Floyd Thoma

Trends in hospitalization for congestive heart failure, 1996–2009

Although heart failure (HF) is a common cause of hospital admissions, few data describe temporal trends in HF hospitalization. We present data on number of HF admissions, length of stay (LOS), and inpatient mortality in the United States, 1996–2009.

The Importance of Invasive Hemodynamics for Pulmonary Hypertension Screening in TAVR Patients

The recent American College of Cardiology expert consensus for transcatheter aortic valve replacement (TAVR) decision pathway mentions pulmonary hypertension (PH) as a major cardiovascular comorbidity [(1)][1]. The consensus does not specify the method of assessment, only suggesting that PH may be

Bare Metal Stent use in Type B Aortic Dissection May Offer Positive Remodeling for the Distal Aorta

BACKGROUNDnThoracic endovascular aortic repair is increasingly used in acute complicated type B aortic dissection. The objective of this study was to demonstrate evidencexa0of aortic remodeling by using a Proximal ExTension to Induce COmplete ATtachment (PETTICOAT) system in patients with acute complicated type B aortic dissections.nnnMETHODSnFrom 2013 to 2016, 213 patients with type B aortic dissection were seen at our institution. A total of 33xa0of those patients underwent thoracic endografting forxa0complicated acute type B aortic dissection. Of these patients, 12 underwent standard thoracic endovascular aortic repair (standard group), and 21 had an additional bare metal stent distal to the covered endograft (PETTICOAT group). Aortic dimensions were measured on the basis of on three-dimensional computed tomographic scans on discharge and at 6 months.nnnRESULTSnThere were no differences in baseline characteristics between the standard group and the PETTICOAT group. At 6 months, both the PETTICOAT and standard groups had significant change in aortic diameter, true lumen diameter, and true lumen ratio throughout the thoracoabdominal aorta demonstrating positive remodeling. The change in true lumen ratio was significantly greater at the level of the celiac artery with the PETTICOAT system when compared with the standard group.nnnCONCLUSIONSnThe use of a PETTICOAT concept with an addition of a bare metal stent distal to the proximal thoracic endograft offers positive aortic remodeling in the thoracoabdominal aorta at 6 months.

EXPRESS: Atrial arrhythmias are associated with increased mortality in pulmonary arterial hypertension.

Pulmonary arterial hypertension (PAH) is a deadly vascular disease, characterized by increased pulmonary arterial pressures and right heart failure. Considering prior non-US studies of atrial arrhythmias in PAH, this retrospective, regional multi-center US study sought to define more completely the risk factors and impact of paroxysmal and non-paroxysmal forms of atrial fibrillation and flutter (AF/AFL) on mortality in this disease. We identified patients seen between 2010 and 2014 at UPMC (Pittsburgh) hospitals with hemodynamic and clinical criteria for PAH or chronic thromboembolic pulmonary hypertension (CTEPH) and determined those meeting electrocardiographic criteria for AF/AFL. We used Cox proportional hazards regression with time-varying covariates to analyze the association between AF/AFL occurrence and survival with adjustments for potential cofounders and hemodynamic severity. Of 297 patients with PAH/CTEPH, 79 (26.5%) suffered from AF/AFL at some point. AF/AFL was first identified after PAH diagnosis in 42 (53.2%), identified prior to PAH diagnosis in 27 (34.2%), and had unclear timing in the remainder. AF/AFL patients were older, more often male, had lower left ventricular ejection fractions, and greater left atrial volume indices and right atrial areas than patients without AF/AFL. AF/AFL (whether diagnosed before or after PAH) was associated with a 3.81-fold increase in the hazard of death (95% CI 2.64–5.52, pu2009<u20090.001). This finding was consistent with multivariable adjustment of hemodynamic, cardiac structural, and heart rate indices as well as in sensitivity analyses of patients with paroxysmal versus non-paroxysmal arrhythmias. In these PAH/CTEPH patients, presence of AF/AFL significantly increased mortality risk. Mortality remained elevated in the absence of a high burden of uncontrolled or persistent arrhythmias, thus suggesting additional etiologies beyond rapid heart rate as an explanation. Future studies are warranted to confirm this observation and interrogate whether other therapies beyond rate and rhythm control are necessary to mitigate this risk.

Persistent sex disparities in implantable cardioverter-defibrillator therapy

Clinical guidelines recommend cardioverter defibrillator implantation for patients with heart failure and reduced ejection fraction. Despite this, women and minorities have been less likely to receive implantable cardioverter‐defibrillator (ICD) therapy than white men. We examined race and sex differences in ICD implantation in a recent cohort.

Impact of cigarette taxes on smoking prevalence from 2001-2015: A report using the Behavioral and Risk Factor Surveillance Survey (BRFSS)

Objectives To provide an up-to-date analysis on the relationship between excise taxes and the prevalence of cigarette smoking in the United States. Methods Linear mixed-effects models were used to model the relationship between excise taxes and prevalence of cigarette smoking in each state from 2001 through 2015. Results From 2001 through 2015, increases in state-level excise taxes were associated with declines in prevalence of cigarette smoking. The effect was strongest in young adults (age 18–24) and weakest in low-income individuals (<

Trends in atrial fibrillation hospitalizations in the United States: A report using data from the National Hospital Discharge Survey

25,000). Conclusions Despite the shrinking pool of current smokers, excise taxes remain a valuable tool in public-health efforts to reduce the prevalence of cigarette smoking. Policy implications States with high smoking prevalence may find increased excise taxes an effective measure to reduce population smoking prevalence. Since the effect is greatest in young adults, benefits of increased tax would likely accumulate over time by preventing new smokers in the pivotal young-adult years.

Outcomes of Heart Failure Admissions Under Observation Versus Short Inpatient Stay

Aims Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. Patients presenting with AF are often admitted to hospital for rhythm or rate control, symptom management, and/or anticoagulation. We investigated temporal trends in AF hospitalizations in United States from 1996 to 2010. Methods Data were obtained from the National Hospital Discharge Survey (NHDS), a national probability sample survey of discharges conducted annually by National Center for Health Statistics. Because of the survey design, sampling weights were applied to the raw NHDS data to produce national estimates. Hospitalizations with a primary diagnosis of AF were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code of 427.31. Weighted least squares regression was used to test for linear trends in the number of AF admissions, length of stay, and inpatient mortality. We further stratified AF admissions based on patients age, gender, and race. Results Admissions for a primary diagnosis of AF increased from approximately 286,000 in 1996 to about 410,000 in 2010 with a significant linear trend (β = 9470 additional admissions per year, p < 0.001). The trend of increased AF admissions was uniform across patient sub-groups. Overall, mean length of stay for AF admissions was 3.75 days, and this remained relatively stable over time (β = 0.002 days, p = 0.884). Inpatient mortality was 0.96% and also remained stable over time (β = 0.031%, p = 0.181). Conclusion Our data demonstrate an increase in the number of AF admissions but constant length of stay and mortality over time.