Greater Baltimore Medical Center (GBMC) is a hospital located in the Baltimore suburb of Towson, Maryland. GBMC serves more than 20,455 inpatient cases and approximately 52,000 emergency department visits annually. GBMC's main campus also includes three medical office buildings—Physicians Pavilion East, Physicians Pavilion West and Physicians Pavilion North I. In addition to its main campus located in Towson, GBMC's care can be found in several facilities located throughout the community including Hereford, Hunt Manor, Hunt Valley, Owings Mills, Perry Hall, Lutherville, Phoenix and Timonium.GBMC HealthCare is a private, not-for-profit corporation that owns and operates Greater Baltimore Medical Center. GBMC HealthCare also owns and operates Gilchrist Hospice Care (formerly known as Hospice of Baltimore and Gilchrist Center for Hospice Care), the largest not-for-profit hospice organization in the state of Maryland. The organization also includes the GBMC Foundation, which supports the GBMC mission by managing fundraising efforts.
Abstract Background Patients with chronic obstructive pulmonary disease (COPD) are particularly vulnerable to severe respiratory infections. While COVID-19 vaccination has demonstrated effectiveness in reducing severe disease in the general population, its real-world impact on clinical outcomes among COPD patients remains underexplored. Understanding these outcomes could strengthen vaccination advocacy and guide COPD management strategies. Research Question Does COVID-19 vaccination reduce the risk of mortality, COPD exacerbations, and mechanical ventilation in adults with COPD? Methods We conducted a retrospective, propensity-matched cohort study using the TriNetX US Collaborative Network, which aggregates de-identified electronic health records from 72 healthcare organizations. Adults with COPD were identified using ICD-10 code J44 and spirometric confirmation (FEV1/FVC ≤ 70%). Cohorts were divided by COVID-19 vaccination status, identified through CPT and RxNorm codes. The index date was defined as the earliest qualifying encounter, with outcomes assessed thereafter.Primary outcome was all-cause mortality; secondary outcomes included COPD exacerbation (J44.1) and mechanical ventilation (ICD-10-PCS 5A1945Z). Propensity-score matching (1:1) was performed on age, sex, race, comorbidities, and baseline clinical characteristics, yielding balanced cohorts (n = 3,969 each). Risk ratios (RR), hazard ratios (HR), and Kaplan-Meier survival analyses were calculated, with significance set at p < 0.05. Results After matching, median follow-up was 894 days for the unvaccinated group and 886 days for the vaccinated group. All-cause mortality 23.8% (942/3,954) in unvaccinated vs 11.1% (442/3,968) in vaccinated; RR 2.14 (95% CI 1.93-2.37); HR 1.80 (95% CI 1.60-2.02); p < 0.001. COPD exacerbations 31.3% (1,243/3,969) in unvaccinated vs 25.3% (1,006/3,969) in vaccinated; RR 1.24 (95% CI 1.15-1.33); HR 1.24 (95% CI 1.14-1.35); p < 0.001. Mechanical ventilation 1.8% (72/3,902) in unvaccinated vs 0.8% (30/3,928) in vaccinated; RR 2.42 (95% CI 1.58-3.69); HR 2.06 (95% CI 1.33-3.18); p = 0.001. Kaplan-Meier curves demonstrated consistently higher survival and event-free probabilities among vaccinated patients across all outcomes. Conclusions In this large, real-world analysis, COVID-19 vaccination was associated with significantly lower risks of all-cause mortality, COPD exacerbations, and need for mechanical ventilation. These findings emphasize the importance of vaccination as a key component of COPD care, supporting its inclusion in quality-improvement metrics and clinical counseling for patients with chronic lung disease. This abstract is funded by: None
Low body mass index (BMI) is an independent risk factor for morbidity and mortality, yet patients who have a BMI < 20 undergoing total hip arthroplasty (THA) have attracted little attention. This paper investigates the incidence of (1) mechanical complications (periprosthetic fracture (PPFX), aseptic loosening, and aseptic revision); (2) infectious complications (prosthetic joint infection (PJI) and surgical site infection (SSI)); and (3) venous thromboembolism (VTE) in this population up to two years postoperatively. A national all-payer database identified THA patients from 2010–2021 with low BMI (< 19.9) or normal BMI (20–24.9) (n = 25,578). Patients with trauma, malignancy, or rheumatoid arthritis were excluded. Propensity score matching yielded low BMI (n = 6372) and normal BMI (n = 14,025) groups. Chi-square analyses evaluated complication rates at 90 days, one year, and two years, with odds ratios (OR) and 95
BACKGROUND:Delirium is an underrecognized geriatric complication after transcatheter structural heart interventions, with limited descriptive data across procedures and an uncertain association with clinical outcomes. AIMS:To quantify incidence, identify predictors, and evaluate in‑hospital outcomes of delirium after transcatheter aortic valve replacement (TAVR), transcatheter edge-to-edge mitral repair (TEER), transcatheter tricuspid valve replacement/repair (TTVR), and left atrial appendage occlusion (LAAO). METHODS:Using the National Inpatient Sample, we performed a retrospective analysis of adults undergoing TAVR, TEER, TTVR, or LAAO identified by ICD‑10 codes. Delirium was captured through validated diagnostic codes. Multivariable logistic and linear regression adjusted for demographic, clinical, and in‑hospital covariates to evaluate predictors of delirium and the independent association of delirium with clinical outcomes of interest. RESULTS:Among 151,455 weighted hospitalizations (86,940 TAVR, 15,305 TEER, 1250 TTVR, and 47,960 LAAO), delirium occurred in 2.8%, 4.0%, 4.4%, and 0.6% of cases, respectively. Delirium was independently associated with increased in-hospital mortality across all procedures (TAVR: aOR 4.5, 95% CI 2.9-6.9; TEER: aOR 2.7, 95% CI 1.1-6.6; TTVR: aOR 27.7, 95% CI 5.6-137.3; LAAO: aOR 24.5, 95% CI 5.4-110.8). Patients with delirium also had higher rates of mechanical ventilation and cardiac arrest, longer length of stay, and greater hospitalization costs. Geriatric-specific conditions, including frailty, dementia, malnutrition, and high comorbidity burden, were among the strongest predictors of delirium. CONCLUSIONS:Delirium after transcatheter structural heart interventions is strongly associated with adverse clinical outcomes and greater resource utilization. These findings underscore the importance of incorporating delirium risk stratification and targeted prevention strategies into structural heart pathways to preserve the net clinical benefit of these interventions.
BACKGROUND:The efficacy of angiotensin receptor-neprilysin inhibitor (ARNI) in reducing recurrence risk of atrial fibrillation (AF) after ablation remains uncertain. METHODS:We summarized the results about ARNI in preventing AF recurrence after radiofrequency ablation. After PROSPERO registration, two researchers independently screened the literature and assessed the risk of bias in the included studies. The fixed effects model was used to merge the effect sizes, and the results were reported separately depending on whether the study was a RCT or a cohort study and on the follow-up duration. We further conducted subgroup analysis by comparing the effect of ARNI in reducing AF recurrence to that of angiotensin-converting enzyme inhibitor and/or angiotensin receptor blocker (ACEI/ARB) and to that of the Blank group. Publication bias and sensitivity analysis were evaluated. RESULTS:Both in RCTs and cohort studies, constant usage of ARNI for 6 and 12 months partly reduced the AF recurrence after ablation (using 3-month ARNI in RCTs: RR = 0.56; 95% CI = 0.37-0.85; p = 0.006; using 6-month ARNI in RCTs: RR = 0.57; 95% CI = 0.39-0.82; p = 0.003; using 12-month ARNI in RCTs: RR = 0.65; 95% CI = 0.49-0.88; p = 0.005; using 6-month ARNI in cohort studies: RR = 0.44; 95% CI = 0.32-0.61; p < 0.001). Subgroup analysis showed that, compared to ACEI/ARB or Blank, both in RCTs and cohort studies, ARNI was more effective in reducing the recurrence rate of atrial fibrillation after ablation. CONCLUSIONS:The using of ARNI may be effective in preventing the recurrence of AF after ablation, with ARNIs being shown to be more effective than ACEI/ARBs.
Infective endocarditis (IE) is a serious condition with potential long-term cardiac complications, yet the risk of arrhythmia development following IE is not well established. This study aimed to quantify the long-term risk of clinically significant arrhythmias among IE survivors. Fig 1 Cumulative Risk of Arrhythmias Following Infective Endocarditis Compared to the General Population. Figure displays the cumulative incidence of five arrhythmia subtypes—atrial fibrillation/flutter (AF), first-degree atrioventricular (AV) block, second-degree AV block, complete AV block, and supraventricular tachycardia (SVT)—over 6 months, 1 year, 3 years, and 5 years following index diagnosis of infective endocarditis (IE). Red lines represent the IE cohort; black lines represent a propensity-matched general population cohort. All arrhythmia subtypes demonstrated significantly increased risk in the IE cohort over time, with divergence in event rates evident as early as 6 months and persisting through 5 years. We conducted a retrospective, propensity score–matched cohort study using the TriNetX Global Collaborative Network, comprising electronic health records from 144 health care organizations. Adults aged ≥18 years diagnosed with IE (ICD-10 I33.0) without prior arrhythmias or structural heart disease were identified and matched 1:1 to a general population cohort with no prior cardiac disease. Matching variables included age, sex, hypertension, diabetes, obesity, tobacco use, and substance use disorders. Outcomes were assessed over 5 years from the index diagnosis using Kaplan-Meier survival analysis and Cox proportional hazards modeling. Primary outcomes included incident atrial fibrillation/flutter (AF), ventricular fibrillation/flutter (VF), atrioventricular (AV) block (first, second, and complete), sick sinus syndrome (SSS), and supraventricular tachycardia (SVT). A total of 25,438 patients were included in each cohort after matching. Compared to general population, the IE cohort had significantly higher 5-year cumulative incidence of AF (3.6% vs 0.7%; HR, 6.14; 95% CI, 5.25–7.19), VF (0.2% vs < 0.1%; HR, 8.63), complete AV block (0.5% vs < 0.1%; HR, 16.74), SSS (0.6% vs 0.1%; HR, 11.59), and SVT (1.1% vs 0.3%; HR, 4.51) (all P< 0.001, Figure 1). Kaplan-Meier curves showed early separation between groups that persisted throughout follow-up. In this large, real-world cohort study, infective endocarditis was associated with significantly elevated risk of multiple arrhythmia subtypes over 5 years. These findings support long-term cardiac monitoring and follow-up strategies in patients recovering from IE. All Authors: No reported disclosures
