Panchal, Vinaykumar

Introduction: Heart Disease and Stroke Statistics_2014 Update suggests more than 424,000 people suffer out of hospital cardiac arrest (OHCA) in the United States. Hypothesis: We assessed seasonal variation in OHCA from a large national hospitalisation database in the past decade. Methods: The Nationwide Inpatient Sample database was used to estimate the annual number of hospitalisations with from 2000-2011. Identification of out of hospital cardiac arrest related hospitalisations was based on the designation of the International Classification of Diseases (9th Edition) Clinical Modification (ICD-9-CM) diagnosis code 427.5 (OHCA) as the principal discharge diagnosis. The frequency of hospitalisation for each month cumulative over 11 years was calculated and divided by number of days in that month to obtain the mean hospitalisations per day for each month. All calculations were carried out using the weighted estimates approximating nationwide population estimates. Results: An estimated 93,209 hospitalisations with primary diagnosis of OHCA occurred in the United States from the beginning of the calendar year 2000 to the end of the calendar year 2011. The number of hospitalisations per day in each month is shown in Figure 1.The number of hospitalisation was maximum in the winter months and minimum in summer months. Specifically, the mean number of hospitalisation each day (averaged over 11 years) was least in August (242). There was a rising trend from August to January. The average number of hospitalisation was highest in January (310); thereafter, the hospitalisation rate dropped to a nadir in August. There was however no seasonal pattern in inhospital mortality. Conclusions: We identified for the first time in United States an impressive pattern of seasonal variation in hospitalisations for OHCA. Further efforts must be made to identify triggers and methods to prevent OHCA and reduce its burden on health care system.

Objective: To identify possible racial and/or health insurance disparities with respect to ablation procedures for atrial fibrillation (AF). Method: Using the Nationwide Inpatient Sample (2000-2011), we identified adult patients (pts) admitted with principle diagnosis of AF by ICD 9 code 427.31 who had catheter ablation (ICD 9 code - 37.34). We stratified patients by race (White, Black, Hispanic, and other minority racial groups), insurance status, age, gender, type of hospital, and type of hospital admission. A hierarchical mixed effect multivariate model was created to identify independent predictors of AF ablation. Results: Among 4,547,144 patients hospitalized with AF during the study period, 201,447(4.43%) underwent ablation procedures. In absolute numbers, the majority of the ablations were performed in Whites (65.7%) and patients with Medicare (66.7%) or private insurance (24.7%). After adjusting for confounding factors, the proportions of Black pts (compare to White), and Medicare, Medicaid, and Uninsured pts (compare to private insurance), receiving ablation therapy were lower (see table). Odds of having ablation were lower in older and female patients and higher in teaching hospitals and after elective admissions (p<0.001 for all comparisions). Similar racial and insurance disparities were observed over the time course of the study. Conclusion: We identified lower rates of AF ablation among black pts even after correction of other factors such as insurance. Ablation rates were also lower among patients without private insurance. These trends persisted during the study period of 2000-2011.

ObjectivesWe studied the trends and predictors of drug eluting stent (DES) utilization from 2006 to 2011 to further expound the inter‐hospital variability in their utilization.BackgroundWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) between 2006 and 2011 using ICD‐9‐CM procedure code, 36.06 (bare metal stent) or 36.07 (drug eluting stents) for Percutaneous Coronary Intervention (PCI). Annual hospital volume was calculated using unique identification numbers and divided into quartiles for analysis.Methods and ResultsWe built a hierarchical two level model adjusted for multiple confounding factors, with hospital ID incorporated as random effects in the model. About 665,804 procedures (weighted n = 3,277,884) were analyzed. Safety concerns arising in 2006 reduced utilization DES from 90% of all PCIs performed in 2006 to a nadir of 69% in 2008 followed by increase (76% of all stents in 2009) and plateau (75% in 2011). Significant between‐hospital variation was noted in DES utilization irrespective of patient or hospital characteristics. Independent patient level predictors of DES were (OR, 95% CI, P‐value) age (0.99, 0.98–0.99, <0.001), female(1.12, 1.09–1.15, <0.001), acute myocardial infarction(0.75, 0.71–0.79, <0.001), shock (0.53, 0.49–0.58, <0.001), Charlson Co‐morbidity index (0.81,0.77–0.86, <0.001), private insurance/HMO (1.27, 1.20–1.34, <0.001), and elective admission (1.16, 1.05–1.29, <0.001). Highest quartile hospital (1.64, 1.25–2.16, <0.001) volume was associated with higher DES placement.ConclusionThere is significant between‐hospital variation in DES utilization and a higher annual hospital volume is associated with higher utilization rate of DES. © 2015 Wiley Periodicals, Inc.

Background: Contemporary data regarding percutaneous closure of atrial septal defect/patent foramen ovale (ASD/PFO) are lacking. We evaluated the current trends in utilization of ASD/PFO closure in adults and investigated the effect of annual hospital volume on in‐hospital outcomes. Methods: We queried the Nationwide Inpatient Sample between the years 2001 and 2010 using the International Classification of Diseases (ICD‐9‐CM) procedure code for percutaneous closure of ASD/PFO with device. Hierarchical mixed effects models were generated to identify the independent multivariate predictors of outcomes. Results: A total of 7,107 percutaneous ASD/PFO closure procedures (weighted n = 34,992) were available for analysis. A 4.7‐fold increase in the utilization of this procedure from 3/million in 2001 to 14/million adults in 2010 in US (P < 0.001) was noted. Overall, percutaneous ASD/PFO closure was associated with 0.5% mortality and 12% in‐hospital complications. The utilization of intracardiac echocardiography (ICE) increased 15 fold (P < 0.001) during the study period. The procedures performed at the high volume hospitals [2nd (14–37 procedures/year) and 3rd (>38 procedures/year) tertile] were associated with significant reduction in complications, length of stay and cost of hospitalization when compared to those performed at lowest volume centers (<13 procedures/year). Majority (70.5%) of the studied hospitals were found to be performing <10 procedures/year hence deviating from the ACC/AHA/SCAI clinical competency guidelines. Conclusions: Low hospital volume is associated with an increased composite (mortality and procedural complications) adverse outcome following ASD/PFO closure. In the interest of patient safety, implementation of the current guidelines for minimum required annual hospital volume to improve clinical outcomes is warranted. © 2014 Wiley Periodicals, Inc.