Kumar, Ashish

Introduction: In the last two decades, risk factors, prevalence, and mortality due to coronary artery disease in young adults is on the rise. Hypothesis: Assess the prevalence, trends, and economic burden of ventricular tachycardia (VT) in young adults (18-44 years). Methods: The Nationwide Inpatient Sample was explored for hospitalizations with VT in patients (Age 19-44) between 2005-2018 and divided among 3 groups of the quadrennial period using validated ICD-9 and ICD-10 CM codes. The Pearson chi-square test and Student’s t-test were used for categorical and continuous variables, respectively. We assessed the temporal trends of mortality in VT as well as trends of VT stratified by age, sex, and race by the linear-by-linear association test (Figure 1). Results: Out of 5,156,326 patients were admitted with VT between 2005-2018, 309,636 were in young adults. Among them, 102,433 were admitted between 2005-2009 (mean age 36.1±6.99; 61% male, 58.5% white), 109,591 between 2010-2014 (mean age 35.5±7.16; 59% male, 54.2% white), and 97,495 between 2015-2018 (mean age 35.4±7.00; 60% male, 52.3% white) (p<0.0001). In the young adults with VT, all-cause mortality was 7.37% from 2005-2009, 7.85% from 2010-2014 (6.5% relative increase from 2005-2009), and 8.98% from 2015-2018 (relative increase of 14.4% from 2010-2014) (p<0.0001). Inflation adjusted cost increased over the years [$12,177 in 2005-2009; $13,249 in 2010-2014; $15,807 in 2015-2018; p<0.0001)]. Conclusions: The prevalence of VT in young individuals is rising. VT-related mortality and healthcare utilization costs are on the rise in the study period. VT burden and poor outcomes were notable for Black males. Further studies are required for targeted screening and preventative measures in young adults.

Introduction: Real-world data on the significance of adding a defibrillator to cardiac resynchronization therapy (CRT-D) in patients with nonischemic cardiomyopathy (NICM) are limited. Hypothesis: CRT-D is associated with a lower risk of mortality and heart failure (HF) readmissions compared to CRT-P in NICM. Methods: We identified patients with NICM who underwent CRT-D and CRT without an ICD (CRT-P) by analyzing the nationwide readmission database from October 2015- December 2018 and using appropriate ICD-10 CM codes. Propensity score matching was performed to adjust for the confounders. Kaplan Meier curves were utilized for time to event analysis. Cox proportional hazard regression was used to generate hazard ratios. All-cause mortality at 6 months was the primary outcome whereas readmission due to HF and any other cause at 6 months were defined as secondary outcomes. Results: Post-PSM, 3054 patients with NICM underwent CRT-P, and 2863 patients underwent CRT-D placement. CRT-D did not show any benefit over CRT-P in reducing all-cause mortality at 6 months (2.92% vs. 2.79%, HR: 0.84, 95% CI: 0.61-1.16, p=0.29). Similarly, there was no difference in terms of readmissions due to other causes among both groups of patients (36.25% vs. 31.85%, HR: 0.98, 95% CI: 0.89-1.08, p=0.77). However, patients with CRT-P implantations had a lower risk of HF readmissions compared to the CRT-D group (10.05% vs. 14.25%, HR: 0.67, 95% CI: 0.58-0.79, p<0.0001). Conclusions: The addition of a defibrillator to CRT failed to show a survival benefit in patients with NICM. Moreover, HF readmissions were higher in CRT-D patients compared to CRT-P.

Introduction: The management of asymptomatic severe aortic stenosis (AS) is controversial and guidelines for the management of the same is not updated based on recently available evidence. Hypothesis: The main objective is to determine the optimal strategy for the management of asymptomatic severe AS between early intervention versus conservative management. Methods: We performed a systematic electronic search of the PubMed and Cochrane databases from the inception of the database to May 31 st , 2020. We used the Mantel Haenszel method with the Paule-Mandel estimator of Tau 2 and Hartung-Knapp adjustment to calculate relative risk (RR) with a 95% confidence interval (CI) and 95% prediction interval (PI). We used P curve analysis to assess publication bias and estimate the true effect of an intervention. All analysis was carried out using R version 3.6.2. Results: A total of seven studies were included in the final analysis, consisting of 1213 patients with early intervention and 2601 patients with conservative management. Early intervention as compared to conservative management was associated with reduced risk of all-cause mortality (RR: 0.32, 95% CI: 0.21-0.48) (Panel A) , cardiac mortality (RR: 0.36, 95% CI: 0.27-0.48) (Panel B) and non-cardiac mortality (RR: 0.40, 95% CI: 0.28-0.56) (Panel C) . There was no difference in the risk of sudden cardiac death (RR: 0.46, 95% CI: 0.15-1.40), stroke (RR: 0.79, 95% CI: 0.17-3.64), myocardial infarction (RR: 0.44, 95% CI: 0.01-16.82) or heart failure hospitalization (RR: 0.18, 95% CI: 0.01-5.29) between the groups. The pooled estimate for all the outcomes was associated with low-moderate heterogeneity. Conclusions: Among asymptomatic severe AS patients, early intervention is associated with reduced mortality without increasing any procedure-related clinical outcomes. Hence, this meta-analysis supports early intervention as opposed to watchful waiting for the management of asymptomatic severe AS.

Introduction: Atrial Fibrillation (AF) has been associated with various behavioral risk factors such as tobacco, alcohol, and/or substance abuse. Hypothesis: The main objective is to describe the national trends and burden of tobacco and substance abuse in AF hospitalizations. Methods: The National Inpatient Sample database from 2007 to 2015 was utilized and the hospitalizations with AF were identified using the international classification of disease, Ninth Revision, Clinical Modification (ICD-9-CM) code 427.31 in the primary diagnosis column. They were stratified into without abuse, tobacco use disorder (TUD), substance use disorder (SUD), alcohol use disorder (AUD), and drug use disorder (DUD). We used the Jonckheere-Terpstra trend test to analyze the trend in this study. Results: Out of 3,631,507 AF hospitalizations, 852,110 (23.46%) had TUD, 1851,170 (5.1%) had SUD, 155,681 (4.29%) had AUD and 42,667 (1.17%) had DUD. The trends of all increased substantially during the study period (Figure) . The prevalence of TUD, SUD, AUD, and DUD was substantially increased across all age groups, races, and gender during the study period. Female sex was associated with lower odds TUD (0.57 (0.56-0.57), P-value <0.001), SUD (0.27 (0.26-0.27), P-value <0.001), AUD (0.22 (0.22-0.22), P-value <0.001), and DUD (0.51 (0.5-0.52), P-value <0.001). Among AF hospitalizations, the black race was associated with higher odds of SUD (1.12 (1.1-1.14), P-value <0.001), and DUD(1.42 (1.38-1.47), P-value <0.001). The younger age group (18-35 years), male, Medicare/Medicaid as primary insurance, and lower socioeconomic status were associated with increased risk of both TUD and SUDs. Conclusions: Tobacco and substance use disorder among hospitalized AF patients in the US mainly affects males, younger individuals, white more than black, and those of lower socioeconomic status which demands the development of preventive strategies to address multilevel influences.

The impact of coronavirus disease, 2019 (COVID-19), has been profound. Though COVID-19 primarily affects the respiratory system, it has also been associated with a wide range of cardiovascular (CV) manifestations portending extremely poor prognosis. The principal hypothesis for CV involvement is through direct myocardial infection and systemic inflammation. We conducted a systematic review of the current literature to provide a foundation for understanding the CV manifestations and outcomes of COVID-19. PubMed and EMBASE databases were electronically searched from the inception of the databases through 27 April 2020. A second literature review was conducted to include major trials and guidelines that were published after the initial search but before submission. The inclusion criteria for studies to be eligible were case reports, case series, and observation studies reporting CV outcomes among patients with COVID-19 infection. This review of the current COVID-19 disease and CV outcomes literature revealed a myriad of CV manifestations with potential avenues for treatment and prevention. Future studies are required to understand on a more mechanistic level the effect of COVID-19 on the myocardium and thus provide avenues to improve mortality and morbidity.