Cardiology

Roberts, W. C., P. A. Grayburn and B. L. Hamman (2017). “Lipoma of the Mitral Valve.” Am J Cardiol 119(7): 1121-1123.

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Described herein is a 67-year-old morbidly obese man who had a lipoma excised from his posterior mitral leaflet after it was found by echocardiogram. Findings in 6 other previously reported cases are reviewed.

Cedars, A., L. Benjamin, S. V. Burns, E. Novak and A. Amin (2017). “Clinical predictors of length of stay in adults with congenital heart disease.” Heart: 2017 Feb [Epub ahead of print].

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OBJECTIVE: Length of stay (LOS) is a major driver of inpatient care costs. To date, few studies have investigated risk factors associated with increased LOS in patients with adult congenital heart disease (ACHD). In the present work, we sought to address this knowledge gap. METHODS: We conducted an analysis of the State Inpatient Databases from Arkansas, California, Florida, Hawaii, Nebraska and New York. We analysed data on admissions in patients with ACHD and constructed a series of hierarchical regression models to identify the clinical factors having the greatest effects on LOS. RESULTS: We identified 99 103 inpatient hospitalisations meeting criteria for inclusion. Diagnoses associated with the longest LOS were septicaemia (LOS=14.2 days in patients atrial septal defect, and 11.7 days among all other ACHD) and pericarditis, endocarditis and myocarditis (LOS=13.6 days and 10.0 days, respectively). When separated by underlying anatomy, the variables most consistently associated with longer LOS were bacterial infection, complications of surgeries or medical care, acute renal disease and anaemia. CONCLUSIONS: In the present study, we identified risk factors associated with longer LOS in ACHD. These data may be used to identify at-risk patients for targeted intervention to decrease LOS and thereby cost.

Packer, M. (2017). “Double vision: Replicating a trial showing a survival benefit.” JACC Heart Fail 5(3): 232-235.

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Many physicians boast that there is no reason to read or keep up with the medical literature. Why? If it is true that 1 trial is never enough to change clinical practice, clinicians can always claim that they are waiting for confirmatory evidence and for critical review by regulatory authorities and peer groups. Such thinking greatly simplifies the challenge of maintaining medical knowledge. Practitioners need not become familiar with any scientific study; they need only to wait for guideline statements, which will determine when a critical mass of evidence has been compiled. Sadly, some clinicians will also wait to see what practices and procedures are reimbursed, because this—not scientific evidence—has become a major factor influencing medical care.

Prasad, A., A. Sohn, J. Morales, K. Williams, S. R. Bailey, D. Levin, P. A. McCullough, R. Mehran, G. Lopez-Cruz and J. Harder (2017). “Contemporary practice patterns related to the risk of acute kidney injury in the catheterization laboratory: Results from a survey of society of cardiovascular angiography and intervention (scai) cardiologists.” Catheter Cardiovasc Interv 89(3): 383-392.

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OBJECTIVES: The goal of the present study was to survey the Society of Cardiovascular Angiography and Intervention (SCAI) member cardiologists to evaluate contemporary practice patterns with regards to contrast use, acute kidney injury (AKI) risk assessment, and prevention in patients undergoing invasive angiography. We sought to compare the physician responses against guideline statements and evidence-based data from clinical studies. METHODS: A 20-question online survey based on a modified Likert scale was sent out via email to the Society of Cardiovascular Angiography and Intervention (SCAI) member cardiologists. The survey questions focused on prophylaxis methods, medication management, risk assessment, contrast agent use, and postprocedure care. A scoring system was developed which examined the individual responses to analyze the 10 questions with the greatest strength of evidence in the literature and guidelines. RESULTS: The survey was completed by 506 individuals. Selected responses of note included the use of standardized volume expansion protocols: 64.8%, use of iso-osmolar contrast (iodixanol) in the majority of patients at risk of AKI: 55%, and 27% of individuals reported diluting contrast with saline for patients at risk of AKI during coronary angiography. For questions with support from guideline documents, 56.9% of the responses were scored as concordant with evidence-based data. Individuals who reported that the risk of AKI was often or always important in planning angiography for “at risk patients” were more likely to closely monitor renal function (76.7% vs. 40.0%, P = 0.003), obtain nephrology consultation (45.2% vs. 13.3%, P = 0.016) and use iso-osmolar contrast agents (56.0% vs. 26.7%, P = 0.033). CONCLUSIONS: The majority of cardiologists participating in this survey, reported practice patterns consistent with guideline and evidence-based recommendations. However, over 40% of responses to questions were inconsistent with these recommendations, suggesting continued opportunities for education and quality improvement concerning AKI prevention.

Cedars, A., L. Benjamin, S. V. Burns, E. Novak and A. Amin (2017). “Clinical predictors of length of stay in adults with congenital heart disease.” Heart: 2017 Feb [Epub ahead of print].

Full text of this article.

OBJECTIVE: Length of stay (LOS) is a major driver of inpatient care costs. To date, few studies have investigated risk factors associated with increased LOS in patients with adult congenital heart disease (ACHD). In the present work, we sought to address this knowledge gap. METHODS: We conducted an analysis of the State Inpatient Databases from Arkansas, California, Florida, Hawaii, Nebraska and New York. We analysed data on admissions in patients with ACHD and constructed a series of hierarchical regression models to identify the clinical factors having the greatest effects on LOS. RESULTS: We identified 99 103 inpatient hospitalisations meeting criteria for inclusion. Diagnoses associated with the longest LOS were septicaemia (LOS=14.2 days in patients atrial septal defect, and 11.7 days among all other ACHD) and pericarditis, endocarditis and myocarditis (LOS=13.6 days and 10.0 days, respectively). When separated by underlying anatomy, the variables most consistently associated with longer LOS were bacterial infection, complications of surgeries or medical care, acute renal disease and anaemia. CONCLUSIONS: In the present study, we identified risk factors associated with longer LOS in ACHD. These data may be used to identify at-risk patients for targeted intervention to decrease LOS and thereby cost.