scholarly journals Effect of Air Quality on the Risk of Emergency Room Visits in Patients With Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Bin Liang ◽  
Xiaonan He ◽  
Xin Du ◽  
Xiaoxia Liu ◽  
Changsheng Ma
Keyword(s):  
Atrial Fibrillation ◽  
Air Quality ◽  
Emergency Room ◽  
Time Lag ◽  
Emergency Room Visits ◽  
Monsoon Climate ◽  
Climate Region ◽  
Increased Risk ◽  
Increase In Risk ◽  
Pm2.5 Concentration

Background: We investigated the effect of particulate matter with aerodynamic diameter <2.5 μm (PM2.5) and meteorological conditions on the risk of emergency room visits in patients with atrial fibrillation (AF) in Beijing, which is considered as a monsoon climate region.Methods: In this case-crossover design study, medical records from patients with AF who visited the Critical Care Center in the Emergency Department of Anzhen Hospital from January 2011 through December 2014 and air quality and meteorological data of Beijing during the same period were collected and analyzed using Cox regression and time-series autocorrelation analyses.Results: A total of 8,241 patients were included. When the average PM2.5 concentration was >430 μg/m3, the risk of emergency room visits for patients with uncomplicated AF, AF combined with cardiac insufficiency, and AF combined with rheumatic heart disease increased by 12, 12, and 40%, respectively. When the average PM2.5 concentration was >420 μg/m3, patients with AF combined with diabetes mellitus had a 75% increased risk of emergency room visits, which was the largest increase in risk among all types of patients with AF. When the average PM2.5 concentration was >390 μg/m3, patients with AF combined with acute coronary syndrome had an approximately 30% increased risk of emergency room visits, which was the highest and fastest increase in risk among all types of patients with AF. The risk of emergency room visits for patients with AF was positively correlated with air quality as the time lag proceeded, with an autocorrelation coefficient of 0.223 between the risk of emergency room visits and air quality in patients with AF on day 6 of the time lag.Conclusion: Exposure to certain concentrations of PM2.5 in a monsoon climate region significantly increased the risk of emergency room visits in patients with AF.

scholarly journals Call for Emergency Room Guidelines to Identify Hyperthyroid Patients Prior to Contrast Imaging

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A922-A923
Author(s):  
Sandhya Bassin ◽  
Louis F Amorosa
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Room ◽  
Definitive Treatment ◽  
Graves Disease ◽  
Contrast Imaging ◽  
Iodinated Contrast ◽  
Increased Risk ◽  
History Of ◽  
The Impact ◽  
Hyperthyroid Patients

Abstract Background: Thyrotoxicosis can be mistaken for conditions such as atrial fibrillation and pulmonary embolism (PE) given the nonspecific symptoms of fatigue, palpitations, and dyspnea. Patients often undergo further imaging on presentation to the emergency room (ER), many of which use iodine for contrast. This can put patients at increased risk for iodine induced hyperthyroidism and delay definitive treatment in patients with Graves’ disease, the most common cause of hyperthyroidism. Clinical Case: A 53-year-old male with history of hyperthyroidism, atrial fibrillation, and prior PE presented with palpitations to the ER. He developed worsening dyspnea on exertion and palpitations over the last three days. He was unable to afford his medications, including methimazole, for the last nine months. In the ER he was in atrial fibrillation with rapid ventricular response. Due to concern for PE, he underwent a CTA with contrast, which was negative. His physical exam was notable for a diffusely enlarged goiter. His labs showed low TSH <0.01 (norm 0.35-5.50mIU/L) and high free T4 >7.77 (norm 0.9-1.8ng/dL). TSH stimulating antibodies were elevated at 1.9 (norm <1.3 TSI index), consistent with Graves’ hyperthyroidism. Endocrinology was then consulted for severe thyrotoxicosis, initially treating the patient with PTU and propranolol. The patient was transitioned to methimazole and continued propranolol on discharge. Since he was given contrast, plan was for repeat thyroid uptake scan and iodine ablation in 3 months. However, patient was not compliant with medications, resulting in readmission for thyrotoxicosis 3 months later. Conclusion: This case highlights the impact of increased use of contrast in imaging in hyperthyroid patients. Hyperthyroid patients are at an increased risk for emboli. However, iodine can cause contrast-induced hyperthyroidism and delay definitive treatment of Graves’ disease. As almost half of thyrotoxic patients receive iodinated contrast prior to an endocrine consultation, endocrinologists should work with emergency physicians to develop a set of guidelines to identify at risk populations for hyperthyroidism (1). We advocate for urgent thyroid testing in patients with new onset atrial fibrillation, a history of Graves’ disease, specific symptoms of Graves’, or those taking thyrotoxic-inducing medications. This will assist in determining if patients should receive a prophylactic dose of anti-thyroid medication prior to iodinated contrast imaging. These guidelines can help prevent contrast induced hyperthyroidism and disruptions in treatment of Graves’ while still imaging patients for other diagnoses on the differential. Reference: (1) Giacomini A, et al. Urgent thyroid-stimulating hormone testing in emergency medicine: A useful tool? J Emerg Med. 2015;49(4):481-487.

scholarly journals Air Quality and Pediatric Emergency Room Visits for Asthma and Atlanta, Georgia

2000 ◽  
Vol 151 (8) ◽  
pp. 798-810 ◽  
Author(s):  
P. E. Tolbert ◽  
J. A. Mulholland ◽  
D. L. Macintosh ◽  
F. Xu ◽  
D. Daniels ◽  
...  
Keyword(s):  
Air Quality ◽  
Emergency Room ◽  
Pediatric Emergency ◽  
Emergency Room Visits

scholarly journals Increased Health Care Cost Associated with Venous Thromboembolism in Patients with Malignant Glioma

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3524-3524
Author(s):  
Heather Wright ◽  
Chris E. Holmes ◽  
Alissa Thomas
Keyword(s):  
Health Care ◽  
Venous Thromboembolism ◽  
Emergency Room ◽  
Malignant Glioma ◽  
Emergency Room Visits ◽  
Total Cost ◽  
Therapeutic Anticoagulation ◽  
Increased Risk ◽  
Inpatient Hospitalizations ◽  
Cancer Types

Abstract Background: The cumulative incidence of symptomatic venous thromboembolism (VTE) among patients with malignant glioma (MG) is high, with estimates ranging from 20-35% during the course of therapy. VTE is the second leading cause of death among ambulatory patients receiving cancer chemotherapy, with a 2-fold or greater increase in mortality compared to those without VTE, even after adjusting for stage. In patients with MG and VTE the chance of two-year survival is significantly reduced. The development of VTE is also associated with increased morbidity, including increased risk of hospitalization, delays in cancer treatment, and an increased risk of complications including pain, bleeding, and bruising from high dose therapeutic anticoagulation. The economic burden of VTE in cancer patients is estimated at a 2-fold increase in cost. Data regarding VTE burden encompasses all cancer types and additional data is needed to characterize VTE burden in specific cancer types, particularly rarer cancers. The aim of this study was to assess the healthcare burden associated with the development of VTE in patients with MG. Methods: A retrospective chart review of patients with MG at an academic medical center was conducted from 2009-2017. Sixty-seven patients, age 18 years and older, with a histologic diagnosis of MG (WHO grade III-IV) were assessed. The number of office visits, emergency room visits, and inpatient hospitalizations with the associated costs of VTE management and its complications were collected. Using SPSS, linear regression models and descriptive statistics were used to determine the relationship between the development of VTE and healthcare consumption. Results: Of the 67 patients in the study, 18 developed VTE (27%). All patients who developed a VTE were placed on therapeutic anticoagulation. Fifty percent of patients developed complications related to anticoagulation, including gastrointestinal, retroperitoneal and intracranial bleeding events. Two patients required placement of an IVC filter after experiencing a bleeding complication. Patients that developed VTE had an increase in inpatient days (16.6 inpatient days) as compared to their non-VTE counterparts (8.8 inpatient days), (p=0.012). There was increased utilization of the emergency room with an average of 3.94 visits in those patients with VTE as compared to those without (1.84), (p=0.003). A full cost analysis found that the average primary total cost for ED visits and inpatient hospitalizations in patients with VTE was $48,863 while those without VTE averaged $35,948. This represented a 26% increase in the average primary total cost in those patients with VTE. Discussion: The development of VTE in patients with MG increases inpatient admissions days and incurs additional pharmaceutical costs related to anticoagulation. This study represents the first assessment of VTE-associated health care burden specific to primary brain cancer. We confirm that VTE affects a large number of patients with MG (27%) and limits the time spent at home due to increased hospitalizations and emergency room visits. VTE may be a preventable complication and further studies are needed to investigate safe prevention strategies for patients with MG. Disclosures No relevant conflicts of interest to declare.

scholarly journals Differences in Healthcare Use Between Patients With Persistent and Paroxysmal Atrial Fibrillation Undergoing Catheter‐Based Atrial Fibrillation Ablation: A Population‐Based Cohort Study From Ontario, Canada

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Andrew C. T. Ha ◽  
Harindra C. Wijeysundera ◽  
Feng Qiu ◽  
Kayley Henning ◽  
Kamran Ahmad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Emergency Room ◽  
Persistent Atrial Fibrillation ◽  
Population Based ◽  
Adverse Outcomes ◽  
Administrative Databases ◽  
Emergency Room Visits ◽  
Success Rates ◽  
Healthcare Use ◽  
Af Ablation

Background Patients with persistent atrial fibrillation (AF) undergoing catheter‐based AF ablation have lower success rates than those with paroxysmal AF. We compared healthcare use and clinical outcomes between patients according to their AF subtypes. Methods and Results Consecutive patients undergoing AF ablation were prospectively identified from a population‐based registry in Ontario, Canada. Via linkage with administrative databases, we performed a retrospective analysis comparing the following outcomes between patients with persistent and paroxysmal AF: healthcare use (defined as AF‐related hospitalizations/emergency room visits), periprocedural complications, and mortality. Multivariable Poisson modeling was performed to compare the rates of AF‐related and all‐cause hospitalizations/emergency room visits in the year before versus after ablation. Between April 2012 and March 2016, there were 3768 consecutive patients who underwent first‐time AF ablation, of whom 1040 (27.6%) had persistent AF. The mean follow‐up was 1329 days. Patients with persistent AF had higher risk of AF‐related hospitalization/emergency room visits (hazard ratio [HR], 1.21; 95% CI, 1.09–1.34), mortality (HR, 1.74; 95% CI, 1.15–2.63), and periprocedural complications (odds ratio, 1.36; 95% CI, 1.02–1.75) than those with paroxysmal AF. In the overall cohort, there was a 48% reduction in the rate of AF‐related hospitalization/emergency room visits in the year after versus before ablation (rate ratio [RR], 0.52; 95% CI, 0.48–0.56). This reduction was observed for patients with paroxysmal (RR, 0.45; 95% CI, 0.41–0.50) and persistent (RR, 0.74; 95% CI, 0.63–0.87) AF. Conclusions Although patients with persistent AF had higher risk of adverse outcomes than those with paroxysmal AF, ablation was associated with a favorable reduction in downstream AF‐related healthcare use, irrespective of AF type.

scholarly journals Association between Ambient Temperature, Particulate Air Pollution and Emergency Room Visits for Conjunctivitis

2021 ◽  
Author(s):  
soltan khalaila ◽  
Tara Coreanu ◽  
Alina Vodonos ◽  
Itai Kloog ◽  
Alexandra Shtein ◽  
...  
Keyword(s):  
Air Pollution ◽  
Particulate Matter ◽  
Emergency Room ◽  
Ambient Temperature ◽  
Medical Center ◽  
Financial Burden ◽  
Positive Association ◽  
Emergency Room Visits ◽  
Increased Risk ◽  
Coarse Particulate Matter

Abstract Background: Numerous studies have confirmed the association of ambient temperature and air pollution with a higher risk of morbidities, yet few have addressed their effect on the ocular system. The purpose of this study was to assess the association between temperature, air pollution, and emergency room visits for conjunctivitis.Methods: In this case-crossover study, the records of all emergency room visits to Soroka University Medical Center (SUMC) from 2009 to 2014 were reviewed for patients with conjunctivitis. Daily exposure to fine and coarse particulate matter and temperature were determined by a hybrid model involving satellite sensors.Results: 6001 patients were diagnosed with conjunctivitis in the SUMC emergency room. We discovered a positive association between temperature increments and incidence of conjunctivitis. The strongest effect was found during summer and autumn, with an immediate (lag0) incidence increase of 8.1% for each 1 °C increase in temperature (OR 1.088 95%CI 1.046;1.132) between 24 and 28 °C in the summer and 7.2% for each 1 °C increase in temperature (OR 1.072 95%CI 1.036;1.108) between 13 and 23 °C in the autumn. There was no statistically significant association between fine and coarse particulate matter and conjunctivitis incidence.Conclusion: Temperature increases during summer and autumn are significantly associated with an increased risk of conjunctivitis. Conjunctivitis is not associated with non-anthropogenic air pollution. These findings may help community clinics and hospital emergency rooms better predict conjunctivitis cases and will hopefully lead to improved prevention efforts that will lower the financial burden on both the individual and the public.

scholarly journals Incident opioid drug use and adverse respiratory outcomes among older adults with COPD

2016 ◽  
Vol 48 (3) ◽  
pp. 683-693 ◽  
Author(s):  
Nicholas T. Vozoris ◽  
Xuesong Wang ◽  
Hadas D. Fischer ◽  
Chaim M. Bell ◽  
Denis E. O'Donnell ◽  
...  
Keyword(s):  
Older Adults ◽  
Emergency Room ◽  
Population Based ◽  
Chronic Obstructive ◽  
Emergency Room Visits ◽  
Opioid Use ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Respiratory Outcomes ◽  
Related Mortality

We evaluated risk of adverse respiratory outcomes associated with incident opioid use among older adults with chronic obstructive pulmonary diseases (COPD).This was a retrospective population-based cohort study using a validated algorithm applied to health administrative data to identify adults aged 66 years and older with COPD. Inverse probability of treatment weighting using the propensity score was used to estimate hazard ratios comparing adverse respiratory outcomes within 30 days of incident opioid use compared to controls.Incident opioid use was associated with significantly increased emergency room visits for COPD or pneumonia (HR 1.14, 95% CI 1.00–1.29; p=0.04), COPD or pneumonia-related mortality (HR 2.16, 95% CI 1.61–2.88; p<0.0001) and all-cause mortality (HR 1.76, 95% CI 1.57–1.98; p<0.0001), but significantly decreased outpatient exacerbations (HR 0.88, 95% CI 0.83–0.94; p=0.0002). Use of more potent opioid-only agents was associated with significantly increased outpatient exacerbations, emergency room visits and hospitalisations for COPD or pneumonia, and COPD or pneumonia-related and all-cause mortality.Incident opioid use, and in particular use of the generally more potent opioid-only agents, was associated with increased risk for adverse respiratory outcomes, including respiratory-related mortality, among older adults with COPD. Potential adverse respiratory outcomes should be considered when prescribing new opioids in this population.

scholarly journals Association between ambient temperature, particulate air pollution and emergency room visits for conjunctivitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
S. Khalaila ◽  
T. Coreanu ◽  
A. Vodonos ◽  
I. Kloog ◽  
A. Shtein ◽  
...  
Keyword(s):  
Air Pollution ◽  
Particulate Matter ◽  
Emergency Room ◽  
Ambient Temperature ◽  
Medical Center ◽  
Financial Burden ◽  
Positive Association ◽  
Emergency Room Visits ◽  
Increased Risk ◽  
Coarse Particulate Matter

Abstract Background Numerous studies have confirmed the association of ambient temperature and air pollution with a higher risk of morbidities, yet few have addressed their effect on the ocular system. The purpose of this study was to assess the association between temperature, air pollution, and emergency room visits for conjunctivitis. Methods In this case-crossover study, the records of all emergency room visits to Soroka University Medical Center (SUMC) from 2009 to 2014 were reviewed for patients with conjunctivitis. Daily exposure to fine and coarse particulate matter and temperature were determined by a hybrid model involving satellite sensors. Mean relative humidity was obtained from the Ministry of Environmental Protection meteorological monitoring station located in Beer-Sheva. Results Six hundred one patients were diagnosed with conjunctivitis in the SUMC emergency room. We discovered a positive association between temperature increments and incidence of conjunctivitis. The strongest effect was found during summer and autumn, with an immediate (lag0) incidence increase of 8.1% for each 1 °C increase in temperature (OR = 1.088, 95%CI: 1.046–1.132) between 24 and 28 °C in the summer and 7.2% for each 1 °C increase in temperature (OR = 1.072, 95%CI: 1.036–1.108) between 13 and 23 °C in the autumn. There was no statistically significant association between fine and coarse particulate matter and conjunctivitis incidence. Conclusion Temperature increases during summer and autumn are significantly associated with an increased risk of conjunctivitis. Conjunctivitis is not associated with non-anthropogenic air pollution. These findings may help community clinics and hospital emergency rooms better predict conjunctivitis cases and will hopefully lead to improved prevention efforts that will lower the financial burden on both the individual and the public.

scholarly journals Short-Term Exposure to Ambient Air Pollution and Increased Emergency Room Visits for Skin Diseases in Beijing, China

Toxics ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 108
Author(s):  
Wanzhou Wang ◽  
Wenlou Zhang ◽  
Jingjing Zhao ◽  
Hongyu Li ◽  
Jun Wu ◽  
...  
Keyword(s):  
Air Pollution ◽  
Air Quality ◽  
Emergency Room ◽  
Skin Diseases ◽  
Ambient Air ◽  
Additive Models ◽  
Ambient Air Pollution ◽  
Emergency Room Visits ◽  
Icd 10 ◽  
Beijing China

Skin diseases have become a global concern. This study aims to evaluate the associations between ambient air pollution and emergency room visits for skin diseases under the background of improving air quality in China. Based on 45,094 cases from a general hospital and fixed-site monitoring environmental data from 2014–2019 in Beijing, China, this study used generalized additive models with quasi-Poisson regression to estimate the exposure–health associations at lag 0–1 to lag 0–7. PM2.5 and NO2 exposure were associated with increased emergency room visits for total skin diseases (ICD10: L00-L99). Positive associations of PM2.5, PM10, O3 and NO2 with dermatitis/eczema (ICD-10: L20–30), as well as SO2 and NO2 with urticaria (ICD-10: L50) visits were also found. For instance, a 10 μg/m3 increase in PM2.5 was associated with increases of 0.7% (95%CI: 0.2%, 1.2%) in total skin diseases visits at lag 0–5 and 1.1% (95%CI: 0.6%, 1.7%) in dermatitis/eczema visits at lag 0–1, respectively. For PM2.5, PM10 and CO, stronger annual associations were typically observed in the high-pollution (2014) and low-pollution (2018/2019) years. For instance, a 10 μg/m3 increase in PM2.5 at lag 0–5 was associated with increases of 1.8% (95%CI: 1.0%, 2.6%) and 2.3% (95%CI: 0.4%, 4.3%) in total skin disease visits in 2014 and 2018, respectively. Our study emphasizes the necessity of controlling the potential health hazard of air pollutants on skin, although significant achievements in air quality control have been made in China.

scholarly journals Association between Ambient Temperature, Particulate Air Pollution and Emergency Room Visits for Conjunctivitis

2019 ◽  
Author(s):  
soltan khalaila ◽  
Tara Coreanu ◽  
Alina Vodonos ◽  
Itai Kloog ◽  
Alexandra Shtein ◽  
...  
Keyword(s):  
Air Pollution ◽  
Particulate Matter ◽  
Emergency Room ◽  
Ambient Temperature ◽  
Medical Center ◽  
Meteorological Data ◽  
Positive Association ◽  
Emergency Room Visits ◽  
Increased Risk ◽  
Coarse Particulate Matter

Abstract Background Numerous studies have confirmed that ambient temperature and air pollution are associated with higher risk of morbidities to different systems of the human body, yet few have addressed their effect on the ocular system. The purpose of this study is to determine the association between temperature, air pollution and emergency room visits for non-specific conjunctivitis Methods In this retrospective cohort study, the records of all emergency room visits to Soroka University Medical Center (SUMC) from 2009 to 2014 were reviewed for patients with conjunctivitis. Exposure to fine and coarse particulate matter and temperature were assessed by a hybrid model that incorporated daily satellite remote sensing. Results The records of the 6001 patients who visited the SUMC emergency room with conjunctivitis, together with the meteorological data, revealed a positive association between temperature increment and incidence of conjunctivitis. The strongest effect was found during summer and autumn: the incidence increased 8.1% for each 1oC rise in temperature between 24oC and 28oC in the summer, and 7.2% for each 1oC rise in temperature between 13oC and 23oC in autumn. The association between fine and coarse particulate matter and incidence of conjunctivitis was not statistically significant. Conclusion High ambient temperature is significantly associated with an increased risk of nonspecific conjunctivitis in summer and autumn and not in spring and winter. Conjunctivitis is not associated with air pollution. The findings can assist community clinics and hospital emergency rooms prepare for the upticks in the condition during certain seasons and acute rises in temperatures, lowering the financial costs to both the individual and the public.

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