Introduction Heart failure with preserved ejection fraction (HFpEF) patients account for over half of all heart failure (HF) hospitalizations, and the proportion is estimated to increase in the coming years. The age-adjusted prevalence of HFpEF has been found to be similar in men and women in small community-based studies. However, there is a lack of large-scale analysis of the prevalence and associated comorbidities of HFpEF in women. Hypothesis The authors postulated that there are significant differences in the inpatient prevalence, characteristics, and outcomes of female patients with HFpEF as compared to their male counterparts. Methods The study analyzed data from the National Inpatient Sample (NIS) database from 2017 to 2020 on adults aged 18 years and above. The study aimed to assess gender-based differences in in-hospital mortality, length of stay, cost of hospitalization, and associated comorbidities. Results Of the 1.47 million HFpEF patients in the sample, 59% were females, and the majority of the patients were aged 60 years or higher, with approximately 35% of people aged over 80 years. Hyperlipidemia, atrial fibrillation, and obesity were significantly associated comorbidities in patients with HFpEF. After matching, the study found that female patients had similar in-hospital mortality (OR 1.012, CI 0.99 - 1.03, p < 0.001) and a shorter length of stay (mean 5.97 vs. 6.42 days, p < 0.001) and lower cost of hospitalization (mean $64933.99 vs. $77742.63, p < 0.001) compared to male patients. Conclusion In patients with HFpEF, female gender was associated with a shorter length of stay and lower cost of hospitalization after adjustment for race, age, and chronic comorbidities. This study highlights the high prevalence of HFpEF in female patients and identifies the associated comorbidities. These observations emphasize the importance of further research on pathogenesis and underlying risk factors, especially in women, to potentially reduce the burden of HFpEF in the elderly population.

Background: Comparison of the real-world cohort on the relative safety of alcohol septal ablation (ASA) vs. septal myectomy (SM) for the management of hypertrophic cardiomyopathy (HCM) has been lacking. Methods: The National Inpatient Sample (NIS) (2012-2019) was used to select all cases of HCM. The safety of ASA vs. SM was compared using a one:many propensity score matched (PSM) analysis. Adjusted odds ratios (aOR) for mortality and other in-hospital complications were computed. Results: A total of 6208 HCM patients (ASA 3106 vs. SM 3102) were included using a PSM analysis. Post -procedural bleeding (aOR 0.18, 95 % CI 0.11-0.32, p < 0.0001) and the need for an intra-aortic balloon pump (aOR 0.51, 95 % CI, 0.28-0.96, p = 0.037) were significantly lower while permanent pacemaker (PPM) implanta-tion was significantly higher in ASA group as compared with SM group (aOR 1.72, 95 % CI, 1.43-2.06, p < 0.0001). The total in-hospital mean adjusted cost and length of stay were also significantly lower in the ASA group. How-ever, there were no significant differences in adjusted odds of all-cause mortality (aOR 0.91, 95 % CI 0.62-1.33, p = 0.61), stroke (aOR 0.91, 95 % CI, 0.59-1.4, p = 0.66), and major bleeding (aOR 1.0, 95 % CI 7.8-1.29, p = 0.99) between the two comparison groups. Conclusion: In patients with hypertrophic cardiomyopathy, alcohol septal ablation appears to be an acceptable alternative to septal myectomy due to a lower risk of post-procedural bleeding and the need for an intra-aortic balloon pump. However, ASA confers a higher risk of PPM placement. (c) 2023 Elsevier Inc. All rights reserved.

Background and study aims Post-ERCP pancreatitis (PEP) is the most common complication attributed to the procedure, its incidence being approximately 9.7%. Numerous studies have evaluated the predictive efficacy of post-procedure serum amylase and lipase levels but with varied procedure-to-test time intervals and cut-off values. The aim of this meta-analysis was to present pooled data from available studies to compare the predictive accuracies of serum amylase and lipase for PEP. Patients and methods A total of 18 studies were identified after a comprehensive search of various databases until June 2021 that reported the use of pancreatic enzymes for PEP. Results The sample size consisted of 11,790 ERCPs, of which PEP occurred in 764 (6.48%). Subgroups for serum lipase and amylase were created based on the cut-off used for diagnosing PEP, and meta-analysis was done for each subgroup. Results showed that serum lipase more than three to four times the upper limit of normal (ULN) performed within 2 to 4 hours of ERCP had the highest pooled sensitivity (92%) for PEP. Amylase level more than five to six times the ULN was the most specific serum marker with a pooled specificity of 93%. Conclusions Our analysis indicates that a lipase level less than three times the ULN within 2 to 4 hours of ERCP can be used as a good predictor to rule out PEP when used as an adjunct to patient clinical presentation. Multicenter randomized controlled trials using lipase and amylase are warranted to further evaluate their PEP predictive accuracy, especially in high-risk patients.

Over 17.7 million gastrointestinal (GI) endoscopic procedures are performed annually, contributing to 68% of all endoscopic procedures in the United States. Usually, endoscopic procedures are low risk, but adverse events may occur, including cardiopulmonary complications, bleeding, perforation, pancreatitis, cholangitis, and infection. Infections after the GI endoscopies most commonly result from the patient’s endogenous gut flora. Although many studies have reported infection after GI endoscopic procedures, a true estimate of the incidence rate of post-endoscopy infection is lacking. In addition, the infection profile and causative organisms have evolved over time. In recent times, multi-drug-resistant microorganisms have emerged as a cause of outbreaks of endoscope-associated infections (EAI). In addition, lapses in endoscope reprocessing have been reported, with some but not all outbreaks in recent times. This systematic review summarizes the demographical, clinical, and management data of EAI events reported in the literature. A total of 117 articles were included in the systematic review, with the majority reported from North America and Western Europe. The composite infection rate was calculated to be 0.2% following GI endoscopic procedures, 0.8% following ERCP, 0.123% following non-ERCP upper GI endoscopic procedures, and 0.073% following lower GI endoscopic procedures. Pseudomonas aeruginosa was the most common culprit organism, followed by other Enterobacteriaceae groups of organisms and Gram-positive cocci. We have also elaborated different prevention methods such as antimicrobial prophylaxis, adequate sterilization methods for reprocessing endoscopes, periodic surveillance, and current evidence supporting their utilization. Finally, we discuss disposable endoscopes, which could be an alternative to reprocessing to minimize the chances of EAIs with their effects on the environmental and financial situation.

Background Obstructive sleep apnea (OSA) is often present in coronary artery disease patients and confers a high risk of complications following percutaneous coronary interventions (PCI). The impact of two commonly associated comorbid conditions, chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS, Pickwickian syndrome) in OSA patients undergoing PCI has never been studied. Methods The National Inpatient Sample (NIS; 2007-2014) was queried using the International Classification of Diseases, Clinical Modification 9 (ICD-9-CM) codes to compare baseline characteristics, comorbidities, and outcomes in adults undergoing PCI with OSA, COPD-overlap syndrome, and OSA+OHS. Results Of a total of 4,792,177 PCI-related inpatient encounters, OSA, OSA-COPD overlap syndrome, and OSA+OHS were found to be present in 153,706 (median age 62 years, 79.4% male), 65135 (median age 65 years, 66.0% male), and 2291 (median age 63 years, 58.2% males) patients, respectively. The OHS+OSA cohort, when compared to the COPD-OSA and OSA cohorts, was found to have the worst outcomes in terms of all-cause mortality (2.8% vs. 1.5% vs. 1.1%), hospital stay (median 6 vs. 3 vs. 2 days), hospital charges ($147, 209 vs. $101,416 vs. $87,983). Complications, including cardiogenic shock (7.3% vs. 3.4% vs. 2.6%), post-procedural myocardial infarction (11.2% vs. 7.1% vs. 6.0%), iatrogenic cardiac complications (6.1% vs. 3.5% vs. 3.7%), respiratory failure, acute kidney injury, infections, and pulmonary embolism, were also significantly higher in patients with OHS+OSA. Adjusted multivariable analysis revealed equivalent results with OHS+OSA having worse outcomes than OSA-COPD and OSA. Conclusion Concomitant OHS and COPD were linked to worse clinical outcomes in patients with OSA undergoing PCI. Future prospective studies are warranted to fully understand related pathophysiology, evaluate and validate long-term outcomes, and formulate effective preventive and management strategies.

Abhilash Perisetti: NO financial relationship with a commercial interest | Hemant Goyal: YES financial relationship with a commercial interest;Aimloxy LLC.:Consulting | Mahanazuddin Syed: NO financial relationship with a commercial interest | Saurabh Chandan: NO financial relationship with a commercial interest | Rami Reddy Bonam: NO financial relationship with a commercial interest | Melissa Egbert: NO financial relationship with a commercial interest | Dushyant Dahiya: NO financial relationship with a commercial interest | Mariajose Rojas-DeLeon: YES financial relationship with a commercial interest;Boston Scientific:Speaking and Teaching | Shivanand Bomman: NO financial relationship with a commercial interest | Sonali Sachdeva: No Answer. | Mark Aloysius: No Answer. | Ragesh Thandassery: NO financial relationship with a commercial interest | Neil Sharma: YES financial relationship with a commercial interest;Boston Scoentific :Consulting;medtronic :Consulting;mauna kea:Consulting;steris :Consulting

Despite the lack of direct evidence that hypertension increases the likelihood of new infections, hypertension is known to be the most common comorbid condition in COVID-19 patients and also a major risk factor for severe COVID-19 infection. The literature review suggests that data is heterogeneous in terms of the association of hypertension with mortality. Hence, it remains a topic of interest whether hypertension is associated with COVID-19 disease severity and mortality. Herein, we perform a multicenter retrospective analysis to study hypertension as an independent risk for in-hospital mortality in hospitalized COVID-19 patients. This multicenter retrospective analysis included 515 COVID-19 patients hospitalized from March 1, 2020 to May 31, 2020. Patients were divided into two groups: hypertensive and normotensive. Demographic characteristics and laboratory data were collected, and in-hospital mortality was calculated in both groups. The overall mortality of the study population was 25.3% (130 of 514 patients) with 96 (73.8%) being hypertensive and 34 (26.2%) being normotensive (p-value of 0.01, statistically non-significant association). The mortality rate among the hypertensive was higher as compared to non-hypertensive; however, hypertensive patients were more likely to be old and have underlying comorbidities including obesity, diabetes mellitus, coronary artery disease, congestive heart failure, stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and cancer. Therefore, multivariable logistic regression failed to show any significant association between hypertension and COVID-19 mortality. To our knowledge, few studies have shown an association between hypertension and COVID-19 mortality after adjusting confounding variables. Our study provides further evidence that hypertension is not an independent risk factor for in-hospital mortality when adjusted for other comorbidities in hospitalized COVID-19 patients.

Background: Smoking has been linked to coronary artery vasoconstriction and increased myocardial oxygen demand. However, its impact on the outcomes of type 2 myocardial infarction (T2MI) remains unknown. Methods: We analyzed odds and predictors of in-hospital mortality in smokers vs. non-smokers from National Inpatient Sample (2018) T2MI hospitalizations after excluding secondary diagnoses of Type 1 MI. Results: Of 33155 T2MI admissions, 55.4% (n=14780) were smokers and 44.6% non-smokers (n=18375). Smokers were often younger (median 68 vs 74 yrs) and males (57.7% vs. 44.9%) than non-smokers. Unadjusted (OR 0.67, 95CI 0.50-0.91 (p=0.01) and demographically adjusted (OR 0.71, 95CI 0.52-0.98 (p=0.034) regression analyses revealed “smokers’ paradox” for in-hospital mortality. However, when additionally adjusted for comorbidities, the lower risk of all-cause mortality in smokers vs non-smokers failed to reach a statistical significance (OR 0.81, 95CI 0.56-1.16, p=0.253) [Table 1a] . Smokers had a higher rate of substance abuse, depression, and prior MI/PCI/CABG/stroke (p<0.05). Higher risk of all-cause mortality was found in patients with advanced age (OR 1.05), males (vs female OR 1.92) whereas whites (vs blacks OR 0.61, Hispanics OR 0.70), patients from higher-income quartile (76-100th vs. 0-25th OR 0.37) had a lower risk of mortality. CHF (OR 27.20), sepsis (OR 8.83), fluid-electrolyte disorders (OR 4.72), metastatic cancers (OR 3.29), coagulopathy (OR 2.16), prior VTE (OR 2.66) and CKD (OR 1.41) raised the odds of mortality in smokers whereas hypertension, hyperlipidemia, past cancer, prior PCI and prior TIA/Stroke showed lower odds of mortality (all p<0.05) [Table 1b] . Conclusion: In-hospital mortality associated with T2MI in unadjusted and sociodemographically adjusted models showed "Smoker's Paradox" but when controlled for comorbidities the lower odds failed to reach a statistical significance. The predictors of T2MI related mortality in smokers may help clinicians to identify high-risk patients.

Hemant Goyal: YES financial relationship with a commercial interest;Aimloxy LLC.:Consulting | Sonali Sachdeva: NO financial relationship with a commercial interest | Abhilash Perisetti: NO financial relationship with a commercial interest | Saurabh Chandan: NO financial relationship with a commercial interest | Muhammad Aziz: NO financial relationship with a commercial interest | Dushyant Dahiya: NO financial relationship with a commercial interest | Jay Bapaye: NO financial relationship with a commercial interest | Neil Sharma: YES financial relationship with a commercial interest;Boston Scoentific :Consulting;medtronic Consulting;mauna kea:Consulting;steris :Consulting | Nirav Thosani: YES financial relationship with a commercial interest;Boston Scientific :Consulting;Pentax America:Consulting;ROSEAId:Other Activities Not in List (use freeform entry below);UpTpDate:Other Activities Not in List (use freeform entry below);Abbvie:Speaking and Teaching