Vyas, Ankit

Background With the increase in popularity of cannabis and its use and the lack of large‐scale data on cannabis use and venous thromboembolism and pulmonary embolism (PE), we used a nationally representative cohort of young adults (aged 18–44 years) to compare the odds of admissions and in‐hospital mortality of PE with and without cannabis use disorder (CUD). Methods and Results Identified patients with PE using the National Inpatient Sample (2018) were compared for baseline, comorbidities, and outcomes. Multivariable regression analysis, adjusted for covariates, was used to compare the odds of PE in young patients with CUD (CUD+) versus those without (CUD−) and those with prior venous thromboembolism. Propensity score–matched analysis (1:6) was also performed to assess in‐hospital outcomes. A total of 61 965 (0.7%) of 8 438 858 young adult admissions in 2018 were PE related, of which 1705 (0.6%) had CUD+. On both unadjusted (odds ratio, 0.80 [95% CI, 0.71–0.90]; P <0.001) and adjusted regression analyses, the CUD+ cohort had a lower risk of PE admission. The CUD+ cohort had fewer routine discharges (58.3% versus 68.3%) and higher transfers to short‐term (7.9% versus 4.8%) and nursing/intermediate care (12.6% versus 9.5%) ( P <0.001). The PE‐CUD+ cohort of in‐hospital mortality did not differ from the CUD− cohort. Propensity score–matched (1:6) analysis revealed comparable mortality odds with higher median hospital stay and cost in the CUD+ cohort. Conclusions Young adults with CUD demonstrated lower odds of PE hospitalizations without any association with subsequent in‐hospital mortality. The median hospital stay of the CUD+ cohort was longer, they were often transferred to other facilities, and they had a higher cost.

Cerebral embolic protection devices (CEPD) during transcatheter aortic valve replacement (TAVR) have been shown to lower the risk of stroke during the procedure. However, their long-term and clinical effects on neuro-cognition are unknown. Therefore, we hypothesized the benefit of CEPD in TAVR patients with a prior history of stroke or transient ischemic attack (TIA). National Inpatient Sample (2019) and International Classification of Diseases, 10th Revision codes were used to identify patients undergoing TAVR with prior stroke or TIA. Propensity-matched analysis was performed to adjust for baseline characteristics and comorbidities. Primary outcome measures were postoperative stroke and all-cause mortality. Length of stay and hospital cost were secondary outcomes. Of 8450 unmatched TAVR patients with prior stroke or TIA in 2019, 1095 (13%) utilized CEPD. After propensity matching previous myocardial infarction (MI), coronary artery bypass grafting, and drug abuse were higher in the TAVR-only cohort. Postoperative stroke rate (1.4% vs 2.2%; P = 0.081) and odds [adjusted odds ratio (aOR), 0.48; 95% confidence interval (CI), 0.11–2.17; P = 0.341] were lower in the CEPD group. There was no difference in all-cause in-hospital mortality between the 2 groups (0.9% vs 1.0%). Length of stay (3 vs 2 days, P <0.001) and hospital expenditure ($172,711 vs $162,284; P = 0.002) were higher for the TAVR-only cohort. CEPD in TAVR patients with prior stroke or TIA did not show statistically significant postoperative stroke benefits. However, further larger-scale prospective studies are needed to evaluate the long-term neurocognitive benefits of CEPD in these patients. As the use of TAVR continues to expand, optimizing peri-procedural strategies such as the use of CEPD remains a critical area of research to improve patient outcomes.

Aim: Studies in the past have linked obesity as a risk factor for atrial fibrillation (AF). However, there is a paucity of data on this influence in young adult males. This meta-analysis aims to evaluate and stratify the association between BMI and AF among young men. Methods: PubMed, Scopus, and Google Scholar databases were systematically reviewed for studies reporting long term-incidence of atrial fibrillation in young male adults (18-49 years) with obesity (BMI>30 kg/m 2 ), and overweight BMI (BMI 20-25 kg/m 2 ). Random effects models were used for the meta-analyses and subgroup analyses. I 2 statistics were used to identify (>50%) heterogeneity. A sensitivity analysis was performed using leave-one-out method. Results: Six studies with a total of 21,856,538 individuals were screened, out of which 6,732,531 young males with higher BMI and obesity were evaluated for the risk of Atrial fibrillation for a median follow-up duration of 6.3 years (3.3 - 29 years range). South Korean and Japanese studies together constituted 99.86% of the study population. Most commonly associated comorbidities were hypertension, diabetes mellitus type 2, dyslipidemia and smoking. The unadjusted HR showed a significant association between overweight (BMI 25-30) [OR:1.42, (95%CI:1.28-1.58, I 2 : 75.86%; p< 0.01] and obesity (BMI >30) and AF [OR: 2.02, (95%CI: 1.77-2.29, I 2 :64.3%; p=0.02] in young adult males. After multivariable analysis, the association remained significant for overweight [OR:1.22, 95%CI: 1.14-1.32, I 2 : 82.74%; p< 0.01] and obesity [OR:1.48, 95%CI: 1.29-1.71, I 2 : 90.43%; p< 0.01]. Sensitivity analysis indicated that no single study unduly influenced the pooled estimates. Conclusion: This meta-analysis revealed that higher BMI (overweight and obese) in young males is associated with an increased long-term risk of AF over a median follow-up duration of 6.3 years.

Abstract Background Inflammation plays a potential role in heart failure (HF) etiology and prognosis. Neutrophil-to-Lymphocyte ratio (NLR) is a simple, routinely available lab criteria. In this meta-analysis, we sought to investigate the role of NLR on HF outcomes which remains unexplored. Methods PubMed, Embase and Scopus were systematically screened to find studies through August 2022, reporting data on association of HF related outcomes [all-cause mortality (ACM), cardiovascular (CV) death, in-hospital, HF readmissions and composite events] and NLR. Random effects models and I2 statistics were used to estimate pooled odds of outcomes and heterogeneity. Leave one out sensitivity analysis was performed. Results A total of 11 studies (6 retrospective and 5 prospective, 4 studies from Asia and Europe each, 2 from the US and 1 multicenter study) including 12954 patients (mean age: 69 years, Males 57.2%) from 2011 to 2022 with an average follow up duration of 54.8 months were included. Elevated NLR was significantly associated with ACM (aOR 1.80, 95%CI 1.46-2.22, p&lt;0.01, Table 1), HF readmissions (aOR 2.53, 95% CI 1.60-3.99), in-hospital mortality (aOR 3.26, 95% CI 1.76- 6.02), CV mortality (aOR 1.84, 95%CI 1.03-3.31) and composite CV outcome including heart transplant (OR 2.07, 95% CI 1.32-3.25), p&lt;0.001. Conclusion Elevated NLR was significantly associated with worse outcomes in HF patients. The NLR test might potentially be useful in identifying high-risk HF patients and curtail worse outcomes.

Background: Obstructive sleep apnea (OSA) increases the risk of stroke and cardiovascular diseases. However, its impact on geriatric patients with a prior history of stroke/transient ischemic attack (TIA) has not been adequately studied. Methods: We utilized the 2019 National Inpatient Sample in the US to identify geriatric patients with OSA (G-OSA) who had a prior history of stroke/TIA. We then compared subsequent stroke (SS) rates among sex and race subgroups. We also compared the demographics and comorbidities of SS+ and SS− groups and utilized logistic regression models to assess outcomes. Results: Out of 133,545 G-OSA patients admitted with a prior history of stroke/TIA, 4.9% (6520) had SS. Males had a higher prevalence of SS, while Asian-Pacific Islanders and Native Americans had the highest prevalence of SS, followed by Whites, Blacks, and Hispanics. The SS+ group had higher all-cause in-hospital mortality rates, with Hispanics showing the highest rate compared to Whites and Blacks (10.6% vs. 4.9% vs. 4.4%, p < 0.001), respectively. Adjusted analysis for covariates showed that complicated and uncomplicated hypertension (aOR 2.17 [95% CI 1.78–2.64]; 3.18 [95% CI 2.58–3.92]), diabetes with chronic complications (aOR 1.28 [95% CI 1.08–1.51]), hyperlipidemia (aOR 1.24 [95% CI 1.08–1.43]), and thyroid disorders (aOR 1.69 [95% CI 1.14–2.49]) were independent predictors of SS. The SS+ group had fewer routine discharges and higher healthcare costs. Conclusions: Our study shows that about 5% of G-OSA patients with a prior history of stroke/TIA are at risk of hospitalization due to SS, which is associated with higher mortality and healthcare utilization. Complicated and uncomplicated hypertension, diabetes with chronic complications, hyperlipidemia, thyroid disorders, and admission to rural hospitals predict subsequent stroke.