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16. Disparity in hospital admissions and length of stay based on income status for emergency department hypertensive crisis visits

Author

Srivastava, Shreya, Vemulapalli, Bhargav, Okoh, Alexis K., and Kassotis, John

Subjects
Hospitalization, Cross-Sectional Studies, Physiology, Internal Medicine, Humans, Length of Stay, Emergency Service, Hospital, Cardiology and Cardiovascular Medicine, Article, Hospitals, Retrospective Studies
Abstract

OBJECTIVE: Racial, gender, and socioeconomic status have been shown to impact the delivery of care. How this impacts the management of hypertensive crisis remains unclear. We aim to identify disparities on admission frequency and length of stay (LOS) among those presenting with hypertensive crisis, as a function of household income. METHODS: This is a cross-sectional analysis of 2016 emergency department visits and supplemental inpatient data from the Nationwide Emergency Department Sample. Median household income quartiles were established. A multivariable logistic regression model was used to estimate odds of admission in each income quartile. A multivariable linear regression model was used to predict LOS. RESULTS: After applying sample weighting, the total number of emergency department visits was 33 727 with 6906, 25 443, and 1378 visits for hypertensive emergency, hypertensive urgency, and unspecified crisis, respectively. There were 13 191, 8889, 6400, 5247 visits in the (first) lowest, second, third′ and fourth (highest) income quartiles, respectively. The median age for the study population was 60. The most common comorbidity was chronic kidney disease. Individuals with the highest income, had a lower likelihood of admission, compared with the lowest quartile (adjusted odds ratio: 0.41, 95% CI 0.22–0.74). There was a significant association between income quartile and LOS among hypertensive emergency patients (beta coefficient: 0.407, P value = 0.019). CONCLUSION: In this study, patients with lower income were more likely to be admitted, whereas those with higher income exhibited a longer LOS. Clinicians must be made aware these disparities to ensure equitable delivery of care.

Published
2022

17. Racial Disparity Among Patients Undergoing Surgical Aortic Valve Replacement and Transcatheter Aortic Valve Replacement in the United States.

Author

Kulkarni, Abha, Arafat, Mohammod, Hou, Linle, Liang, Shiochee, and Kassotis, John

Subjects
AFRICAN Americans, RACISM, ONLINE information services, HEART valve prosthesis implantation, META-analysis, CONFIDENCE intervals, AORTIC stenosis, SURGICAL complications, DESCRIPTIVE statistics, HEALTH equity, MEDLINE, ODDS ratio
Abstract

Transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative to surgical aortic valve replacement (SAVR). However, racial disparities in the utilization of TAVR persist. This meta-analysis attempts to determine whether the prevalence of adverse outcomes (procedure-related complications) represent barriers to the use of TAVR among African Americans (AA). The TAVR cohort consisted of 89.6% Caucasian (C) and 4.7% AA, while the SAVR cohort included 86.9% C and 6.4% AA. The utilization rate (UR) of TAVR was 1.48 and.35 among C and AA, respectively, while the UR of SAVR was 1.44 and.48 among C and AA, respectively. Following TAVR, for AA the odds ratio (OR) was greater for stroke (OR = 1.22, P =.02) and transient ischemic attack (TIA) (OR = 1.57, P <.001) and lower for undergoing the insertion of a permanent pacemaker (OR =.81, P <.001). While there was a significant difference between C and AA in TAVR and SAVR utilization, outcomes between groups following TAVR are comparable; therefore, adverse outcomes do not appear to be a barrier to the use of TAVR among eligible AA. [ABSTRACT FROM AUTHOR]

Published
2023
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21. WHERE DID THE NEEDLE GO?

Author

Mishra, Nikita, primary, Batarseh, Alberto, additional, Aboyme, Andrew, additional, Lemaire, Anthony, additional, Zafar, Amna, additional, and Kassotis, John, additional

Published
2023
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25. IS MYOCARDIAL BRIDGING A BENIGN EVENT?

Author

Batarseh, Alberto, primary, Cai, Janet, additional, Hiltner, Emily, additional, Boyce, Steven W., additional, Weigold, William Guy, additional, Ghosh, Bobby, additional, and Kassotis, John, additional

Published
2023
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30. An Unusual Cause of AV Dyssynchrony: Dual AV Node Physiology With Retrograde Decremental Conduction

Author

Dalsania, Raj, Aboyme, Andrew, Coromilas, James, and Kassotis, John

Subjects
Imaging Vignette
Abstract

A 71-year-old male with persistent atrial fibrillation and a dual chamber permanent pacemaker presented complaining of dyspnea on exertion, easy fatiguability, and intermittent cough. A 12-lead electrocardiogram revealed ventricular paced complexes, native QRS complexes, and irregular atrial activity. Herein we present an unusual mechanism of atrioventricular dyssynchrony. (Level of Difficulty: Intermediate.)

Published
2023

31. Disparities in Drug-Eluting Stent Utilization in Patients With Acute ST-Elevation Myocardial Infarction: An Analysis of the National Inpatient Sample.

Author

Bhasin, Varun, Hiltner, Emily, Singh, Anjuli, Elsaid, Ossama, Awasthi, Ashish, Kassotis, John, and Sethi, Ankur

Subjects
CONFIDENCE intervals, PERCUTANEOUS coronary intervention, DRUG-eluting stents, RACE, RETROSPECTIVE studies, PATIENTS, ST elevation myocardial infarction, HOSPITAL admission & discharge, HEALTH insurance, HOSPITAL care, DESCRIPTIVE statistics, CORONARY artery disease, HEALTH equity, LOGISTIC regression analysis, ODDS ratio, WHITE people, MEDICAID, ACUTE diseases, AFRICAN Americans
Abstract

The superiority of drug-eluting stents (DES) compared with bare-metal stents (BMS) is well-established, but data regarding DES use in ST-elevation myocardial infarction (STEMI) as a function of race is limited. Our goal was to examine stent utilization patterns and disparities based on race, sex, and insurance status in patients with STEMI undergoing percutaneous coronary intervention. The National Inpatient Sample database was used to retrospectively compare DES vs BMS use in patients admitted with STEMI from 2009 to 2018. Multivariable logistic regression was performed to assess the independent predictors of DES use. DES utilization increased significantly from 62.8% in 2009 to 94.0% in 2018. However, African Americans were less likely to receive a DES (odds ratio [OR].82, 95% confidence interval [CI].77–.87) compared with Caucasians. Women were more likely to undergo DES implantation (OR 1.07, 95% CI 1.05–1.10). Patients insured by Medicaid (OR.84, 95% CI.80–.89) and those classified as Self-pay (OR.63, 95% CI.61–.66) were less likely to undergo DES implantation compared to those with private insurance (OR 1.33, 95% CI 1.29–1.38). Disparities based on race and insurance status continue to persist despite a significant increase in DES utilization in STEMI patients across the identified subgroups. [ABSTRACT FROM AUTHOR]

Published
2023
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36. A Survey of Antibiotic Use During Insertion of Cardiovascular Implantable Devices Among United States Implanters.

Author

Kranick, Stephen, Mishra, Nikita, Theertham, Arjun, Vo, Hung, Hiltner, Emily, Coromilas, James, and Kassotis, John

Subjects
ANTIBIOTICS, SURGICAL therapeutics, IMPLANTABLE cardioverter-defibrillators, HEART assist devices, INFECTION, SURVEYS, ANTIBIOTIC prophylaxis, QUESTIONNAIRES, DESCRIPTIVE statistics, VASCULAR catheters, PATIENT care, COMPLICATIONS of prosthesis
Abstract

Antibiotic use for cardiovascular implantable devices (CIED) prophylaxis is well-accepted despite a paucity of data. Pre-procedural prophylaxis lowers the rate of CIED infections; however, data is lacking for intra- or post-procedural antibiotic use. Antibiotic-eluting envelopes (ENVELOPE) [TYRX®TM] have been shown to reduce post-procedural infections. Understanding implanter practices may provide insight as to the need for antibiotic stewardship. The purpose of this survey was to assess the practices of implanters nationally. A survey was completed by 150 implanters across the US. Participants were board certificated, implanters of CIEDs, with varying experience (1–25 years), in various hospital settings. Of the respondents, 97% reported routine use of systemic antibiotics pre-operatively. About two-thirds of implanters continue systemic antibiotics post-operatively, with half continuing antibiotics for >24 h; 83% of implanters add antibiotic to saline for the purpose of irrigating the wound; 55% routinely use ENVELOPE on approximately 38% of patients. Common reasons cited for ENVELOPE use were infection concerns, significant risk factors, prior device infection, and immunosuppressed status. Two-thirds of respondents use systemic antibiotics during generator changes, with >50% continuing antibiotics for >24 h. This study suggests wide variations in practice among implanters. Additional attention to existing guidelines and evidence regarding appropriate use of ENVELOPE is still needed. [ABSTRACT FROM AUTHOR]

Published
2023
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38. Supplemental Material - Disparities in Drug-Eluting Stent Utilization in Patients With Acute ST-Elevation Myocardial Infarction: An Analysis of the National Inpatient Sample

Author

Bhasin, Varun, Hiltner, Emily, Singh, Anjuli, Elsaid, Ossama, Awasthi, Ashish, Kassotis, John, and Sethi, Ankur

Subjects
Cardiology
Abstract

Supplemental Material for Disparities in Drug-Eluting Stent Utilization in Patients With Acute ST-Elevation Myocardial Infarction: An Analysis of the National Inpatient Sample by Varun Bhasin, Emily Hiltner, Anjuli Singh, Ossama Elsaid, Ashish Awasthi, John Kassotis, and Ankur Sethi in Angiology

Published
2022
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42. MACHINE-LEARNING FOR THE ASSESSMENT OF PATIENT PROSTHESIS MISMATCH IN PATIENTS WITH LOW GRADIENT SEVERE AORTIC STENOSIS UNDERGOING TAVR

Author

Nahass, Meghan, primary, Chaudhary, Ashok, additional, Lindsay, David-Allen, additional, Liang, Shiochee, additional, Yanamala, Naveena, additional, Bhatti, Sabha, additional, Sethi, Ankur, additional, Hakeem, Abdul, additional, Kassotis, John, additional, Lee, Leonard Y., additional, Russo, Mark, additional, and Sengupta, Partho P., additional

Published
2022
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