scholarly journals Trends in hospitalization and factors associated with in-hospital death among pediatric admissions with implantable cardioverter defibrillators

2021 ◽  
Author(s):  
Amna Qasim ◽  
Tam Dan Pham ◽  
Jeffrey Kim ◽  
Santiago Valdes ◽  
Taylor Howard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Multivariable Analysis ◽  
Diagnostic Category ◽  
Patient Characteristics ◽  
Hospital Death ◽  
Implantable Cardioverter Defibrillators ◽  
Factors Associated ◽  
Admission Rates ◽  
Hospital Deaths

Background: As pediatric implantable cardioverter defibrillator (ICD) utilization increases, hospital admission rates will increase. Data regarding hospitalizations among pediatric patients with ICDs is lacking. In addition, hospital mortality rates are unknown. This study aimed to evaluate 1) trends in hospitalization rates of admissions over 20 years, 2) hospital mortality, and 3) factors associated with hospital mortality among pediatric admissions with ICDs. Methods: The Kids’ Inpatient Database (2000-2016) was used to identify all hospitalizations with an existing ICD 20 years of age. ICD9/10 codes were used to stratify admissions by underlying diagnostic category as: 1) congenital heart disease (CHD), 2) primary arrhythmia, 3) primary cardiomyopathy, or 4) other. Trends were analyzed using linear regression. Hospital and patient characteristics among hospital deaths were compared to those surviving to discharge using mixed multivariable logistic regression, accounting for hospital clustering. Results: Of 42,570,716 hospitalizations, 4165 were admitted <21 years with an ICD. ICD admissions increased four-fold (p = 0.002) between 2000-2016. Hospital death occurred in 54 (1.3%). In multivariable analysis, cardiomyopathy (OR 3.5, 95%CI 1.1–11.2, p=0.04) and CHD (OR 4.8, 95%CI 1.5–15.6, p=0.01) were significantly associated with mortality. In further exploratory multivariable analysis incorporating a coexisting diagnosis of heart failure, only the presence of heart failure remained associated with mortality (OR 8.6, 95%CI 3.7-20.0, p<0.0001). Conclusions: Pediatric ICD hospitalization are increasing over time and hospital mortality is low (1.3%). Hospital mortality is associated with cardiomyopathy or CHD; however, the underlying driver for in-hospital death may be heart failure.

scholarly journals Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Selcuk ◽  
M Keskin ◽  
T Cinar ◽  
N Gunay ◽  
S Dogan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Troponin I ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Previous History ◽  
Hospital Death ◽  
Funding Sources ◽  
Elevated Glucose ◽  
Artery Disease

Abstract Introduction The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95% CI: 0.76–0.97). Conclusion The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure

2021 ◽  
Vol 13 (2) ◽  
pp. 141-145
Author(s):  
Murat Selçuk ◽  
Muhammed Keskin ◽  
Tufan Çınar ◽  
Nuran Günay ◽  
Selami Doğan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Troponin I ◽  
Prognostic Significance ◽  
Multivariable Analysis ◽  
Previous History ◽  
Hospital Death ◽  
Elevated Glucose ◽  
History Of ◽  
Artery Disease

Introduction:The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF). Methods:A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis. Results: A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95%CI:0.76-0.97). Conclusion: The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.

scholarly journals Factors Associated with Intra-hospital Mortality of Peripartum Cardiomyopathy Patients in Northcentral Nigeria

2021 ◽  
pp. 1-10
Author(s):  
Ogunmodede James Ayodele ◽  
Kolo Philip Manma ◽  
Dele-Ojo Bolade Folashade ◽  
Ogunmodede Adebusola Jane ◽  
Yusuf Idris Abiola ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Serum Sodium ◽  
Survival Curve ◽  
Severe Heart Failure ◽  
Peripartum Cardiomyopathy ◽  
Hospital Death ◽  
Hospital Outcomes ◽  
Targeted Interventions ◽  
Factors Associated

Aims:  We studied the patient characteristics, intra-hospital outcomes and factors associated with intra-hospital mortality in patients admitted for Peripartum Cardiomyopathy (PPCM) in our centre using data from the Ilorin Heart failure Registry. Study design: Prospective Observational Methodology: All the 22 confirmed PPCM patients admitted between January 1, 2016 and December 31, 2019 were recruited and followed up for intra-hospital outcomes. The primary outcome was all-cause intra-hospital mortality. Results: Intra-hospital death occurred in four out of 22 patients (18.2%). The mean age of all patients was 28.4 ± 4.8 years and it was similar in both survivors and patients who died (P=0.960). Majority of patients (14, 63.7%) presented in New York Heart Association Class IV. Mean duration of hospital stay was 11 + 5.7days which was similar between patients who died and those who survived hospital admission (9.0 ± 2.8 vs 11.4 ± 6.1, P=0.457). Median ECG heart rate was 120 (116-123) bpm which was similar between both groups. Factors associated with mortality were biochem ical parameters serum sodium and eGFR which were significantly lower among those who died (125.0 ± 4.1 vs 133.7 ± 2.5mmol/L, P=<0.001; 41.0 ± 18.8 vs 81.9 ± 11.03 mls/min/1.73m2, P<0.001) and the Ejection fraction (EF) and Fractional Shortening (FS) which were also significantly lower in the patients who died 24.0 ± 8.2% vs 37.9 ± 6.2%, P=0.002; 11.0 ± 4.3% vs 18.4 ± 3.8, P=0.003 respectively. Other echocardiographic parameters were similar between the two groups of patients.  A Kaplan-Meier survival curve was drawn to show the time to outcome. Conclusion: Majority of PPCM patients present in clinically severe heart failure and the intra-hospital mortality is high. The importance of serum sodium, eGFR, EF and FS as factors associated with mortality indicates patient sub-groups requiring greater attention and targeted interventions.

Abstract 9381: Comparison of Clinical Characteristics and Adverse Outcomes in Pregnant Women with Cardiomyopathy Subtypes at the Time of Delivery in the US: 2006-2010

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Fabio V Lima ◽  
Puja B Parikh ◽  
Jiawen Zhu ◽  
Jie Yang ◽  
Kathleen Stergiopoulos
Keyword(s):  
Heart Failure ◽  
Pregnant Women ◽  
Teaching Hospital ◽  
Clinical Characteristics ◽  
Hospital Admissions ◽  
Multivariable Analysis ◽  
Patient Characteristics ◽  
Adverse Outcomes ◽  
Hospital Death ◽  
Cerebrovascular Event

Introduction: Investigation of patient characteristics and outcomes in women with cardiomyopathy (CDM) at the time of delivery has been limited. The aim of this study was to determine the clinical characteristics and outcomes in women with peripartum (PCDM) and hypertrophic cardiomyopathy (HCDM), and the predictors for adverse clinical outcomes in pregnant women at the time of delivery. Methods and Results: The Healthcare Cost and Utilization Project’s National Inpatient Sample was screened for hospital admissions for delivery in pregnant women with CDM subtypes (peripartum, hypertrophic and all others) from 2006-2010. Clinical characteristics and maternal outcomes were identified in women with subtypes of CDM and without. The primary outcome of interest was major adverse clinical events (MACE), a composite of in-hospital death, acute myocardial infarction, heart failure, arrhythmia, cerebrovascular event, or embolic event. Our study population consisted of 2,078 patients with CDM and 4,438,439 patients without CDM. Of those with CDM, 52 (2.5%) had HCDM, 1039 (50.0%) had PCDM, and 987 (47.5%) were classified as other CDM (OCDM). PCDM cohort was more likely to be insured by Medicaid and the HCDM patients were more likely to deliver at a teaching hospital (p<0.01 for all). The PCDM and all OCDM cohorts had a larger proportion of black patients and most were from the South. PCDM patients experienced the highest rates of MACE (46%), compared with HCDM (23%) or OCDM (38.9%), mainly driven by heart failure and arrhythmia. Maternal mortality in all CDM subgroups was extremely low (< 0.5%). Significant predictors of MACE in the PCDM cohort were the presence of valvular heart disease (OR 2.16, 95% CI 1.49-3.14), severe pre-eclampsia (OR 1.54, 95% CI: 1.08-2.21), and Cesarean delivery (OR 1.36, 95% CI: 1.04-1.78); delivery at a teaching hospital was associated with a reduction in MACE. In multivariable analysis, the presence of PCDM (OR 2.22, 95% CI 1.07-4.55) was independently predictive of MACE. Conclusions: Peripartum CDM patients had the highest likelihood of MACE compared to hypertrophic and all other CDM subtypes.

Association of Ventilator Type with Hospital Mortality in Critically Ill Patients with SARS-CoV2 Infection: A Retrospective Study.

2021 ◽  
Author(s):  
Alexis FERRE ◽  
Fabien Marquion ◽  
Marc Delord ◽  
Jean-Pierre Bédos ◽  
Hugo Bellut ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Multivariate Regression ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Prospective Data ◽  
Factors Associated ◽  
Kaplan Meier ◽  
Patient Groups

Abstract Background: To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection) during the first wave of the disease in France.Methods: We retrospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March and May 2020. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a transport ventilator was used. Kaplan-Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality.Results: We included 82 patients (61 [74.4%] men) with a median age of 64 years [55–74], of whom 23 (28.1%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were older age (HR, 1.06/year; 95%CI, 1.00–1.11; P=0.05) and diabetes mellitus (HR, 3.32; 95%CI, 1.13–9.76; P=0.03) but not ventilator type. Using non-ICU ventilator was associated neither with a longer duration of invasive mechanical ventilation (20 [12-36] vs. 25 [15-31] days; P=0.87) nor with a longer ICU stay (24 [14-40] vs. 27 [15-37] days; P=0.64).Conclusions: In patients with ARDS due to COVID-19, the use of non-ICU ventilators, such as transport ventilators, was not associated with worse outcomes. Although prospective data are needed to confirm our findings, this study suggests that transport ventilators may be valuable during COVID-19 surges that overwhelm ICU resources.

scholarly journals A Combination of Chest Radiography and Estimated Plasma Volume May Predict In-Hospital Mortality in Acute Heart Failure

2022 ◽  
Vol 8 ◽  
Author(s):  
Masatake Kobayashi ◽  
Amine Douair ◽  
Stefano Coiro ◽  
Gaetan Giacomin ◽  
Adrien Bassand ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Natriuretic Peptide ◽  
Plasma Volume ◽  
Risk Model ◽  
Hospital Death ◽  
Pulmonary Congestion ◽  
Patients With Heart Failure ◽  
High Prediction ◽  
Score Index

Background: Patients with heart failure (HF) often display dyspnea associated with pulmonary congestion, along with intravascular congestion, both may result in urgent hospitalization and subsequent death. A combination of radiographic pulmonary congestion and plasma volume might screen patients with a high risk of in-hospital mortality in the emergency department (ED).Methods: In the pathway of dyspneic patients in emergency (PARADISE) cohort, patients admitted for acute HF were stratified into 4 groups based on high or low congestion score index (CSI, ranging from 0 to 3, high value indicating severe congestion) and estimated plasma volume status (ePVS) calculated from hemoglobin/hematocrit.Results: In a total of 252 patients (mean age, 81.9 years; male, 46.8%), CSI and ePVS were not correlated (Spearman rho &lt;0 .10, p &gt; 0.10). High CSI/high ePVS was associated with poorer renal function, but clinical congestion markers (i.e., natriuretic peptide) were comparable across CSI/ePVS categories. High CSI/high ePVS was associated with a four-fold higher risk of in-hospital mortality (adjusted-OR, 95%CI = 4.20, 1.10-19.67) compared with low CSI/low ePVS, whereas neither high CSI nor ePVS alone was associated with poor prognosis (all-p-value &gt; 0.10; Pinteraction = 0.03). High CSI/high ePVS improved a routine risk model (i.e., natriuretic peptide and lactate)(NRI = 46.9%, p = 0.02), resulting in high prediction of risk of in-hospital mortality (AUC = 0.85, 0.82-0.89).Conclusion: In patients hospitalized for acute HF with relatively old age and comorbidity burdens, a combination of CSI and ePVS was associated with a risk of in-hospital death, and improved prognostic performance on top of a conventional risk model.

Abstract MP29: Patient Characteristics And Outcomes Associated With In-hospital Onset Of Acute Decompensated Heart Failure

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Corey A Kalbaugh ◽  
Patricia P Chang ◽  
Kunihiro Matsushita ◽  
Sunil K Agarwal ◽  
Melissa Caughey ◽  
...  
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Acute Decompensated Heart Failure ◽  
Case Fatality ◽  
Patient Characteristics ◽  
Decompensated Heart Failure ◽  
Hospital Length Of Stay ◽  
Smoking History ◽  
One Year

Introduction: There has been little focus on hospitalized acute decompensated heart failure (ADHF) that develops after admission, which may occur because of comorbid conditions, over-administration of fluid or post-surgical complications. Aims: To compare patient characteristics, case fatality, and hospital length of stay (LOS) associated with ADHF that develops after hospital admission as compared to those with ADHF at admission. Methods: Hospitalizations with possible ADHF were sampled, based on HF ICD codes, among those aged > 55 years from the four communities of the Atherosclerosis Risk in Communities Study (2005-2010). Medical records were abstracted with events classified by physician panel or computer classified. Case fatality was obtained through the National Death Index. We identified 4,503 (unweighted) events with definite/probable ADHF, after excluding those with unknown time of decompensation (n=81), hospital transfers (n=102), and race other than black or white (n=118). Demographic and clinical characteristics were compared by ADHF onset (at/after admission). Logistic regression was used to evaluate the association of ADHF onset with in-hospital mortality, and 28-days and one-year mortality, adjusted for demographics and comorbidity. Linear regression was used to evaluate the association of ADHF onset with log-transformed hospital LOS, adjusted for demographics. All analyses were weighted to account for the stratified sampling design. Results: Of 21,052 (weighted) ADHF events, 7.4% (n=1561) developed ADHF after admission. Patients with ADHF occurring after admission were older (mean: 79 vs. 75 years), and more likely white and female. Those with ADHF at admission were more likely to have a positive smoking history, COPD, and to be on dialysis. Presence of diabetes, hypertension and coronary artery disease were not significantly different between groups. In hospital mortality (16.5% vs. 6.3%; OR= 2.7, 95% CI=1.9-3.8) and 28-day mortality (23.9% vs. 10.1%; OR= 2.4, 95% CI=1.7-3.4) was higher among those who developed ADHF after admission. One-year case fatality was similar (39.4% vs. 33.6%; OR= 1.2, 95% CI=0.9-1.6). Unadjusted mean LOS was longer for those with ADHF occurring after admission (12.8 days, 95% CI=11.8-13.8) than those with ADHF at admission (7.2 days, 95% CI=6.8-7.6). The adjusted and geometric mean LOS was 1.3 days (95% CI=1.2-1.4) longer for those who developed ADHF after admission. Conclusion: Although patients with ADHF onset after admission were slightly older, differences in comorbidity do not indicate an easily identifiable subgroup for closer in-hospital monitoring. Development of ADHF after admission was associated with an alarmingly high early case fatality and longer hospital LOS compared to those with ADHF at hospital admission.

Abstract 12789: Clinical Factors Associated With Mortality Among Patients Hospitalized for Heart Failure in Egypt

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ahmed Hassanin ◽  
Mahmoud M Hassanein ◽  
Madiha F Abdel-maksoud
Keyword(s):  
Heart Failure ◽  
Hospital Mortality ◽  
Univariate Analysis ◽  
Elevated Serum ◽  
The United States ◽  
Clinical Factors ◽  
Clinical Variables ◽  
Factors Associated ◽  
The Us ◽  
One Year

Introduction: Heart failure (HF) is a growing public health burden in many low and middle-income countries (LMIC). However, most HF registries were conducted in high income countries, which often have different ethnic and cultural backgrounds from that of LMIC. Hypothesis: Independent clinical variables associated with mortality in patients hospitalized for HF in Egypt are different from those established in the United States (US). Methods: Between 2011 and 2014, 1,660 patients hospitalized for HF were enrolled from 20 centers across Egypt as part of the European Society of Cardiology HF long-term Registry. Deceased patients were compared to survivors, to identify demographic, clinical and biochemical variables associated with in-hospital and one-year mortality. Variables associated with mortality on univariate analysis, and independent variables identified in the Acute Decompensated Heart Failure National Registry (ADHERE) and in the Seattle Heart Failure Model, both based in the US, were entered into the multivariate logistic regression model. Results: In-hospital mortality was 5%. Only two independent clinical factors associated with in-hospital mortality were identified: elevated serum creatinine (sCr), OR=1.47 [95% CI: 1.23, 1.74] for every point increases above one mg/dl; and low admission systolic blood pressure (SBP), OR=1.54; [95% CI: 1.43, 1.65] for every 10 points decrease in SBP below 140 mmHg. At one-year follow up, mortality was 27%. Independent predictors of one-year mortality were: age, OR=1.47; [95% CI: 1.23,1.75] for every 10-year increase above 40; low discharge SBP, OR=1.30 [95% CI: 1.08, 1.52] for every 10 points decrease below 140 mmHg; low ejection fraction, OR=1.51 [95% CI: 0.59,0.73] for every 5 points decrease from 65%; chronic liver disease, OR=3.0 [95% CI: 1.51,5.88]; history of stroke, OR=3.2 [95% CI: 1.52,6.65]. These variables overlapped with those identified in US registries. Conclusions: Independent clinical variables associated with mortality after HF hospitalization in Egypt are similar to those reported in HF registries in the US.

The clinical impact of delirium in the patients with acute decompensated heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y.A Aikawa ◽  
T.N Noguchi ◽  
I.M Morii
Keyword(s):  
Heart Failure ◽  
Acute Decompensated Heart Failure ◽  
Multivariable Analysis ◽  
Composite Endpoint ◽  
Decompensated Heart Failure ◽  
Cardiovascular Death ◽  
Clinical Impact ◽  
Hospital Death ◽  
Early Screening ◽  
H2 Blocker

Abstract Background Delirium is frequent in-hospital complication in patients with illness. However, the clinical impact of delirium on cardiovascular mortality has not been fully addressed in patients with acute decompensated heart failure (ADHF). Methods Between April 2016 and May 2019, 474 consecutive patients with ADHF admitted to our institution were enrolled and followed for 6 months after discharge. Delirium was defined according to the Intensive Care Delirium Checklist. To compare the clinical outcome, we divided study patients into 3 groups according to the presence or absence of delirium: non-delirium (ND) (n=349), improved-delirium during hospitalization (ID) (n=68), and prolonged delirium (PD) (n=57). Results One hundred twenty-five (26.4%) patients developed delirium. During hospitalization, PD had higher incidence of all-cause death, cardiovascular death, and worsening heart failure compared with ND and ID (20.0% vs. 3.7% and 2.9%, 10.9% vs. 2.5% and 1.4%, 21.8% vs. 2.5% and 4.3%, p&lt;0.001, respectively). Multivariable analysis identified the presence of frailty (OR: 8.56, 95% CI: 3.46–23.7) and dementia (OR: 7.34, 95% CI: 3.52–15.9), use of H2-blocker (OR: 3.41, 95% CI: 1.08–10.9) and plasma level of CRP (OR: 1.30, 95% CI: 1.06–1.61) as significant independent determinants of delirium. Also, in multivariable analysis, the development of frailty (OR: 5.51, 95% CI: 2.80–11.5), delirium (OR: 4.59, 95% CI: 2.23–9.66) and age (OR: 1.06, 95% CI: 1.03–1.11) were the independent determinants of composite endpoint with in-hospital death and discharge to other than home. Early treatment of delirium performed significantly higher in ID than PD (55.7% vs. 29.1%, p=0.003). Conclusion This study suggested that PD contributed to increasing in-hospital events in the patients with ADHF and significance of early screening and treatment for delirium. Figure 1. Outcomes during hospitalization Funding Acknowledgement Type of funding source: None

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