scholarly journals ICES Report: Choices and Tradeoffs: Decreasing Costs or Improving Hospital Mortality Rates

2088 ◽  
Vol 11 (1) ◽  
pp. 23-24
Author(s):  
Ann Tourangeau
Keyword(s):  
Hospital Mortality ◽  
Mortality Rates

scholarly journals Procedural and remote outcome among patients undergoing urgent trans-catheter aortic valve implantation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Berkovitch ◽  
A Segev ◽  
A Finkelstein ◽  
R Kornowski ◽  
H Danenberg ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Hospital Mortality ◽  
Mortality Rates ◽  
P Value ◽  
Complication Rates ◽  
Increased Risk ◽  
Procedural Complication ◽  
Elective Procedure ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Severe aortic stenosis patients suffer frequent heart failure decompensations events often requiring hospitalization. In extreme situations patients can be found with pulmonary edema and cardiogenic shock, unresponsive to medical treatment. Urgent trans-catheter aortic valve implantation (TAVI) has emerged as a treatment option for these high-risk patients. Methods We investigated 3,599 patients undergoing TAVI. Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N=3,448) and those who had an urgent TAVI (N=151). Peri-procedural complications were documented according to the VARC-2 criteria. In hospital and 1-year mortality rates were prospectively documented. Results Mean age of the study population was 82±7, of whom 52% were female. Peri-procedural complication rates was significantly higher among patients with an urgent indication for TAVI compared to those having an elective procedure: valve malposition 3.6% vs. 0.6% (p-value=0.023), valve migration 3.2% vs. 0.9% (p-value=0.016), post procedure myocardial infarction 3.7% vs. 0.3% (p-value=0.004), and stage 3 acute kidney injury 2.6% vs. 0.5%, (p-value=0.02). Univariate analysis found that patients with urgent indication for TAVI had significantly higher in hospital mortality (5.8% vs. 1.4%, p-value<0.001). similarly, multivariate analysis adjusted for age, gender and cardio-vascular risk factors found that patients with urgent indication had more than 5-folds increased risk of in-hospital mortality (OR 5.94, 95% CI 2.28–15.43, p-value<0.001). Kaplan-Meier's survival analysis showed that patients undergoing urgent TAVI had higher 1-year mortality rates compared to patients undergoing an elective TAVI procedure (p-value log-rank<0.001, Figure). Multivariate analysis found they had more than 2-folds increased risk of mortality at 1-year (HR 2.27, 95% CI 1.53–3.38, p<0.001 compared to those having an elective procedure. Conclusions Patients with urgent indication for TAVI have higher in-hospital mortality and higher peri-procedural complication rates. However, if these patients survive the index hospitalization, they enjoy good prognosis. Kaplan-Meier's survival analysis Funding Acknowledgement Type of funding source: None

Features of Stroke in Chinese Diabetes Patients: A Hospital-based Study

2007 ◽  
Vol 35 (4) ◽  
pp. 540-546 ◽  
Author(s):  
X-D Zhang ◽  
Y-R Chen ◽  
L Ge ◽  
Z-M Ge ◽  
Y-H Zhang
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Ischaemic Stroke ◽  
Cerebral Haemorrhage ◽  
Mortality Rates ◽  
Demographic Characteristics ◽  
Major Influence ◽  
Diabetic Patients ◽  
Clinical Factors ◽  
Patients With Diabetes

In this study, demographic characteristics, risk factors, stroke subtypes and outcome were compared in 2532 patients with and without diabetes hospitalized for first-ever stroke. Diabetes was present in 471 (18.6%) of the patients. Patients with diabetes presented more frequently with ischaemic stroke (92.1% versus 71.3%), especially lacunar infarction (41.2% versus 35.2%), compared with non-diabetics. Cerebral haemorrhage was less frequent in diabetics than non-diabetics (4.2% versus 18.1%). In-hospital mortality rates from ischaemic stroke were similar in the two groups (18.2% in diabetics and 16.9% in non-diabetics). Predictors of in-hospital mortality in diabetic patients included decreased consciousness, congestive heart failure and atrial fibrillation. In conclusion, stroke in diabetic patients was different to stroke in non-diabetic patients: in diabetics the frequency of cerebral haemorrhage was lower and the rate of lacunar infarct syndrome was higher, but in-hospital mortality from ischaemic stroke was not increased. Clinical factors evident at the onset of stroke have a major influence on in-hospital mortality and may help clinicians provide a more accurate prognosis.

In-hospital mortality rates and HIV: a medical ward review, Lilongwe, Malawi

2011 ◽  
Vol 22 (8) ◽  
pp. 465-470 ◽  
Author(s):  
A Akinkuotu ◽  
E Roemer ◽  
A Richardson ◽  
D C Namarika ◽  
C Munthali ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Mortality Rates ◽  
Medical Ward

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.

scholarly journals In-Hospital Mortality and Morbidity Among Patients Presenting with Intracranial Hemorrhage: A Single Center's Experience with Vitamin K Antagonists and the Direct Oral Anticoagulants

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3668-3668
Author(s):  
Christopher Cipkar ◽  
Sujitha Srinathan ◽  
Philip Chiang ◽  
Lana A Castellucci
Keyword(s):  
Hospital Mortality ◽  
Chart Review ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Bleeding Event ◽  
Mortality Rates ◽  
Clinical Impact ◽  
Mortality And Morbidity ◽  
Ottawa Hospital

Background Oral anticoagulants are the preferred therapy for the treatment of venous thromboembolism and for stroke prevention among patients with atrial fibrillation. Given their widespread use, clinicians must balance efficacy of anticoagulation with their associated bleeding risks. Specifically, intracranial hemorrhage (ICH) is the most feared complication as this form of bleeding has the highest mortality and morbidity. To date, clinical trials suggest a lower incidence of ICH and better safety profile among patients prescribed the direct oral anticoagulants (DOACs) compared with traditional vitamin k antagonists (VKAs). Although promising, further understanding is needed to appreciate the clinical impact once a DOAC-related bleeding event does occur. The aim of this study was to evaluate anticoagulation use, in-hospital mortality rates and functional outcome among patients presenting with ICH to a large tertiary care center in Canada. Methods In this study, we present data from a retrospective chart review of patients who presented to The Ottawa Hospital with ICH between January 2016 and December 2017. Patients were identified using ICD-10 codes from the Ottawa Hospital Data Warehouse. Patient demographics, type of anticoagulant/antiplatelet agent and indication for therapy were collected. The primary outcome was in-hospital mortality rates among patients prescribed oral anticoagulants compared with those not anticoagulated or on antiplatelet therapy. A secondary outcome was functional assessment of survivors at hospital discharge using the modified Rankin Scale (mRS), a validated tool used widely in contemporary stroke research to measure the degree of disability after a neurological event. Results 481 patients were identified in the Data Warehouse and manual chart review confirmed 429 patients diagnosed with ICH. Patients not taking any anticoagulant or antiplatelet therapy tended to be younger and had lengthier admissions with longer stays in the ICU. The most common indication for anticoagulation in those presenting with ICH was atrial fibrillation. Intraparenchymal bleeding was most common among patients on DOACs, while patients on warfarin tended to have more subdural hematomas (Table 1). In-hospital mortality was 45.8% in DOAC-related ICH, 29.4% in warfarin-related ICH and 15.5% in patients not on an anticoagulant or antiplatelet. Average modified Rankin Scale at the time of discharge was 4.52 in DOAC-related ICH, 4.23 in warfarin-related ICH and 3.2 in patients not on an anticoagulant or antiplatelet (Table 2). Conclusions In this cohort of patients presenting with ICH to a large academic hospital, the in-hospital mortality rate was higher in patients receiving oral anticoagulation compared to those not on anticoagulants. DOAC-related ICH tended to have worse outcomes with higher in-hospital mortality and worse functional outcomes among survivors on discharge. Although the DOACs are reported in the literature to have an overall lower incidence of ICH, further information is still needed to understand the clinical impact when a bleeding event does occur. Disclosures Castellucci: BMS: Honoraria; Pfizer: Honoraria; Bayer: Honoraria; LEO Pharma: Honoraria; Sanofi: Honoraria; Aspen: Honoraria; Servier: Honoraria.

Abstract P79: Characteristics, Management and Outcomes of Patients with Acute Coronary Syndrome: A Comparison Between the Global Registry of Acute Coronary Events (GRACE) and the Gulf Registry of Acute Coronary Events (Gulf RACE)

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Hamza H Awad ◽  
Mohammad Zubaid ◽  
Alawi A Alsheikh-Ali ◽  
Gordon FitzgGerald ◽  
Frederick A Anderson ◽  
...  
Keyword(s):  
Middle East ◽  
Hospital Mortality ◽  
Treatment Strategies ◽  
Mortality Rates ◽  
Clinical Practices ◽  
Unique Region ◽  
Coronary Syndrome ◽  
Coronary Events ◽  
Global Registry ◽  
Arab Middle East

Background: Developing countries have been under-represented in multinational cardiovascular registries despite playing an important role in global cardiovascular burden. The Arab Middle East is a unique region of the developing world where little is known about the characteristics, clinical practices, and hospital outcomes of patients hospitalized with an ACS. The objective of this study was to compare ACS patients hospitalized in the Arab Middle East to patients enrolled in a multinational ACS registry. Methods: The study sample consisted of patients (pts) recruited in 2007 with a confirmed diagnosis of ACS, including 4,445 from the Global Registry of Acute Coronary Events (GRACE) and 6,706 from the Gulf Registry of Acute Coronary Events (Gulf RACE). Results: The average age in Gulf RACE was nearly a decade younger than GRACE (56 vs 66 years). Patients in Gulf RACE were significantly more likely to be male (5,071(76%) vs 3,072(69%)), smoke (2,452(37%) vs 1,217(28%)), be diabetic (2,745(41%) vs 1,181(27%)) and have a STEMI (2,619(39%) vs 1,504(34%)), while less likely to be hypertensive (3,364(55%) vs 2,929(66%)) compared to pts in GRACE. Patients in Gulf RACE had a significantly higher odds of receiving aspirin (6,563(98%) vs 4,181(94%)) and statins (6,079(91%) vs 3,574(81%)) and significantly lower likelihood of being treated with ACE inhibitors or ARBs (4,618(69%) vs 3,574 (81%)), β-blockers (4,361(65%) vs (3,858 (87%)) and clopidogrel (3,605(54%) vs 3,274(73%)) during hospitalization. The reperfusion strategy of choice among eligible STEMI patients was thrombolysis in Gulf RACE (1,415(84%) vs 297(24%)), while in GRACE it was PCI (805(66%) vs 139(8%)). While overall unadjusted in-hospital mortality rates were not significantly different between Gulf RACE and GRACE (247(3.7%) vs 167(3.8%)), age stratified rates were higher for Gulf RACE across all strata. After adjustment for additional potential confounders, there were no significant differences in hospital mortality of pts enrolled in the two registries. All P<0.01 Conclusions: Despite differences in demographics, clinical characteristics, and treatment strategies, short-term mortality rates are comparable between ACS pts enrolled in registries from different geographic settings.

scholarly journals Mid-term survival of patients with chronic kidney disease after extracorporeal membrane oxygenation

2020 ◽  
Vol 31 (5) ◽  
pp. 595-602
Author(s):  
Yueh-An Lu ◽  
Shao-Wei Chen ◽  
Cheng-Chia Lee ◽  
Victor Chien-Chia Wu ◽  
Pei-Chun Fan ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mortality Rate ◽  
Extracorporeal Membrane Oxygenation ◽  
Hospital Mortality ◽  
Subgroup Analysis ◽  
Mortality Rates ◽  
Term Survival ◽  
Membrane Oxygenation ◽  
Ecmo Treatment

Abstract OBJECTIVES Chronic kidney disease (CKD) impairs the elimination of fluids, electrolytes and metabolic wastes, which can affect the outcomes of extracorporeal membrane oxygenation (ECMO) treatment. This study aimed to elucidate the impact of CKD on in-hospital mortality and mid-term survival of adult patients who received ECMO treatment. METHODS Patients who received first-time ECMO treatment between 1 January 2003 and 31 December 2013 were included. Those with CKD were identified and matched to patients without CKD using a 1:2 ratio and were followed for 3 years. The study outcomes included in-hospital outcomes and the 3-year mortality rate. A subgroup analysis was conducted by comparing the dialytic patients with the non-dialytic CKD patients. RESULTS The study comprised 1008 CKD patients and 2016 non-CKD patients after propensity score matching. The CKD patients had higher in-hospital mortality rates [69.5% vs 62.2%; adjusted odds ratio 1.41; 95% confidence interval (CI) 1.15–1.72] than the non-CKD patients. The 3-year mortality rate was 80.4% in the CKD group and 68% in the non-CKD group (adjusted hazard ratio 1.17; 95% CI 1.06–1.28). The subgroup analysis showed that the 3-year mortality rates were 84.5% and 78.4% in the dialytic and non-dialytic patients, respectively. No difference in the 3-year mortality rate was noted between the 2 CKD subgroups (P = 0.111). CONCLUSIONS CKD was associated with increased risks of in-hospital and mid-term mortalities in patients who received ECMO treatment. Furthermore, no difference in survival was observed between the patients with end-stage renal disease and non-dialytic CKD patients.

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