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Atrial fibrillation (AF) is the most common sustained arrhythmia, affecting between 3 and 6 million people in the United States. It is associated with a reduced quality of life and increased risk of stroke, cognitive decline, heart failure and death. Black patients have a lower prevalence of AF than White patients but are more likely to suffer worse outcomes with the disease. It is important that stakeholders understand the disproportionate burden of disease and management gaps that exists among Black patients living with AF. Appropriate treatments, including aggressive risk factor control, early referral to cardiovascular specialists and improving healthcare access may bridge some of the gaps in management and improve outcomes.

Background:Mitral valve prolapse (MVP) affects about 2-3% of the general population. A small proportion of persons may have arrhythmic symptoms, leading to ventricular arrhythmias and sudden cardiac death (SCD). Mitral annular disjunction is a recently described entity that may be present with MVP or independently.Case:A 55-year-old male patient presented to the hospital with cardiac arrest. He has a history of percutaneous coronary intervention with stenting to left anterior descending (LAD) and right coronary artery (RCA) in 2015. He had ventricular fibrillation (VF) and subsequently arrested and underwent resuscitation. Electrocardiogram (EKG) showed sinus rhythm with prolonged QTc 487msec with no ischemia; echocardiography showed mitral annular disjunction, severe left ventricular global hypokinesis with ejection fraction of 10%. Left heart catheterization revealed nonobstructive moderate coronary artery disease. Right heart catheterization showed a severely reduced cardiac index of 2.1, and he was placed on mechanical support (Impella) for cardiogenic shock. On day 5, repeat echocardiography revealed left ventricular ejection fraction of 60%. Subsequent cardiac magnetic resonance (CMR) showed no evidence of infiltrative diseases but revealed an inferolateral wall scar from previous myocardial infarction and MVP with MAD. An implantable cardiac defibrillator was placed for secondary prevention of SCD.Discussion:The potential etiology of our patient's ventricular fibrillation cardiac arrest may include a scar from previous myocardial infarction or arrhythmogenic MVP with MAD. Myocardial fibrosis arising from MAD may be an origin of ectopic activity and arrhythmia. EKG, echocardiographic, and cardiac magnetic resonance imaging (CMR) are essential in diagnosing arrhythmic MVP and MAD. Young patients with premature ventricular contractions without clear etiology should be evaluated for MAD, and incidental findings of MAD should warrant further investigations, given its arrhythmogenic potential.Conclusion:MVP with MAD is associated with life-threatening arrhythmias. Further studies are required to explore treatment options to reduce the incidence of malignant VAs and SCDs in patients with MVP.

INTRODUCTION:Studies have analyzed contemporary data on outcomes at teaching vs non-teaching hospitals with the results found to be dissimilar in certain procedures in the United States. Coronary Atherectomy (CA) is a minimally invasive procedure that involves the opening of obstruction from heavily calcified blocked coronaries to improve blood flow to the heart. This study is set out to examine the differences in health care outcomes between teaching and non-teaching hospitals in patients who underwent CA using a nationally representative sample.METHODS:We reviewed data from the National Inpatient Sample (NIS) of patients admitted between 2016-2019. Using ICD-10 procedural codes, we identified patients who underwent CA (Rotational or Orbital) within the study period. We further categorized our study population into 2 groups based on teaching vs non-teaching status. Multivariate analysis was done to investigate the in-hospital outcomes between both groups and adjust for confounders.RESULTS:A total of 171,740 CA procedures were performed within the study period. 75% (129,585) vs 25% (42,155) of these procedures were performed in teaching vs non-teaching hospitals respectively. The mean age of patients who underwent the procedure was 65 years, with a higher preponderance in males (71.4%). There was no significant difference in in-hospital mortality in both groups (AOR 1.06, 95% CI 0.93 -1.21, p=0.372). There was also no observed difference in the odds of coronary perforation or cardiac tamponade (AOR 1.26, 95% CI 0.89-1.28 p=0.19) and (AOR 1.23, 95% CI 0.82-1.87, p=0.31) respectively. However, the teaching hospital groups had an increased odds of Coronary dissection (AOR 1.34, 95% CI 1.05 - 1.71, p=0.017) and heart Block (AOR 1.22, 95% CI 1.11-1.34, p< 0.001). We also noticed an increased odds of septic shock (AOR 1.24, 95% CI 1.05-1.80, p= 0.018), AKI (AOR 1.12, 95% CI 1.07-1.22, p=0.005) and a higher hospitalization duration (Adjusted coefficient 0.43, 95% CI 0.30-0.56, p< 0.001) in the teaching hospital group.CONCLUSION:CA performed at teaching hospitals is found to be associated with an increased risk of cardiac (coronary dissection and heart block) and non-cardiac (septic shock and AKI) outcomes.

Introduction:Substance Use Disorder (SUD) is a chronic relapsing disease emanating from the uncontrolled use of drugs despite devastating physical, neurologic and psychological consequences. Studies have proven an association of SUD with a variety of life-threatening cardiac conditions. Aortic dissection (AD) is an acute condition caused by a tear in the inner layer of the aorta and requires immediate intervention. Our study aimed to ascertain the in-hospital outcomes of patients with substance use disorders presenting with Aortic dissection using a national representative sample.Methods:This was a retrospective study done using the 2016-2019 National inpatient sample, ICD 10 codes were used to identify individuals who were admitted for aortic dissection who were further categorized into two groups based on a history of SUD or not. Multivariate analysis was used to control for confounders and assess in-hospital mortality and other hospital outcomes.Results:A total of 63,380 patients were admitted for Aortic dissection during the study period. 26% (16,775) of the population sample had active abuse of at least 1 substance. AD was identified in a younger age group with SUD vs those without SUD with a mean age of 57. vs 65 years respectively. 68% of patients with SUD were found to be males with the predominant race being white (56%). A higher proportion of SUD patients had co-morbid Hypertension (60%) and smoked Cigarette (92%). Comparing both groups, there was no statistical difference in in-hospital mortality (AOR 1.06, 95% CI 0.88-1.26, p=0.50). However, there was a higher risk of acute coronary syndrome (AOR 1.77, 95% CI 1.20-2.40, p= 0.01), Cardiogenic shock (AOR 1.26, 95% CI 1.01-1.57, p< 0.001) and Embolic stroke (AOR 1.33, 95% CI 1.05-1.67, p=0.019) in the SUD group. We also observed no difference in the mean length of stay (adjusted coefficient 0.456, 95% CI 0.049- 0.96, p=0.077) or the mean of total hospital charges (adjusted coefficient 3882, 95% CI -10548.17- 18313.79, p= 0.60) in both groups.Conclusions:We observed that in hospitalized patients with AD, SUD is not associated with an increased risk of in-hospital mortality, however, there is a significantly increased risk of cardiogenic shock, coronary syndrome, and embolic stroke.

Introduction:The transition of training to a new Academic year and the beginning of training for new interns and fellows have been suggested to affect the quality of patient care and health care outcomes in critically ill patients, a phenomenon known as the “July Effect” in the United States. Prior studies have shown mixed reports regarding the “July Effect” existence. This study provides an insight into the “July Effect” in patients who suffered Cardiac arrest using a National Database.Methods:We performed a retrospective analysis using the National inpatient sample (2016- 2019). The NIS was searched for hospitalized adult patients with cardiac arrest as a principal diagnosis. We subsequently divided our sample into two cohorts based on the quarter of training (1st quarter, July to September, and the Last quarter of Training April to June). The primary outcome was inpatient mortality, and the secondary outcomes were the length of stay (LOS), total hospitalization charges (THC), and transfer frequency to other acute care facilities.Results:There were 27,940 Patients who suffered a cardiac arrest in the first and last quarter of our study period. Approximately 49.2% (13,755) vs. 50.8% (14,185) patients were identified in the 1st and Last quarters, respectively. There was a similar distribution of Age (63.5 ± 0.2) and Sex (Females) (43%) in both cohorts. There was similar inpatient mortality for patients who presented in both quarters (AOR 1.05, 95% CI 0.855-1.14, p=0.935). There was also no significant difference in LOS (adjusted coefficient -0.19, 95% CI -0.50-0.46, p=0.937), THC (adjusted coefficient 115.9, 95% CI -6483.46 - 6715, p=0.973) and frequency of transfer to other acute care facilities (AOR 0.95, 95% CI 0.82-1.11, p=0.57).Conclusions:This study suggests that the “July Effect” is not apparent in patients who suffered cardiac arrest as there were no significant differences in the rate of in-hospital mortality, length of stay, total hospitalization charges, and frequency of transfer to other acute care facilities.

Introduction:Coronary artery dissection is an emergency condition due to a tear in the coronary arterial wall, and it’s an uncommon cause of acute coronary syndrome. The Effect of Obesity on the outcome of acute coronary artery dissection is poorly documented. Hence, our study sought to estimate the impact of Obesity on clinical outcomes of hospitalizations of patients with acute Coronary artery dissection using the national database.Methods:We queried the National Inpatient Sample (NIS) database from 2016 to 2019. The NIS is the largest inpatient hospitalization database in the United States. The NIS was searched for hospitalization of adult patients with acute Coronary artery dissection as a principal diagnosis with and without Obesity as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. The secondary results were Acute kidney injury (AKI), Cardiogenic shock (CS), Cardiac arrest (CA), Total hospital charge (THC), and length of stay (LOS). Multivariate logistic and linear regression analyses were used accordingly to adjust for confounders.Results:About 2440 patients were admitted for acute Coronary artery dissection; 17.4% (425) had underlying obesity. Cohorts with obesity vs No obesity had a mean age of 52.9 years [CI 50.4 - 55.5] vs 55.9 years [CI 54.5 - 57.4]; male (20% vs 25.8%), female (80% vs 74.2%); white (71.3% vs 73.3%), black (21.3% vs 12.0%), and Hispanic (6.3% vs 7.8%). Compared to patients without obesity, patients admitted with coexisting obesity had similar inpatient mortality (7.1% vs 3.2%, AOR 3.22, 95% CI 0.74 - 13.88, P=0.118), AKI (15.3% vs 9.9%, P 0.357), CS (9.4% vs 11.2% P=0.098), CA (5.9% vs 5.0% P=0.530), THC (IRR 0.94, 95% CI 0.64 - 1.37, P=0.738), and LOS (IRR 0.79, 95% CI 0.59 - 1.05, P=0.107).Conclusions:Patients admitted primarily for acute Coronary artery dissection with co-existing Obesity had similar inpatient mortality, AKI, CS, CA, THC, and LOS compared to patients without Obesity.