Pradhum Ram
Albert Einstein Medical Center
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Publication
Featured researches published by Pradhum Ram.
Clinical Research in Cardiology | 2018
Mahek Shah; Soumya Patnaik; Brijesh Patel; Pradhum Ram; Lohit Garg; Manyoo Agarwal; Sahil Agrawal; Shilpkumar Arora; Nilay Patel; Joyce Wald; Ulrich P. Jorde
BackgroundRecent trends on outcomes in cardiogenic shock (CS) complicating acute myocardial infarction (AMI) suggest improvements in early survival. However, with the ever-changing landscape in management of CS, we sought to identify age-based trends in these outcomes and mechanical circulatory support (MCS) use among patients with both AMI and non-AMI associated shock.MethodsWe queried the 2005–2014 Nationwide Inpatient Sample databases to identify patients with a diagnosis of cardiogenic shock. Trends in the incidence of hospital-mortality, and use of MCS such as intra-aortic balloon pump (IABP), Impella/TandemHeart (IMP), and extra corporeal membrane oxygenation (ECMO) were analyzed within the overall population and among different age-categories (50 and under, 51–65, 66–80 and 81–99 years). We also made comparisons between patient groups admitted with CS complicating AMI and those with non-AMI associated CS.ResultsWe studied 144,254 cases of CS, of which 55.4% cases were associated with an AMI. Between 2005 and 2014, an overall decline in IABP use (29.8–17.7%; ptrend < 0.01), and an uptrend in IMP use (0.1–2.6%; ptrend < 0.01), ECMO use (0.3–1.8%; ptrend < 0.01) and in-hospital mortality (44.1–52.5% AMI related, 49.6–53.5% non-AMI related; ptrend < 0.01) was seen. Patients aged 81–99 years had the lowest rate of MCS use (14.8%), whereas those aged 51–65 years had highest rate of MCS use (32.3%). Multivariable analysis revealed that patients aged 51-65 years (aOR 1.46, 95% CI 1.40–1.52; p<0.001), 66–80 years (aOR 2.51, 95% CI 2.39–2.63; p<0.01) and 81–99 years (aOR 5.04, 95% CI 4.78–5.32; p<0.01) had significantly higher hospital mortality compared to patients aged ≤ 50 years. Patients admitted with CS complicating AMI were older and had more comorbidities, but lower hospital mortality (45.0 vs. 48.2%; p < 0.001) when compared to non-AMI related CS. We also noted that the proportion of patients admitted with CS complicating AMI significantly decreased from 2005 to 2014 (65.3–45.6%; ptrend < 0.01) whereas those admitted without an associated AMI increased.ConclusionsIABP use has declined whereas IMP and ECMO use has increased over time among CS admissions. Older age was associated with an incrementally higher independent risk for hospital mortality. Recent trends indicate an increase in both proportion of patients admitted with CS without associated AMI and in-hospital mortality across all CS admissions irrespective of AMI status.
Clinical Cardiology | 2018
Mahek Shah; Pradhum Ram; Kevin Bryan Lo; Natee Sirinvaravong; Brijesh Patel; Byomesh Tripathi; Shantanu Patil; Vincent M. Figueredo
Limited data exist on readmission among patients with takotsubo cardiomyopathy (TC), a commonly reversible cause of heart failure.
American Journal of Cardiology | 2018
Mahek Shah; Pradhum Ram; Kevin Bryan Lo; Soumya Patnaik; Brijesh Patel; Byomesh Tripathi; Shantanu Patil; Marvin Lu; Ulrich P. Jorde; Vincent M. Figueredo
Peripartum cardiomyopathy (PPCM) is a pregnancy-associated cause of heart failure. Given the significant impact of heart failure on healthcare, we sought to identify etiologies and predictive factors for readmission in PPCM. We queried the 2013 to 2014 National Readmissions Database to identify patients admitted with a diagnosis of PPCM. Patients who were readmitted within 30 days were evaluated to identify etiologies and predictors of readmission. We identified 6,977 index admissions with PPCM. Of the 6,880 (98.6%) patients who survived the index hospitalization, 30-day readmission rate was 13%. Seventy-six percent of readmitted patients were admitted once, and the other 24% were readmitted at least twice within 30 days of discharge. Length of stay was ≥8 days (adjusted odds ratio [aOR] 2.80, 95% confidence interval [CI] 2.08 to 3.77), multiparity (aOR 2.07, 95% CI 1.09 to 3.92), coronary artery disease (aOR 2.28, 95% CI 1.42 to 3.67), and long-term anticoagulation use (aOR 2.51, 95% CI 1.73 to 3.64) were independently associated with increased risk of 30-day readmission. Among the readmissions, 48% were due to cardiac causes, where PPCM and related complications (24%) were the most common cardiac cause followed by heart failure (16%). The annual cost of stay for index admissions was
Clinical Cardiology | 2017
Pradhum Ram; Kenechukwu Mezue; Gregg S. Pressman; Janani Rangaswami
64.2 million (average cost for index admission was
Clinical Cardiology | 2018
Pradhum Ram; Mahek Shah; Natee Sirinvaravong; Kevin Bryan Lo; Shantanu Patil; Brijesh Patel; Byomesh Tripathi; Lohit Garg; Vincent M. Figueredo
16,892). The annual charges attributed to readmission within 30 days were ≈
Coronary Artery Disease | 2017
Soumya Patnaik; Mahek Shah; Yaser Alhamshari; Pradhum Ram; Ritika Puri; Marvin Lu; Percy Balderia; John B. Imms; Obiora Maludum; Vincent M. Figueredo
9 million. Cardiac etiologies were the most common cause for 30-day readmissions in PPCM patients, with a readmission rate of 13%. Long-term anticoagulation use, multiparity, coronary disease and length of stay predicted higher 30-day readmission.
American Journal of Emergency Medicine | 2017
Pradhum Ram; Ritesh G. Menezes; Natee Sirinvaravong; Sushil Allen Luis; Syed Ather Hussain; Mohammed Madadin; Savita Lasrado; Glenn Eiger
Transcatheter aortic valve replacement (TAVR) is a treatment option in high‐risk patients with severe aortic stenosis who are not surgical candidates. In light of emerging evidence, it is being increasingly performed even in intermediate‐risk patients in recent years. Patients who develop acute kidney injury (AKI) following TAVR are known to have worse outcomes. The objective of this concise review was to identify the prevalence and the impact of AKI following TAVR on patient outcomes by including the most recent literature in our search. After a thorough search on MEDLINE, Google Scholar, and PubMed, we included all literature relevant to AKI following TAVR. We found that AKI was caused by a variety of reasons, such as hemodynamic instability during rapid pacing, blood transfusion, periprocedural embolization, and use of contrast medium, to name a few. In patients who developed AKI following TAVR, 30‐day and 1‐year mortality were increased. Further, in these patients, length and cost of hospital stay were increased as well. Preventive measures such as optimal periprocedural hydration, careful contrast use, and techniques to prevent embolization during device implantation have been tried with limited success. Given that TAVR is expected to be increasingly performed, this review aimed to summarize the rapidly expanding currently available literature in an effort to reduce procedural complications and thereby improve patient outcomes.
Medical mycology case reports | 2018
Prithiv Prasad; Kevin Bryan Lo; Pradhum Ram
Left ventricular thrombosis (LVT) is a well‐known complication of acute myocardial infarction, most commonly seen in anterior wall ST‐segment elevation myocardial infarction (STEMI). It is associated with systemic thromboembolism.
Journal of the American College of Cardiology | 2018
Natee Sirinvaravong; Pradhum Ram; Mahek Shah; Shantanu Patil; Brijesh Patel; Shilpkumar Arora; Nilay Patel; Lohit Garg; Sahil Agrawal; Larry E. Jacobs; Vincent M. Figueredo
Background Chest pain is one of the most common presentations to a hospital, and appropriate triaging of these patients can be challenging. The HEART score has been used for such purposes in some countries and only a few validation studies from the USA are available. We aim to determine the utility of the HEART score in patients presenting with chest pain to an inner-city hospital in the USA. Patients and methods We retrospectively screened 417 consecutive patients admitted with chest pain to the observation/telemetry units at Einstein Medical Center Philadelphia. After applying inclusion and exclusion criteria, 299 patients were included in the analysis. Patients were divided into low-risk (0–3) and intermediate-high (≥4)-risk HEART score groups. Baseline characteristics, thrombolysis in myocardial infarction score, need for revascularization during index hospitalization, and major adverse cardiovascular events (MACE) at 6 weeks and 12 months were recorded. Results There were 98 and 201 patients in the low-score group and intermediate-high-score group, respectively. Compared with the low-score group, patients in the intermediate-high-risk group had a higher incidence of revascularization during the index hospital stay (16.4 vs. 0%; P=0.001), longer hospital stay, higher MACE at 6 weeks (9.5 vs. 0%) and 12 months (20.4 vs. 3.1%), and higher cardiac readmissions. HEART score of at least 4 independently predicted MACE at 12 months (odds ratio 7.456, 95% confidence interval: 2.175–25.56; P=0.001) after adjusting for other risk factors in regression analysis. Conclusion HEART score of at least 4 was predictive of worse outcomes in patients with chest pain in an inner-city USA hospital. If validated in multicenter prospective studies, the HEART score could potentially be useful in risk-stratifying patients presenting with chest pain in the USA and could impact clinical decision-making.
International Journal of Cardiology | 2018
Mahek Shah; Brijesh Patel; Byomesh Tripathi; Manyoo Agarwal; Soumya Patnaik; Pradhum Ram; Shantanu Patil; J.J. Shin; Ulrich P. Jorde
&NA; Cardiopulmonary resuscitation (CPR) has been shown to increase survival after cardiac arrest, but is associated with the risk of acquired injuries to the patient. While traumatic chest wall injuries are most common, other injuries include upper airway, pulmonary and intra‐abdominal injuries. This review discusses the risk factors and prevalence of CPR‐related injuries. Highlights:CPR, although lifesaving, may be associated with significant injuries.CPR is associated with a wide range of injuries, from the head and neck down to the abdomen and pelvis.Appropriate technique and position of chest compression may help prevent some CPR‐related injuries.CPR‐related injuries should be considered in all patients who do not improve despite correction of the cause of arrest
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University of Texas Health Science Center at San Antonio
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