Karan Sud

Nationwide Hospitalization Trends in Adult Congenital Heart Disease Across 2003-2012.

Background We aimed to assess trends in hospitalization, outcomes, and resource utilization among patients admitted with adult congenital heart disease (ACHD). Methods and Results We used the 2003–2012 US Nationwide Inpatient Sample for this study. All admissions with an ACHD were identified using standard ICD codes. Resource utilization was assessed using length of stay, invasive procedure utilization, and cost of hospitalization. There was a significant increase in the number of both simple (101%) as well as complex congenital heart disease (53%)–related admissions across 2003–2012. In addition, there was a considerable increase in the prevalence of traditional cardiovascular risk factors including older age, along with a higher prevalence of hypertension, diabetes, smoking, obesity, chronic kidney disease, and peripheral arterial disease. Besides miscellaneous causes, congestive heart failure (11.8%), valve disease (15.5%), and cerebrovascular accident (26.1%) were the top causes of admission to the hospital among patients with complex ACHD, simple ACHD without atrial septal defects/patent foramen ovale and simple atrial septal defects/patent foramen ovale patients, respectively. In‐hospital mortality has been relatively constant among patients with complex ACHD as well as simple ACHD without atrial septal defects/patent foramen ovale. However, there has been considerable increase in the average length of stay and cost of hospitalization among the ACHD patients during 2003–2012. Conclusions There has been a progressive increase in ACHD admissions across 2003–2012 in the United States, with increasing healthcare resource utilization among these patients. Moreover, there has been a change in the cardiovascular comorbidities of these patients, adding a layer of complexity in management of ACHD patients.

Trends in the Use of Mechanical Circulatory Support Devices in Patients Presenting With ST-Segment Elevation Myocardial Infarction

Cardiogenic shock remains an important cause of death in acute ST-segment elevation myocardial infarction (STEMI) [(1)][1]. Intra-aortic balloon pump (IABP) is widely used for hemodynamic support in cardiogenic shock. The availability of novel mechanical circulatory support (MCS) devices has

Degenerative Mitral Stenosis: Unmet Need for Percutaneous Interventions

Degenerative mitral stenosis (DMS) is an important cause of mitral stenosis, developing secondary to severe mitral annular calcification. With the increase in life expectancy and improved access to health care, more patients with DMS are likely to be encountered in developed nations. These patients are generally elderly with multiple comorbidities and often are high-risk candidates for surgery. The mainstay of therapy in DMS patients is medical management with heart rate control and diuretic therapy. Surgical intervention might be delayed until symptoms are severely limiting and cannot be managed by medical therapy. Mitral valve surgery is also challenging in these patients because of the presence of extensive calcification. Hence, there is a need to develop an alternative percutaneous treatment approach for patients with DMS who are otherwise inoperable or at high risk for surgery. In this review, we summarize the available data on the epidemiology of DMS and diagnostic considerations and current treatment strategies for these patients.

Trends in the Burden of Adult Congenital Heart Disease in US Emergency Departments

We assessed trends in incidence, in‐hospital mortality, and admission among patients with adult congenital heart disease (ACHD) presenting to the emergency department (ED) from 2006 to 2012.

Feasibility of LAA Closure for Left Atrial Thrombus in Patients With Aortic Stenosis and AF.

Percutaneous left atrial appendage (LAA) closure has emerged as a safe and cost-effective alternative to anticoagulation therapy for prevention of thromboembolic events in patients with nonvalvular atrial fibrillation (NVAF) [(1)][1]. NVAF has been defined inconsistently in different trials and

NATIONWIDE TRENDS OF SURGICAL AND ENDOVASCULAR REVASCULARIZATION PROCEDURES FOR HOSPITAL ADMISSION, COST UTILIZATION, ALL-CAUSE MORTALITY, AND MAJOR AMPUTATION AMONG ADULTS WITH CRITICAL LIMB ISCHEMIA FROM 2003-2012

We evaluated the trends and outcomes following hospitalization of patients with critical limb ischemia (CLI) in the US from 2003 to 2012 We used the 2003-12 Nationwide Inpatient Sample. In-hospital death and amputation were co-primary outcomes. Length of stay (LOS) and cost of hospitalization were

STROKE AND SYSTEMIC EMBOLISM PROPHYLAXIS IN NON-VALVULAR ATRIAL FIBRILLATION: A NETWORK META-ANALYSIS COMPARING WARFARIN, NOVEL ORAL ANTICOAGULANTS AND WATCHMAN DEVICE

There is no direct or indirect evidence available for relative efficacy and safety of WATCHMAN device as compared to Novel oral anticoagulants. All major databases were searched for randomized controlled trials comparing factor Xa inhibitors, Dabigatran, the WATCHMAN device, and warfarin for