Shaker M. Eid

Nationwide Inpatient Prevalence, Predictors, and Outcomes of Alzheimer’s Disease among Older Adults in the United States, 2002–2012

In the inpatient setting, prevalence, predictors, and outcomes [mortality risk (MR), length of stay (LOS), and total charges (TC)] of Alzheimers disease (AD) are largely unknown. We used data on older adults (60+ y) from the Nationwide Inpatient Sample (NIS) 2002-2012. AD prevalence was ∼3.12% in 2012 (total weighted discharges with AD ± standard error: 474, 410 ± 6,276). Co-morbidities prevailing more in AD inpatient admissions included depression (OR = 1.67, 95% CI: 1.63-1.71, p <  0.001), fluid/electrolyte disorders (OR = 1.25, 95% CI: 1.22-1.27, p <  0.001), weight loss (OR = 1.26, 95% CI: 1.22-1.30, p <  0.001), and psychosis (OR = 2.59, 95% CI: 2.47-2.71, p <  0.001), with mean total co-morbidities increasing over time. AD was linked to higher MR and longer LOS, but lower TC. TC rose in AD, while MR and LOS dropped markedly over time. In AD, co-morbidities predicting simultaneously higher MR, TC, and LOS (2012) included congestive heart failure, chronic pulmonary disease, coagulopathy, fluid/electrolyte disorders, metastatic cancer, paralysis, pulmonary circulatory disorders, and weight loss. In sum, co-morbidities and TC increased over time in AD, while MR and LOS dropped. Few co-morbidities predicted occurrence of AD or adverse outcomes in AD.

Predictors of early care withdrawal following out-of-hospital cardiac arrest.

AIMS To identify factors that associated with early care withdrawal in out-of-hospital cardiac arrest patients. METHODS Data was collected from 189 survivors to hospital admission. Patients were classified by survival status upon hospital discharge, and those who died were categorized into withdrawal vs. no withdrawal of care. Those who had care withdrawn were further subdivided into early care withdrawal i.e. ≤72 h vs. late withdrawal >72 h. Multivariable adjusted odds ratios were used to assess factors associated with early care withdrawal. RESULTS Of 189 patients with cardiac arrest, only 36 had advanced directives (19%) and 99 (52%) had care withdrawn. Most patients whose care was withdrawn died in hospital (94/99, 95%), and the remainder died in hospice. Care was withdrawn early ≤72 h in the majority of patients (59/94, 63%). Median time to early care withdrawal was 2 days IQR (1-3). Factors associated with early care withdrawal were age ≥75 years, poor initial neurologic exam, multiple co morbidities, multi-organ failure, lactic acid ≥10 mmolL(-1), Caucasian race and absence of bystander CPR. Advance directives did not appear to determine early care withdrawal. CONCLUSIONS Although most cardiac arrest patients do not have advance directives, care is often withdrawn in more than 50% and in many before the accepted time for neurological awakening (72h). The decision to withdraw care is influenced by older age, race, preexisting co morbidities, multi-organ failure, and a poor initial neurological exam. Further studies are needed to better understand this phenomenon and other sociological factors that guide such decisions.

Survival, expenditure and disposition in patients following out-of-hospital cardiac arrest: 1995–2013

AIMS To investigate trends in survival to hospital discharge, in-hospital expenditures, and post-acute-care disposition following out-of-hospital cardiac arrest (OHCA) in the United States. METHODS We performed this nationwide serial cross-sectional study using data from the National Inpatient Sample on all patients (age >18years) hospitalized with OHCA between January 1, 1995, and December 31, 2013. Our main outcome measure was survival to hospital discharge. We fitted multivariable regression models with survival, in-hospital expenditures, and post-acute-care disposition as our dependent variables. RESULTS Of 247,684 patients included in this study, 58.8% were men; mean age was 67 years. Overall trend of survival to discharge was unchanged (Ptrend=0.56) but a non-significant linear trend increase (49.9% [95% CI, 39.8%-60.0%] in 1995 to 54.0% [95% CI 46.3%-61.8%] in 2013) was noted. Survival improved for patients with VF arrest rhythm but not for those with non-VF arrest rhythm. Increasing age, female gender, non-Caucasian race, high comorbidity burden, non-private primary insurance, non-VF-arrest rhythm and weekend arrest were all negatively associated with neurologically-intact survival. The cost of hospitalization increased from

Relationship of Physical Intimate Partner Violence with Mental Health Diagnoses in the Nationwide Emergency Department Sample

18,287 (

Sleep Disturbances among Older Adults in the United States, 2002–2012: Nationwide Inpatient Rates, Predictors, and Outcomes

683) in 2001 to

The association between post resuscitation hemoglobin level and survival with good neurological outcome following Out Of Hospital cardiac arrest.

21,092 (

Using Innovative Methodologies From Technology and Manufacturing Companies to Reduce Heart Failure Readmissions

514) in 2013 at an average annual rate of

Sex, Race, and Socioeconomic Disparities in Patients With Aortic Stenosis (from a Nationwide Inpatient Sample)

261 (Ptrend<0.001). No change in post-acute discharge disposition was observed except for transfer to a short-term hospital (Ptrend<0.01). CONCLUSIONS Overall survival to discharge following out-of-hospital cardiac arrest remained static between 1995 and 2013. Renewed national efforts are needed to warrant better knowledge translation and wider implementation of the best available science in order to improve outcomes.

Factors Associated with Timing and Adverse Outcomes in Patients with Biliary Atresia Undergoing Kasai Hepatoportoenterostomy

OBJECTIVES We examined associations of physical intimate partner violence (PIPV) with selected mental health disorders using a nationally representative sample of emergency department (ED) discharges corresponding to men and women (18-64 years) from the 2010 Nationwide Emergency Department Sample. METHODS PIPV was determined using International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) external cause of injury code E967.3 (battering by spouse or partner). ICD-9-CM clinical classification of discharge diagnoses was used to identify mental health disorders. Multivariable logistic regression models were constructed to estimate adjusted odds ratios (ORadj) and their 95% confidence intervals (CIs). RESULTS PIPV prevalence was estimated at 0.36 per 1000 ED discharges. The strongest correlates of PIPV were alcohol-related (ORadj = 3.02, 95% CI: 2.62-3.50), adjustment (ORadj = 2.37, 95% CI: 1.56-3.58), intentional self-harm (ORadj = 1.41, 95% CI: 1.05-1.89), anxiety (ORadj = 1.23, 95% CI: 1.07-1.40), drug-related (ORadj = 1.22, 95% CI: 1.01-1.47), and mood (ORadj = 1.16, 95% CI: 1.04-1.31) disorders. PIPVs association with alcohol-related disorders was stronger among women (ORadj = 3.22, 95% CI: 2.79-3.72) versus men (ORadj = 1.98, 95% CI: 1.42-2.77). Similarly, drug-related disorders were stronger correlates of PIPV among women (ORadj = 1.32, 95% CI: 1.09-1.60) versus men (ORadj = 0.59, 95% CI: 0.31-1.16). CONCLUSIONS In EDs, PIPV was linked to several mental health disorders, with women experiencing comorbid PIPV and substance use more frequently than men.

Palliative care utilization following out-of-hospital cardiac arrest in the United States

Objective/Background: We examined the rates, predictors, and outcomes [mortality risk (MR), length of stay (LOS), and total charges (TC)] of sleep disturbances in older hospitalized patients. Patients/Methods: Using the U.S. Nationwide Inpatient Sample database (2002–2012), older patients (≥60 years) were selected and rates of insomnia, obstructive sleep apnea (OSA) and other sleep disturbances (OSD) were estimated using ICD-9CM. TC, adjusted for inflation, was of primary interest, while MR and LOS were secondary outcomes. Multivariable regression analyses were conducted. Results: Of 35,258,031 older adults, 263,865 (0.75%) had insomnia, 750,851 (2.13%) OSA and 21,814 (0.06%) OSD. Insomnia rates increased significantly (0.27% in 2002 to 1.29 in 2012, P-trend < 0.001), with a similar trend observed for OSA (1.47 in 2006 to 5.01 in 2012, P-trend < 0.001). TC (2012