during pregnancy were black race compared to white ( OR 1.6, 95% CI 1.3-1.9, p<0.001), co-existing comorbidities such as hypertension (OR 1.9, 95% CI 1.5-2.5, p<0.001),, thrombophilia (OR 4.8, 95% CI 2.7-8.5, p<0.001), diabetes milletus (OR 1.4, 95% CI 1.0-1.9, p<0.027),hyperlipidemia (OR 13.2, 95% CI 9.9-17.6, p<0.001),smoking (OR 3.3, 95% CI 2.3-4.6, p<0.001), substance abuse (OR 1.7, 95% CI 1.2-2.6, p=0.007), congestive heart failure (OR 26.0, 95% CI 20.3-33.2 p<0.001), deep venous thrombosis (OR 2.8, 95% CI 1.3-6.2, p=0.010) as well as obstetric condition including postpartum hemorrhage (OR 1.8, 95% CI 1.3-2.4, p<0.001),, transfusion during pregnancy (OR 3.2, 95% CI 2.4-4.2, p<0.001), postpartum infection (OR 2,7, 95% CI 1.9-3.9, p<0.001),, fluid and electrolyte imbalance (OR 5.2, 95% CI 4.2- 6.6, p<0.001), and postpartum depression (OR 1.4, 95% CI 1.1-1.9 p=0.013). Conclusions: We identified certain patient-level characteristics which correlated to high risk of AMI. This information can be utilized to decide resource allocation and the introduction of early multidisciplinary intervention among high-risk population

Abstract TP121: National Patterns of Carotid Revascularization in the Pre- and Post- Crest Era

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Fadar O Otite ◽  
Priyank Khandelwal ◽  
Amer M Malik ◽  
Seemant Chaturvedi
Keyword(s):  
Nationwide Inpatient Sample ◽  
Age Groups ◽  
Western Region ◽  
Peripheral Vascular ◽  
Multivariate Models ◽  
Carotid Revascularization ◽  
International Classification Of Disease ◽  
Asymptomatic Women ◽  
Over Time

Background: The Carotid Revascularization Endarterectomy vs. Stenting Trial (CREST) showed greater safety of carotid artery stenting (CAS) in patients (pts) <70 yo and endarterectomy (CEA) in >70 yo. The aim of this study was to evaluate national patterns in CAS performance in pts >70yo in the pre- (2007-2010) and post-CREST (2011-2013) era. Methods: Adults requiring CAS or CEA were identified from the 2007-2013 Nationwide Inpatient Sample (NIS) using International Classification of Disease (ICD-9) codes. We estimated the proportion of CAS performed in all age groups and used multivariate models adjusted for clinical and hospital factors to compare odds of receiving CAS in the pre- to post-CREST era. Results: We identified 839,357 weighted cases of CAS and CEA from the NIS. 15.7% of CAS and 8.4% of CEA were performed in symptomatic pts. CAS increased in all age groups over time (figure 1). Proportion of >70yo receiving CAS increased from 11.9% in the pre- to 13.9% in the post-CREST era (p=0.004). In multivariate models, odds of receiving CAS as opposed to CEA increased by 15% in all pts >70yo in the post-CREST compared to the pre-CREST period (OR 1.15, 95%CI 1.10-1.19, p<0.001) including asymptomatic women (OR 1.10, 1.03-1.18). Congestive heart failure (OR 1.50, 95%CI 1.41-1.60), peripheral vascular disease (OR 1.41, 95%CI 1.34-1.48) and hospitalization in the Western region as opposed to the Northeast (OR 1.25, 95%CI 1.16-1.34) were associated with higher odds of CAS in pts>70yo, while female sex (OR 0.92, 95%CI =0.89-0.97), smoking (OR 0.84, 95%CI 0.79-0.90) and weekend admission (OR 0.78, 95%CI 0.70-0.86) were negatively associated with odds of CAS. Conclusion: Rates of CAS increased in the post- compared to pre-CREST era in pts >70yo including asymptomatic women. Despite the concerns of higher periprocedural complications with CAS in elderly pts, the results of CREST have not influenced clinical revascularization practice in pts >70yo.

Incidence of Sinusitis Associated With Endotracheal and Nasogastric Tubes: NIS Database

2018 ◽  
Vol 27 (1) ◽  
pp. 24-31
Author(s):  
Norma A. Metheny ◽  
Leslie J. Hinyard ◽  
Kahee A. Mohammed
Keyword(s):  
Endotracheal Tube ◽  
Nasogastric Tube ◽  
Nationwide Inpatient Sample ◽  
International Classification Of Disease ◽  
Nasogastric Tubes ◽  
Nationwide Inpatient Sample Database ◽  
Nosocomial Sinusitis ◽  
Tube Type ◽  
Low Incidence

Background Endotracheal and nasogastric tubes are recognized risk factors for nosocomial sinusitis. The extent to which these tubes affect the overall incidence of nosocomial sinusitis in acute care hospitals is unknown. Objective To use data for 2008 through 2013 from the Nationwide Inpatient Sample database to compare the incidence of sinusitis in patients with nasogastric tubes with that in patients with an endotracheal tube alone or with both an endotracheal tube and a nasogastric tube. Methods Patients’ data with any of the following International Classification of Disease, Ninth Revision, Clinical Modification codes were abstracted from the database: (1) 96.6, enteral infusion of concentrated nutritional substances; (2) 96.07, insertion of other (naso-)gastric tube; or (3) 96.04, insertion of an endotracheal tube. Sinusitis was defined by the appropriate codes. Weighted and unweighted frequencies and weighted percentages were calculated, categorical comparisons were made by χ2 test, and logistic regression was used to examine odds of sinusitis development by tube type. Results Of 1 141 632 included cases, most (68.57%) had an endotracheal tube only, 23.02% had a nasogastric tube only, and 8.41% had both types of tubes. Sinusitis was present in 0.15% of the sample. Compared with patients with only a nasogastric tube, the risk for sinusitis was 41% greater in patients with an endotracheal tube and 200% greater in patients with both tubes. Conclusion Despite the low incidence of sinusitis, a significant association exists between sinusitis and the presence of an endotracheal tube, especially when a nasogastric tube is also present.

Recent trends in the treatment of spontaneous intracerebral hemorrhage: analysis of a nationwide inpatient database

2009 ◽  
Vol 110 (3) ◽  
pp. 403-410 ◽  
Author(s):  
Norberto Andaluz ◽  
Mario Zuccarello
Keyword(s):  
Intracerebral Hemorrhage ◽  
Large Scale ◽  
Nationwide Inpatient Sample ◽  
Length Of Hospital Stay ◽  
Healthcare Research ◽  
Hospital Charges ◽  
Significant Progress ◽  
Nationwide Inpatient Sample Database ◽  
Recent Trends ◽  
Multiple Variables

Object Recently updated guidelines failed to reflect significant progress in the treatment of intracerebral hemorrhage (ICH). Using data from a nationwide hospital database, the authors identified recent trends in therapy and outcomes for ICH, as well as the effect of associated comorbidities and procedures, including surgery. Methods Data from the Nationwide Inpatient Sample hospital discharge database (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality) for the period 1993–2005 was retrospectively reviewed. Multiple variables were categorized and subjected to statistical analysis for codes related to ICH from the International Classification of Diseases, 9th revision, Clinical Modification. Data linked by the Nationwide Inpatient Sample database to associated diagnoses and procedures were also retrieved and analyzed. Results The number of discharges remained constant for ICH. The mortality rate remained unchanged at an average of 31.6%, whereas routine discharges (home) steadily declined by 25%, and discharges other than home doubled (p < 0.01). By the end of the study, length of hospital stay decreased by 30% (p < 0.01), and mean hospital charges steadily increased to more than twice the original figures. Arterial hypertension was the most frequently associated comorbidity. Seizures were associated with longer hospital stays and higher mean hospital charges. Craniotomy was associated with decreased mortality rates but also with worse outcomes and lower rates of patients discharged home (p < 0.01). No geographic differences in treatment and outcomes were noted. Conclusions From 1993 to 2005, no significant progress in treatment and prevention of ICH was noted. There were no regional differences in the treatment and outcome of ICH. The role of surgery for ICH remains uncertain, and large-scale controlled studies are greatly needed to clarify this role.

Abstract W P68: Treatment of Unruptured Intracranial Aneurysms Within the Pediatric Population

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Malik M Adil ◽  
Lori C Jordan ◽  
Adnan I Qureshi
Keyword(s):  
Hospital Mortality ◽  
Intracranial Aneurysms ◽  
Pediatric Population ◽  
Primary Diagnosis ◽  
Favorable Outcome ◽  
High Rate ◽  
Discharge Disposition ◽  
International Classification Of Disease ◽  
Unruptured Intracranial Aneurysms

Background: The rates and outcomes of treatments for intracranial aneurysms have not been exclusively determined within the pediatric population. We determined the rates of endovascular and microsurgical treatments for unruptured intracranial aneurysms (UIA) and associated rates of favorable outcome. Methods: We analyzed the data obtained as part of the Kids’ Inpatient Database between 2003 and 2009 with primary diagnosis of UIA (identified by the International Classification of Disease codes, Ninth Revision). Patients undergoing endovascular treatment (ET) were compared to those undergoing microsurgical treatment (MT). Outcomes were defined as rates of intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), in-hospital mortality, or favorable outcome (discharge disposition of home/self-care). Results: There were 818 cases of UIAs during the timeline examined. A total of 111 patients (mean age 14±6 years, 37.6% female) underwent MT and another 200 patients (mean age 13±7 years, 42.5% female) underwent ET. There were no significant differences in rates of ICH (MT 4.4% versus ET 2%, p=0.4) and SAH (MT 15.5% versus ET 9.3%, p=0.2). There was no in-hospital mortality among those who received MT, and 3 patients died among those who received ET. A high rate of favorable outcome was observed in patients who received either treatment (MT 87.7% versus ET 91.6%, p=0.4). There was a trend towards a significantly shorter mean hospitalization stay among those who received ET as opposed to MT (6±12 days versus 9±11 days, p=0.06). There was also a significant trend towards higher utilization of ET as opposed to MT from 2003 to 2009 (p=0.02). Conclusion: Although outcomes except for length of stay are comparable between ET and MT patients, there is a trend towards higher utilization of ET among children with UIAs from 2003 to 2009.

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