Citations

Background: Non-Hodgkin lymphoma (NHL) survivors are at increased risks of cardiovascular disease related death (CVD) compared to the general population. Objective: This study sought to determine the longitudinal trends in mortality attributed to CVD with comorbid NHL by race, sex, and geographic location. Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database among patients aged 18 and above from 1999 to 2020. Patients were identified when the primary causes of death were ischemic heart diseases (ICD 10 I20-I25), cerebrovascular diseases (I60-I69), or hypertensive disease (I10-I15), and NHL (C82-C85) was a contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and determined the trends over time by estimating the annual percent change using the Joinpoint regression program. Results: In the 22-year study period, a total of 22,778 CVD with comorbid NHL were identified. Overall, there was a significant decrease in annual trends for the AAMRs of CVD from 6.91 per 1,000,000 individuals in 1999 to 4.12 per 1,000,000 individuals in 2020 (p<0.05), with an annual percent decrease of 3.3. Overall, men recorded a higher AAMRs compared to women (6.76 vs 3.45, p<0.05). When stratified by race, White individuals had the highest AAMRs (5.07), while the AAMRs for American African, Asian, American Indian individuals were 3.01, 2.77, and 2.48 per 1,000,000 individuals respectively. The AAMRs were higher in the rural region than in the urban region (4.97 vs 4.78, p<0.05). Among all consensus regions, South region had the highest AAMRs. Conclusion: In conclusion, our study revealed a significant decrease in cardiovascular disease related deaths with comorbid NHL over the past two decades. It provides valuable insights into the effectiveness of management of comorbid CVD or CVD risk factors in patients with NHL.

Background: While cardiac involvement in sarcoidosis could be significant, data assessing geographical disparities in cardiovascular deaths (CVDs) among patients with sarcoidosis are limited. Objective: This study aims to determine the mortality attributed to CVDs with comorbid sarcoidosis in different geographic locations in the United States. Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database and performed serial cross-sectional analyses of national death certificate data for CVDs with comorbid sarcoidosis among patients aged 25 and above. Diseases of the circulatory system (ICD-10 I00-I99) were listed as the underlying cause of death, and sarcoidosis (ICD-10 D86) as contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and compared the mortality among census regions and states. Results: In the 22-year study period, 5,630 CVDs with comorbid sarcoidosis in the United States were identified between 1999 and 2020. The South region had the highest AAMRs for CVDs with comorbid sarcoidosis (1.32 [95% CI, 1.26-1.37] per 1,000,000 individuals), followed by Northeast region (1.25 [95% CI, 1.18-1.32] per 1,000,000 individuals), Midwest region (1.24 [95% CI, 1.17-1.30] per 1,000,000 individuals), and West Region (0.92 [95% CI, 0.86-0.98] per 1,000,000 individuals). The AAMRs for CVDs with comorbid sarcoidosis were between 0.57 [95% CI, 0.43-0.75] per 1,000,000 individuals and 1.96 [95% CI, 1.73-2.19] per 1,000,000 individuals throughout the States, except Maryland and the District of Columbia, which recorded 2.79 [95% CI, 2.44-3.14] and 6.01 [95% CI, 4.44-7.94], respectively. Conclusion: The South region, particularly Maryland recorded the highest CVDs in sarcoidosis. Geographical disparities observed in CVDs with comorbid sarcoidosis highlight the need to improve public health measures at state-level.

Background: Sarcoidosis is a multisystem inflammatory disease that could result in debilitating cardiac manifestations. Despites, data on the cardiovascular deaths (CVDs) among patients with sarcoidosis are limited. Objective: This study sought to determine the longitudinal trends in mortality attributed to CVDs with comorbid sarcoidosis by age, sex, and race in the United States. Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research database and performed serial cross-sectional analyses of national death certificate data for CVDs with comorbid sarcoidosis among patients aged 25 and above. Diseases of the circulatory system (ICD-10 I00-I99) were listed as the underlying cause of death, and sarcoidosis (ICD-10 D86) as contributing cause of death. We calculated age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and determined the trends over time by estimating the annual percent change using the Joinpoint Regression Program. Results: In the 22-year study period, 5,630 CVDs with comorbid sarcoidosis in the United States were identified between 1999 and 2020. The AAMRs from CVDs with comorbid sarcoidosis increased from 1.03 (95% CI, 0.88-1.17) in 1999 to 1.38 (95% CI, 1.24-1.52) in 2020. Overall, women recorded a higher AAMRs compared to men (1.25 [95% CI, 1.21-1.30] vs. 1.10 [95% CI, 1.06-1.15]). Black individuals had higher AAMRs than White individuals (5.17 [95% CI, 4.97-5.37] vs. 0.68 [95% CI, 0.66-0.71]). A higher percentage of CVDs with comorbid sarcoidosis was seen in the age groups of 55-64 in men (24.68%) and 65-74 in women (22.62%). Conclusion: The CVDs in sarcoidosis have increased over the last two decades, with disparities seen in women and Black individuals. Most CVDs with comorbid sarcoidosis occurred at a younger age compared to general population. This highlights the importance of early screening for cardiovascular diseases in sarcoidosis individuals.

Background: Catheter ablation for ventricular tachycardia (VT) has been increasingly performed. While it is estimated that 42% of adults in the United States are obese, the impact of obesity on VT ablation procedures remains unclear. Objective: This study aimed to evaluate the procedural outcomes and 30-day readmission among non-obese and obese patients who underwent catheter ablation of VT. Method: Using the Nationwide Readmissions Database, our study included patients aged 18 years or older who underwent catheter ablation for VT between 2017 and 2020. The study cohort was stratified into non-obese (BMI < 30kg/m 2 ) and obese (BMI ≥ 30kg/m 2 ). The in-hospital procedural outcome and 30-day readmission were analyzed between these groups. Results: Our study included a total of 835 obese patients (19.7%) and 3393 non-obese patients (80.3%). Obese group had a higher rate of prolonged length of stay (>7 days) (37.6% vs 31.2%, p<0.01) and a higher cost of hospitalization ($39 983 vs $37 015, p<0.01). Overall, there were no significant differences in early mortality (4.5% vs 3.8%, p=0.45). Apart from increased vascular complications in the obese group (1.8% vs 0.9%, p=0.03), there were no significant differences in other procedural complications between both groups. There were no significant differences in 30-day readmission rates between obese and non-obese groups (15.5% vs 14.1%, p=0.38). Additional analysis performed in the obese group revealed a non-significant decreasing trend in early mortality rate post-procedurally (5.4% to 4.8%, P trend = 0.66). On multivariable analysis, heart failure was associated with a higher risk of 30-day readmission in obese patients (OR: 2.00; 95% CI: 1.01-3.99; p=0.05). Conclusion: Our study suggests that catheter ablation for VT can be performed relatively safely in obese patients without significant differences in 30-day mortality and readmission outcomes. Patients should not be excluded from VT ablation on the basis of obesity.

Background: Despite the optimal efficacy of catheter ablation for ventricular tachycardia (VT), recurrence of VT can occur post-procedurally. However, data on the high-risk population for VT recurrence and the in-hospital outcomes remain scarce. Objective: This study aimed to determine the predictors of 30-day readmission for recurrent VT after catheter ablation of VT and assess the in-hospital outcomes. Method: Using the all-payer, nationally representative Nationwide Readmissions Database, we identified the patients aged ≥18 years who underwent catheter ablation for VT and were readmitted within 30 days because of recurrent VT from 2017 to 2020. We performed unweighted univariable and multivariable analyses to determine the outcomes and to identify the patient and hospital variables that were predictive of 30-day readmissions for recurrent VT. A p-value of <0.05 is considered statistically significant. Results: In our analysis, a total of 4,102 patients were discharged alive after VT ablation, of which 278 (6.8%) were readmitted within 30 days for recurrent VT. Recurrent VT was also the most common cause of 30-day readmission (47.7%, n=278/583). Compared to non-recurrent VT readmission, readmission due to recurrent VT had higher mortality during rehospitalization (7.55% vs 3.72%, p<0.01) and higher cumulative hospitalization cost ($57584 vs $37846, p<0.01). Via multivariable analysis, congestive heart failure (aOR: 1.84; 95% CI: 1.07-3.17; P=0.03) and non-elective index admissions (aOR: 1.88; 95% CI: 1.32-2.68; P<0.01) were the independent predictors of 30-day readmission for recurrent VT. Conclusion: Recurrent VT was the most common cause of 30-day readmission following VT ablation. Congestive heart failure and non-elective index admissions were the independent predictors of 30-day readmissions for recurrent VT. These highlight the importance of further research in ablation strategies to improve the efficacy of VT ablation.

Background: Catheter ablation for ventricular tachycardia (VT) has been increasingly performed over the past decades. However, the real-world data on the safety profile of this procedure among elderly patients is limited. Objective: This study aimed to evaluate the procedural outcomes and 30-day readmission among those aged 18-64 years versus those aged ≥65 years who underwent catheter ablation of VT. Method: Using the all-payer, nationally representative Nationwide Readmissions Database, our study included patients aged 18 years or older who underwent VT catheter ablation between 2017 and 2020. We divided the patients into non-elderly (18-64 years old) and elderly age groups (≥65 years old). We then analyzed the in-hospital procedural outcome and 30-day readmission between these groups. Results: Our study included 2075 (49.1%) non-elderly patients and 2153 (50.9%) elderly patients who underwent VT ablation. Following the procedure, elderly patients had significantly higher rates of prolonged index hospitalization (≥7 days) (35.5% vs 29.3%, p<0.01), non-home discharge (13.4% vs 6.0%, p<0.01), 30-day readmission (17.0% vs 11.4%, p<0.01), and early mortality (5.5% v 2.4%, p<0.01). The median cumulative cost of hospitalization was significantly higher in the elder groups ($40,230 vs. $37,612, p ≤0.01). There was no significant difference in the procedural complications between the two groups. Through multivariable analysis, the elderly group was associated with significantly higher odds of early mortality (OR: 7.50; CI 1.86 - 30.31, p=0.01), non-home discharge (OR: 2.41; CI: 1.93 - 3.00, p<0.01) and 30-day readmissions (OR: 1.58; CI 1.32 - 1.89, p<0.01). Conclusion: Our study suggests that elderly patients have poorer in-hospital outcome in early mortality, non-home discharge and 30-day readmissions following catheter ablation for VT. There was no significant difference between elderly and non-elderly groups in the procedural complications.

AbstractBackgroundCardiac arrest (CA) is a leading cause of death in the United States (US). Social determinants of health may impact CA outcomes. We aimed to assess mortality trends, disparities, and the influence of the social vulnerability index (SVI) on CA outcomes in the young.MethodsWe conducted a cross‐sectional analysis of age‐adjusted mortality rates (AAMRs) related to CA in the United States from the Years 1999 to 2020 in individuals aged 35 years and younger. Data were obtained from death certificates and analyzed using log‐linear regression models. We examined disparities in mortality rates based on demographic variables. We also explored the impact of the SVI on CA mortality.ResultsA total of 4792 CA deaths in the young were identified. Overall AAMR decreased from 0.20 in 1999 to 0.14 in 2020 with an average annual percentage change of −1.3% (p = .001). Black (AAMR: 0.30) and male populations (AAMR: 0.14) had higher AAMR compared with White (AAMR: 0.11) and female (AAMR: 0.11) populations, respectively. Nonmetropolitan (AAMR: 0.29) and Southern (AAMR: 0.26) regions were also impacted by higher AAMR compared with metropolitan (AAMR: 0.11) and other US census regions, respectively. A higher SVI was associated with greater mortality risks related to CA (risk ratio: 1.82 [95% CI, 1.77–1.87]).ConclusionsOur analysis of CA in the young revealed disparities based on demographics, with a decline in AAMR from 1999 to 2020. There is a correlation between a higher SVI and increased CA mortality risk, highlighting the importance of targeted interventions to address these disparities effectively.

Purpose:Recent studies demonstrate the success of Kasai portoenterostomy for biliary atresia (BA) is linearly related to infant age at time of Kasai. We sought to review the feasibility and safety of laparoscopic needle micropuncture cholangiogram with concurrent core liver biopsy (if needed) for expedited exclusion of BA in patients with direct conjugated hyperbilirubinemia.Methods:Expedited laparoscopic cholangiogram and liver biopsy were instituted at our facility for infants with direct hyperbilirubinemia for whom clinical exam and laboratory workup failed to diagnose. A retrospective chart review was performed in infants <1 year with hyperbilirubinemia from 2016 to 2021. Demographics, preoperative evaluation, procedure details, and complications were reviewed.Results:Two hundred ninety‐seven infants with unspecified jaundice were identified, of which, 86 (29%) required liver biopsy. Forty‐seven percutaneous liver biopsies were obtained including 8 (17%) in whom BA could not be excluded. Laparoscopic cholangiogram was attempted in 47 infants following basic workup; BA was diagnosed in 22 infants (47%) of which 3 were <18 days old. Biliary patency was demonstrated laparoscopically in 22 of 25 (88%); 3 (12%) required conversion to open cholangiogram. Infants with percutaneous liver biopsy had an average delay of 3 days (range: 2–36) to cholangiogram. Preoperative studies and liver biopsy alone did not reliably exclude the diagnosis of BA.Conclusion:Laparoscopic cholangiogram with liver biopsy is a safe procedure resulting in the confirmation or exclusion of BA in infants. Forty‐seven percent of infants who underwent laparoscopic cholangiogram were found to have BA; those who were surgical candidates underwent Kasai during the same operation.

AbstractBackgroundReal‐world clinical data on the adverse events related to the use of cryoballoon catheter for pulmonary vein isolation remains limited.ObjectiveTo report and describe the adverse events related to the use of Artic Front cryoballoon catheters (Arctic Front, Arctic Front Advance, and Arctic Front Advance Pro) reported in the Food and Drug Administration's (FDA) Manufacturers and User Defined Experience (MAUDE) database.MethodsWe reviewed all the adverse events reported to the FDA MAUDE database over a 10.7‐year study period from January 01, 2011 to September 31, 2021. All events were independently reviewed by two physicians.ResultsDuring the study period, a total of 320 procedural‐related adverse events reported in the MAUDE database were identified. The most common adverse event was transient or persistent phrenic nerve palsy (PNP), accounting for 48% of all events. This was followed by cardiac perforation (15%), pulmonary vein stenosis (8%), transient ischemic attack or stroke (6%), vascular injury (4%), transient or persistent ST‐elevation myocardial infarction (3%), hemoptysis (2%), pericarditis (2%), and esophageal ulcer or fistula (1%). There were six reported intra‐procedural death events as a result of cardiac perforation.ConclusionThe two most common procedural adverse events associated with cryoballoon ablation were PNP and cardiac perforation. All cases of procedural mortality were due to cardiac perforation.