Objectives Acute heart failure is a life-threatening condition with a dramatic burden in terms of symptoms, morbidity, and mortality. We sought to determine the outcome of white and black patients admitted for heart failure with reduced ejection fraction exacerbation and less than 50 years. Methods Using the 2020 National Inpatient Sable, we conducted a retrospective analysis of patients admitted for acute heart failure as a principal diagnosis according to ICD-10 codes. Our primary outcome was inpatient mortality. Secondary outcomes include acute kidney injury (AKI), cardiogenic shock, ventricular fibrillation, ventricular tachycardia, intra-aortic pump use, ventricular assist devise use, acute hypoxic respiratory failure, length of hospital stay, and total hospital charges between groups. (Black and White female Patients less than 50 years old) Results A total of 55,100 patients were admitted to the hospital for heart failure with reduced ejection fraction. Of those, 2.3% were black females and less than 50 years old. Black female patients were younger (36 years old, 95% CI 34 - 37 VS 39 years old, 95% CI 37 - 40) when compared to white female patients. There was no statistically significant difference in in-hospital mortality (p=0.8713), acute kidney injury (p=0.2530), ventricular fibrillation (p=0.3917), ventricular tachycardia (p=0.1121), intra-aortic pump use (p=0.0712), ventricular assist devise use (p=0.3758) and acute hypoxic respiratory failure (p=0.1438). Female black patients had increased cardiogenic shock (p=0.0498), length of hospital stays (7 days, 95% CI 6 - 8 VS 6 DAYS, 95% CI 5 - 7), and total hospital charges ($125,899.1, 95% CI $46,415.06 - $165,383.2 VS $89,871.6, 95% CI $64,949.87 - $114,793.3) Conclusion This study shows that black female patients who were less than 50 years old had no increase in-hospital mortality when compared to white female patients. Black patients had increased cardiogenic shock, length of hospital stays, and charges.
Objectives Heart Failure is a syndrome, a group of signs and symptoms, caused by an impairment of heart pumping function. There is limited data about the outcome of acute heart failure in dementia patients. Methods Using the 2020 National Inpatient Sample Database, patients admitted with acute heart failure as the principal diagnosis with or without a history of dementia as the secondary diagnosis using the ICD-10 codes were identified. Outcomes were in-hospital mortality, acute kidney injury (AKI), cardiogenic shock, ventricular tachycardia, ventricular fibrillation, intra-aortic pump use, ventricular assist device, acute hypoxic respiratory failure, length of hospital stay, and total hospital charges. Results 81400 patients were admitted for acute heart failure, of those 6% had dementia. Patients with a history of dementia were older (84 years, 95% CI 83 - 84 VS 65 years, 95% CI 65 - 66). Patients with dementia had an increase in in-hospital mortality (p=0.0002) and acute hypoxic respiratory failure (p<0.0001). There was no difference in acute kidney injury (p=0.6043), ventricular fibrillation (p=0.3533), and ventricular assist device (p=0.0933). Patients with dementia had reduced cardiogenic shock (p<0.0001), ventricular tachycardia (p<0.0001), intra-aortic pump use (p=0.0373), length of hospital stays (5.5 days, 95% CI 5.1 - 5.8 VS 5.8 days, 95% CI 5.6 - 6) and total hospital charges ($ 47,574.04, 95% CI $43,353.96 - $51,794.13 VS $70,419.16, 95% CI $62,701.94 - $78136.37) Conclusion Per this study, patients with dementia had increased hospital mortality when compared to the general population admitted for acute heart failure. Patients with dementia had reduced cardiogenic shock, intra-aortic pump use, ventricular tachycardia, length of hospital stays, and charges.
BACKGROUND The CLASP IID randomized trial (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial) demonstrated the safety and effectiveness of the PASCAL system for mitral transcatheter edge-to-edge repair (M-TEER) in patients at prohibitive surgical risk with significant symptomatic degenerative mitral regurgitation (DMR). OBJECTIVES This study describes the echocardiographic methods and outcomes from the CLASP IID trial and analyzes baseline variables associated with residual mitral regurgitation (MR) <= 1+. METHODS An independent echocardiographic core laboratory assessed echocardiographic parameters based on American Society of Echocardiography guidelines focusing on MR mechanism, severity, and feasibility of M-TEER. Factors associated with residual MR <= 1+ were identified using logistic regression. RESULTS In 180 randomized patients, baseline echocardiographic parameters were well matched between the PASCAL (n = 117) and MitraClip (n = 63) groups, with flail leaflets present in 79.2% of patients. Baseline MR was 4thorn in 76.4% and 3+ in 23.6% of patients. All patients achieved MR <= 2+ at discharge. The proportion of patients with MR <= 1+ was similar in both groups at discharge but diverged at 6 months, favoring PASCAL (83.7% vs 71.2%). Overall, patients with a smaller flail gap were significantly more likely to achieve MR <= 1+ at discharge (adjusted OR: 0.70; 95% CI: 0.50-0.99). Patients treated with PASCAL and those with a smaller flail gap were significantly more likely to sustain MR <= 1+ to 6 months (adjusted OR: 2.72 and 0.76; 95% CI: 1.08-6.89 and 0.60-0.98, respectively). CONCLUSIONS The study used DMR-specific echocardiographic methodology for M-TEER reflecting current guidelines and advances in 3-dimensional echocardiography. Treatment with PASCAL and a smaller flail gap were significant factors in sustaining MR <= 1+ to 6 months. Results demonstrate that MR <= 1+ is an achievable benchmark for successful M-TEER. (Edwards PASCAL TrAnScatheter Valve RePair System Pivotal Clinical Trial [CLASP IID]; NCT03706833) (J Am Coll Cardiol Img 2024;17:471-485) (c) 2024 by the American College of Cardiology Foundation.
BACKGROUND:Cardiovascular magnetic resonance (CMR) is increasingly utilized to evaluate expanding cardiovascular conditions. The Society for Cardiovascular Magnetic Resonance (SCMR) Registry is a central repository for real-world clinical data to support cardiovascular research, including those relating to outcomes, quality improvement, and machine learning. The SCMR Registry is built on a regulatory-compliant, cloud-based infrastructure that houses searchable content and Digital Imaging and Communications in Medicine images. The goal of this study is to summarize the status of the SCMR Registry at 150,000 exams. METHODS:The processes for data security, data submission, and research access are outlined. We interrogated the Registry and presented a summary of its contents. RESULTS:Data were compiled from 154,458 CMR scans across 20 United States sites, containing 299,622,066 total images (∼100 terabytes of storage). Across reported values, the human subjects had an average age of 58 years (range 1 month to >90 years old), were 44% (63,070/145,275) female, 72% (69,766/98,008) Caucasian, and had a mortality rate of 8% (9,962/132,979). The most common indication was cardiomyopathy (35,369/131,581, 27%), and most frequently used current procedural terminology code was 75561 (57,195/162,901, 35%). Macrocyclic gadolinium-based contrast agents represented 89% (83,089/93,884) of contrast utilization after 2015. Short-axis cines were performed in 99% (76,859/77,871) of tagged scans, short-axis late gadolinium enhancement (LGE) in 66% (51,591/77,871), and stress perfusion sequences in 30% (23,241/77,871). Mortality data demonstrated increased mortality in patients with left ventricular ejection fraction <35%, the presence of wall motion abnormalities, stress perfusion defects, and infarct LGE, compared to those without these markers. There were 456,678 patient-years of all-cause mortality follow-up, with a median follow-up time of 3.6 years. CONCLUSION:The vision of the SCMR Registry is to promote evidence-based utilization of CMR through a collaborative effort by providing a web mechanism for centers to securely upload de-identified data and images for research, education, and quality control. The Registry quantifies changing practice over time and supports large-scale real-world multicenter observational studies of prognostic utility.
