Smit Patel

Burden of Arrhythmias in Epilepsy Patients: A Nationwide Inpatient Analysis of 1.4 Million Hospitalizations in the United States

Arrhythmias have been one of the common complications in epilepsy patients and have also been the reason for death. However, limited data exist about the burden and outcomes of arrhythmias by subtypes in epilepsy. Our study aims at evaluating the burden and differences in outcomes of various subtypes of arrhythmias in epilepsy patient population. The Nationwide Inpatient Sample (NIS) database from 2014 was examined for epilepsy and arrhythmias related discharges using appropriate International Classification of Disease, Ninth Revision Clinical Modification (ICD-9-CM) codes. The frequency of arrhythmias, gender differences in arrhythmia by subtypes, in-hospital outcomes and mortality predictors was analyzed. A total of 1,424,320 weighted epilepsy patients was determined and included in this study. Around 23.9% (n =277,230) patients had cardiac arrhythmias. The most frequent arrhythmias in the descending frequency were: atrial fibrillation (AFib) 9.7%, other unspecified causes 7.3%, sudden cardiac arrest (SCA) 1.4%, bundle branch block (BBB) 1.2%, ventricular tachycardia (VT) 1%. Males were more predisposed to cardiac arrhythmias compared to females (OR [odds ratio]: 1.1, p <0.001). The prevalence of most subtypes arrhythmias was higher in males. Arrhythmias were present in nearly a quarter of patients with epilepsy. Life threatening arrhythmias were more common in male patients. The length of stay (LOS) and mortality were significantly higher in epilepsy patients with arrhythmia. It is imperative to develop early diagnosis and prompt therapeutic measures to reduce this burden and poor outcomes due to concomitant arrhythmias in epilepsy patients.

Impact of Cocaine Use on Acute Ischemic Stroke Patients: Insights from Nationwide Inpatient Sample in the United States

Cocaine is the third most common substance of abuse after cannabis and alcohol. The use of cocaine as an illicit substance is implicated as a causative factor for multisystem derangements ranging from an acute crisis to chronic complications. Vasospasm is the proposed mechanism behind adverse events resulting from cocaine abuse, acute ischemic strokes (AIS) being one of the few. Our study looked into in-hospital outcomes owing to cocaine use in the large population based study of AIS patients. Using the national inpatient sample (NIS) database from 2014 of United States of America, we identified AIS patients with cocaine use using International Classification of Disease, Ninth Revision (ICD-9) codes. We compared demographics, mortality, in-hospital outcomes and comorbidities between AIS with cocaine use cohort versus AIS without cocaine use cohort. Acute ischemic strokes (AIS) with cocaine group consisted of higher number of older patients (> 85 years) (25.6% versus 18.7%, p <0.001) and females (52.4% versus 51.0%, p <0.001). Cocaine cohort had higher incidence of valvular disorders (13.2% versus 9.7%, p <0.001), venous thromboembolism (3.5% versus 2.6%, p<0.03), vasculitis (0.9% versus 0.4%, p <0.003), sudden cardiac death (0.4% versus 0.2%, p<0.02), epilepsy (10.1% versus 7.4%, p <0.001) and major depression (13.2% versus 10.7%, p<0.007). The multivariate logistic regression analysis found cocaine use to be the major risk factor for hospitalization in AIS cohort. In-hospital mortality (odds ratio (OR)= 1.4, 95% confidence interval= 1.1-1.9, p <0.003) and the disposition to short-term hospitals (odds ratio (OR)= 2.6, 95% confidence interval = 2.1-3.3, p <0.001) were also higher in cocaine cohort. Venous thromboembolism was observed to be linked with cocaine use (OR= 1.5, 95% confidence interval= 1.0-2.1, p < 0.01) but less severely than vasculitis (OR= 3.0, 95% confidence interval= 1.6-5.8, p <0.001). Further prospective research is warranted in this direction to improve the outcomes for AIS and lessen the financial burden on the healthcare system of the United States.

Recreational Marijuana Use and Acute Myocardial Infarction: Insights from Nationwide Inpatient Sample in the United States

Background Marijuana is a widely used recreational substance. Few cases have been reported of acute myocardial infarction following marijuana use. To our knowledge, this is the first ever study analyzing the lifetime odds of acute myocardial infarction (AMI) with marijuana use and the outcomes in AMI patients with versus without marijuana use. Methods We queried the 2010-2014 National Inpatient Sample (NIS) database for 11-70-year-old AMI patients. Pearson Chi-square test for categorical variables and Student T-test for continuous variables were used to compare the baseline demographic and hospital characteristics between two groups (without vs. with marijuana) of AMI patients. The univariate and multivariate analyses were used to assess and compare the clinical outcomes between two groups. We used Cochran–Armitage test to measure the trends. All statistical analyses were executed by IBM SPSS Statistics 22.0 (IBM Corp., Armonk, NY). We used weighted data to produce national estimates in our study. Results Out of 2,451,933 weighted hospitalized AMI patients, 35,771 patients with a history of marijuana and 2,416,162 patients without a history of marijuana use were identified. The AMI-marijuana group consisted more of younger, male, African American patients. The length of stay and mortality rate were lower in the AMI-marijuana group with more patients being discharged against medical advice. Multivariable analysis showed that marijuana use was a significant risk factor for AMI development when adjusted for age, sex, race (adjusted OR 1.079, 95% CI 1.065-1.093, p<0.001); adjusted for age, female, race, smoking, cocaine abuse (adjusted OR 1.041, 95% CI 1.027-1.054, p<0.001); and also when adjusted for age, female, race, payer status, smoking, cocaine abuse, amphetamine abuse and alcohol abuse (adjusted OR: 1.031, 95% CI: 1.018-1.045, p<0.001). Complications such as respiratory failure (OR 18.9, CI 15.6-23.0, p<0.001), cerebrovascular disease (OR 9.0, CI 7.0-11.7, p<0.001), cardiogenic shock (OR 6.0, CI 4.9-7.4, p<0.001), septicemia (OR 1.8, CI 1.5–2.2, p<0.001), and dysrhythmia (OR 1.8, CI 1.5-2.1, p<0.001) were independent predictors of mortality in AMI-marijuana group. Conclusion The lifetime AMI odds were increased in recreational marijuana users. Overall odds of mortality were not increased significantly in AMI-marijuana group. However, marijuana users showed higher trends of AMI prevalence and related mortality from 2010-2014. It is crucial to assess cardiovascular effects related to marijuana overuse and educate patients for the same.

Unplanned 30-Day Hospital Readmissions of Symptomatic Carotid and Vertebral Artery Dissection

Tapan Mehta, Smit Patel, Shailesh Male, Romil Parikh, Kathan Mehta, Kamakshi Lakshminarayan, Ramachandra Tummala, Mustapha Ezzeddine Department of Neurology, University of Minnesota, Minneapolis, MN, USA Department of Neurology, University of Connecticut, Farmington, CT, USA Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA Division of Hematology-Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA

COMPARISON OF 30-DAY READMISSION RATE, COST, AND PREDICTORS IN ATRIAL FIBRILLATION PATIENTS TREATED WITH VERSUS WITHOUT ENDOVASCULAR ABLATION

Background: Atrial fibrillation (AFib) accounts for high rates of unfavorable outcomes in cardiac as well as non-cardiac patients. The unplanned 30-day readmission rate, cost burden and predictors in AFib patients treated with or without Endovascular Ablation (EVA) remain unclear. Methods: We used

Trends in Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhages

Introduction: Aneurysmal subarachnoid hemorrhage (aSAH) accounts for 5% of all strokes; 30-day mortality is as high as 40%. We sought to evaluate outcomes of aSAH patients treated 2004-2014 by endovascular therapy (EVT), to demonstrate associated trends, and to evaluate angioplasty use for aSAH-related cerebral vasospasm. Methods: The Nationwide Inpatient Sample (NIS) database 2004-2014 was used to derive a study cohort using ICD-9 codes. Survey procedures were used to adjust for stratified cluster design of NIS. NIS trend weights were used to generate national estimates. Mortality during hospitalization and use of angioplasty for aSAH-induced cerebral vasospasm trends were evaluated with multivariate regression analysis. Results: We identified n = 10,822 (weighted n = 52,062) EVT-treated aSAH hospitalizations. Increasing years independently predicted decreased mortality (odds ratio [OR] 0.926, 95% confidence interval [CI] 0.905-0.948, p < 0.0001), decreased utilization of angioplasty (age ≥50 years [OR 0.916, 95% CI 0.867-0.968, p = 0.0019] and age <50 years [OR 0.922, 95% CI 0.879-0.967, p = 0.0009]) after controlling for increasing age, Charlson comorbidity index, and external ventricular drain placement. Angioplasty rates were higher in age <50 years compared to age ≥50 years (5 vs. 3.63%, p < 0.001). Conclusion: It is notable that EVT for aSAH management will be an integral and increasingly useful tool for initial aneurysm management. Advances in procedural techniques, operator experience, and periprocedural management could be significant contributors of decreasing mortality and reducing the need for angioplasty for cerebral vasospasm in patients admitted with aSAH.