Homam Moussa Pacha

Burden of hospitalization in clinically diagnosed peripheral artery disease: A community-based study

The burden and predictors of hospitalization over time in community-based patients with peripheral artery disease (PAD) have not been established. This study evaluates the frequency, reasons and predictors of hospitalization over time in community-based patients with PAD. We assembled an inception cohort of 1798 PAD cases from Olmsted County, MN, USA (mean age 71.2 years, 44% female) from 1 January 1998 through 31 December 2011 who were followed until 2014. Two age- and sex-matched controls (n = 3596) were identified for each case. ICD-9 codes were used to ascertain the primary reasons for hospitalization. Patients were censored at death or last follow-up. The most frequent reasons for hospitalization were non-cardiovascular: 68% of 8706 hospitalizations in cases and 78% of 8005 hospitalizations in controls. A total of 1533 (85%) cases and 2286 (64%) controls (p < 0.001) were hospitalized at least once; 1262 (70%) cases and 1588 (44%) controls (p < 0.001) ≥ two times. In adjusted models, age, prior hospitalization and comorbid conditions were independently associated with increased risk of recurrent hospitalizations in both groups. In cases, severe PAD (ankle–brachial index < 0.5) (HR: 1.25; 95% CI: 1.15, 1.36) and poorly compressible arteries (HR: 1.26; 95% CI: 1.16, 1.38) were each associated with increased risk for recurrent hospitalization. We demonstrate an increased rate of hospitalization in community-based patients with PAD and identify predictors of recurrent hospitalizations. These observations may inform strategies to reduce the burden of hospitalization of PAD patients.

Antithrombotic Therapy After Percutaneous Left Atrial Appendage Occlusion Using the WATCHMAN Device

Patients with atrial fibrillation are at risk of developing a stroke, and the left atrial appendage (LAA) is the most common site for clot formation. Although anticoagulation is the mainstay treatment for stroke prevention, some patients are at high risk of bleeding and are not candidates for

Beyond Beck's Triad: A Rare Cause of Cardiac Tamponade and Hemoptysis

Background: Primary cardiac angiosarcoma (CAS) is a rare tumor with a dismal prognosis. Many patients present with noncardiac symptoms related to metastatic disease that could delay the diagnosis and deteriorate the outcome. Case Report: A 36-year-old male presented with hemoptysis. Initial imaging and biopsies were inconclusive, but a repeat transthoracic echocardiogram to evaluate the patients pericardial effusion showed a mass inferior to the right atrium and invading the wall. Biopsy results from 3 different sites confirmed the diagnosis of CAS. However, the patients course was complicated with respiratory failure that ultimately led to his death. Autopsy demonstrated CAS involving the full thickness of the right atrium and pericardial tissue, with a diffuse metastatic process involving the lung, brain, and stomach. Conclusion: The case highlights the importance of having an increased level of suspicion for cardiac malignancy among young patients presenting with noncardiac symptoms.

RATE AND PREDICTORS FOR LIMB REVASCULARIZATION AND AMPUTATION AFTER DIAGNOSIS OF PERIPHERAL ARTERIAL DISEASE: A COMMUNITY-BASED STUDY

Peripheral arterial disease (PAD) is associated with impaired ambulatory function, diminished quality of life and high health care costs. Rates of adverse limb outcomes in PAD in a community-based setting are not known. We aimed to assess rates and predictors of incident limb revascularization (