Research Spotlight

Mack, M. J. (2016). “The harder one looks, the more one finds.” J Thorac Cardiovasc Surg 152(1): 5-6.

Full text of this article.

The article by Gleason and colleagues in this issue of the Journal reports the risk and extent of neurologic injury in high risk patients with aortic stenosis undergoing either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). The study reports the rate of stroke at 30 days, 1 year, and 2 years postprocedure in the 750 patients enrolled in the Corevalve High-Risk Study. They found no difference in stroke between the TAVR and SAVR groups at 30 days and 1 year, but a higher incidence of stroke at 2 years in the group undergoing SAVR.

Cedars, A. M., S. Burns, E. L. Novak and A. P. Amin (2016). “Lesion-specific factors contributing to inhospital costs in adults with congenital heart disease.” Am J Cardiol 117(11): 1821-1825.

Full text of this article.

The population of adults with congenital heart disease (ACHD) in the United States is growing rapidly with concomitant increases in care costs. We sought to define the variables having the greatest influence on annual cost of inpatient care in patients with ACHD in the United States. To do so, we conducted a retrospective analysis of admissions in patients >18 years old with a 3-digit International Classification of Disease, Ninth Revision, code of 745 to 747 from the State Inpatient Databases of Arkansas (2008 to 2010), California (2003 to 2012), Florida (2005 to 2012), Hawaii (2006 to 2010), Nebraska (2003 to 2011), and New York (2005 to 2012). We selected variables we believed would have the greatest effect on care costs and built a series of multivariable regression models grouping patients by congenital lesion to examine the relative contribution of the specified variables to total annual inpatient cost. We analyzed a total of 68,314 patients aged 57 +/- 18.6 years, 51% of whom were women. The multivariable regression model had an overall R(2) of 0.35. Readmission was responsible for 10.3% of annual inpatient cost among all patients with ACHD and had the greatest effect on inpatient care cost for each congenital lesion except Eisenmenger syndrome and conotruncal abnormalities, for both of which it was the second most significant contributor. Other major contributors to annual inpatient care costs included length of stay and operative procedures. In conclusion, rehospitalization is the most significant contributor to annual inpatient cost for individual patients with ACHD in the United States, regardless of underlying anatomy.

Roberts, W. C. (2016). “Books in cardiovascular disease received in 2015 and early 2016.” Am J Cardiol 118(1): 149-152.

Full text of this article.

The Good Books from the editor columns were initially published in 1986 and have appeared annually since that time. In 1985, a total of 16 books were received and discussed in the 1986 column. As shown in the accompanying figure (Figure 1), the number of books received rose to a peak in 1993 when 81 books were received and reviewed in the 1994 column. Since that time the number of books received yearly has slowly but steadily decreased such that in 2015 only 22 books were received and all were commented on. It appears that the number of medical books published yearly is decreasing, and publishers apparently are not sending out copies of the books published to medical journals for review. Although I love books, I now often go initially to Google for medical information and then to books and journals.

Roberts, W. C. (2016). “Proceedings of the editorial board meeting of the American journal of cardiology on April 3, 2016.” Am J Cardiol 118(1): 153-154.

Full text of this article.

The annual editorial board meeting of The American Journal of Cardiology (AJC) was held on April 3, 2016, at the time of the Annual Scientific Sessions of the American College of Cardiology. The major purpose of the meeting is to thank the editorial board members for their considerable help during the previous year in reviewing manuscripts and to seek their suggestions for improving the journal. The meeting began with a discussion by the publisher, Ms. Joan Anuels, who described several initiatives that Elsevier has introduced during the past year for many of the journals, including the AJC.

Prasad, A., A. Sohn, J. Morales, K. Williams, S. R. Bailey, D. Levin, P. A. McCullough, R. Mehran, G. Lopez-Cruz and J. Harder (2016). “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: 2016 June [Epub ahead of print].

Full text of this article.

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.