Somers, Virend K.

With rising healthcare costs and the rapid increase in remote physiologic monitoring and care delivery, there is an increasing need for economical, accurate, and non-invasive continuous measures of blood analytes. Based on radio frequency identification (RFID), a novel electromagnetic technology (the Bio-RFID sensor) was developed to non-invasively penetrate inanimate surfaces, capture data from individual radio frequencies, and convert those data into physiologically meaningful information and insights. Here, we describe groundbreaking proof-of-principle studies using Bio-RFID to accurately measure various concentrations of analytes in deionized water. In particular, we tested the hypothesis that the Bio-RFID sensor is able to precisely and non-invasively measure and identify a variety of analytes in vitro. For this assessment, varying solutions of (1) water in isopropyl alcohol; (2) salt in water, and (3) commercial bleach in water were tested, using a randomized double-blind trial design, as proxies for biochemical solutions in general. The Bio-RFID technology was able to detect concentrations of 2000 parts per million (ppm), with evidence suggesting the ability to detect considerably smaller concentration differences.

Background Obstructive sleep apnea (OSA) is a common comorbidity in patients with heart failure, although current evidence is equivocal regarding the potential benefits of treating OSA with positive airway pressure (PAP) therapy in patients with heart failure. This study assessed the impact of adherence to PAP therapy on health care resource utilization in patients with OSA and heart failure with reduced ejection fraction. Methods and Results Administrative insurance claims data linked with objective PAP therapy use data from patients with OSA and heart failure with reduced ejection fraction were used to determine associations between PAP adherence and a composite outcome of hospitalizations and emergency room visits. One‐year PAP adherence was based on an adapted US Medicare definition. Propensity score methods were used to create groups with similar characteristics across PAP adherence levels. The study cohort included 3182 patients (69.9% male, mean age 59.7 years); 39% were considered adherent to PAP therapy (29% intermediate adherent, 31% nonadherent). One year after PAP initiation, adherent patients had fewer composite visits than matched nonadherent patients, driven by a 24% reduction in emergency room visits for adherent patients. Composite visit costs were lower in adherent versus nonadherent patients ($3500 versus $5879, P =0.031), although total health care costs were not statistically different ($13 028 versus $14 729, P =0.889). Conclusions PAP therapy adherence in patients with OSA with heart failure with reduced ejection fraction was associated with a reduction in health care resource utilization. This suggests that greater emphasis should be placed on diagnosing and effectively treating OSA with PAP in patients with heart failure with reduced ejection fraction.

Abstract Cardiovascular disease (CVD) is a leading cause of death and disability in the United States and worldwide. Untreated obstructive sleep apnea (OSA) is common among older adults with CVD and may increase their risk of hospitalization. However, prior research has been limited by smaller samples of participants undergoing diagnostic sleep testing. Our objective was to estimate the effect of untreated OSA on the risk of hospitalization among older Medicare beneficiaries with CVD age 65+. Using a 5% sample of Medicare administrative claims data from 2006 to 2013, beneficiaries were identified as cases diagnosed with OSA or controls without any sleep-related diagnoses. Then, we restricted only to beneficiaries with a CVD diagnosis by the index date (i.e., OSA diagnosis date or matched date in controls). Next, we assessed the risk of hospitalization, counting only one per beneficiary, during the year before the index date. Because OSA is typically present long before it is diagnosed, the year before OSA diagnosis was assumed to represent a period of untreated OSA. Covariates were balanced between cases and controls using inverse probability of treatment weighting (IPTW). Then using logistic regression, we estimated the risk of hospitalizations the year prior to the index date. Of the 142,893 beneficiaries with CVD, only 19,390 were diagnosed with OSA. In the IPTW model, beneficiaries with untreated OSA were more likely to be hospitalized (odds ratio, 1.82; 95% CI 1.77–1.87). Results suggest screening for OSA among Medicare beneficiaries with CVD may identify older adults at increased risk of hospitalization.

AbstractIntroductionThe use of intracardiac echocardiography (ICE) is beneficial during the ablation of atrial fibrillation (AF). Evidence is conflicting regarding the clinical impact of using ICE on arrhythmia recurrence and mortality.MethodsPatients undergoing catheter ablation of AF during 2010–2017 were identified using the International Classification of Diseases‐9th and 10th Revision‐Clinical Modification (ICD‐9‐CM and ICD‐10‐CM) from the Nationwide Readmissions Database. Propensity matching was used to generate a control group. Patient demographics, Charlson comorbidity indexes, time from discharge to readmission, and the reason of readmission were extracted.ResultsFrom 2010 to 2017, 51 129 patients were included in the analysis out of which ICE was used in 8005 (15.7%) patients. The in‐hospital mortality at readmission was significantly higher in the patients without ICE use (2.9% vs. 1.7%, p = .02). The length of stay (LOS) at readmission was significantly higher in non‐ICE arm (median [interquartile range, IQR]: 3 [2–6] vs. 2 [3–5] days, p < .0001) with similar healthcare‐associated cost (HAC) in both the groups (median [IQR]: US$7507.3 [4057.8–15 474.2] vs. 7339.4 [4024.8–15 191.6], p = .43). Freedom from readmission was 12% higher (hazard ratio [HR] [95% confidence interval, CI]: 0.88 [0.83–0.94], p < .0001) with the use of ICE at 90‐day follow‐up, which was driven by 24% reduction in heart failure (HF) at follow‐up (HR [95% CI]: 0.76 [0.60–0.96], p = .02).ConclusionsICE use during AF ablation procedure reduces readmissions at 90 days by 12%, driven by a 24% decrease in HF‐related admissions. The non‐ICE arm showed a significantly higher LOS which offsets marginally higher HAC in the ICE arm.

Background Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder affecting multiple systems, particularly the cardiovascular system. The leading causes of death in MFS are aortopathies and valvular disease. We wanted to identify the frequency of arrhythmia and postural orthostatic tachycardia syndrome, length of hospital stay, health care–associated costs (HAC), and in‐hospital mortality in patients with MFS. Methods and Results The National Inpatient Sample database from 2005 to 2014 was queried using International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD‐9‐CM ) codes for MFS and arrhythmias. Patients were classified into subgroups: supraventricular tachycardia, ventricular tachycardia (VT), atrial fibrillation, atrial flutter, and without any type of arrhythmia. Data about length of stay, HAC, and in‐hospital mortality were also abstracted from National Inpatient Sample database. Adjusted HAC was calculated as multiplying HAC and cost‐to‐charge ratio; 12 079 MFS hospitalizations were identified; 1893 patients (15.7%) had an arrhythmia; and 4.9% of the patients had postural orthostatic tachycardia syndrome. Median values of length of stay and adjusted HAC in VT group were the highest among the groups (VT: 6 days, $18 975.8; supraventricular tachycardia: 4 days, $11 906.6; atrial flutter: 4 days, $11 274.5; atrial fibrillation: 5 days, $10431.4; without any type of arrhythmia: 4 days, $8336.6; both P =0.0001). VT group had highest in‐patient mortality (VT: 5.3%, atrial fibrillation: 4.1%, without any type of arrhythmia: 2.1%, atrial flutter: 1.7%, supraventricular tachycardia: 0%; P <0.0001) even after adjustment for potential confounders (without any type of arrhythmia versus VT; odds ratio [95% CI]: 3.18 [1.62–6.24], P =0.001). Conclusions Arrhythmias and postural orthostatic tachycardia syndrome in MFS were high and associated with increased length of stay, HAC, and in‐hospital mortality especially in patients with VT.