Association between diagnosis code expansion and changes in 30-day risk-adjusted outcomes for cardiovascular diseases

BACKGROUND In January 2011, Centers for Medicare and Medicaid Services expanded the number of inpatient diagnosis codes from 9 to 25, which may influence comorbidity counts and risk-adjusted outcome rates for studies spanning January 2011. This study examines the association between (1) limiting versus not limiting diagnosis codes after 2011, (2) using inpatient-only versus inpatient and outpatient data, and (3) using logistic regression versus the Centers for Medicare and Medicaid Services risk-standardized methodology and changes in risk-adjusted outcomes. METHODS AND RESULTS Using 100% Medicare inpatient and outpatient files between January 2009 and December 2013, we created 2 cohorts of fee-for-service beneficiaries aged ≥65 years. The acute myocardial infarction cohort and the heart failure cohort had 578 728 and 1 595 069 hospitalizations, respectively. We calculate comorbidities using (1) inpatient-only limited diagnoses, (2) inpatient-only unlimited diagnoses, (3) inpatient and outpatient limited diagnoses, and (4) inpatient and outpatient unlimited diagnoses. Across both cohorts

Real-World Safety of Neurohormonal Antagonist Initiation Among Older Adults Following a Heart Failure Hospitalization

AIMS: To optimize guideline-directed medical therapy for heart failure, patients may require the initiation of multiple neurohormonal antagonists (NHAs) during and following hospitalization. The safety of this approach for older adults is not well established. METHODS AND RESULTS: We conducted an observational cohort study of 207 223 Medicare beneficiaries discharged home following a hospitalization for heart failure with reduced ejection fraction (HFrEF) (2008-2015). We performed Cox proportional hazards regression to examine the association between the count of NHAs initiated within 90 days of hospital discharge (as a time-varying exposure) and all-cause mortality, all-cause rehospitalization, and fall-related adverse events over the 90 day period following hospitalization. We calculated inverse probability-weighted hazard ratios (IPW-HRs) with 95% confidence intervals (CIs) comparing initiation of 1, 2, or 3 NHAs vs. 0. The IPW-HRs for mortality were 0.80 [95% CI (0.78-0.83)] for 1 NHA, 0.70 [95% CI (0.66-0.75)] for 2, and 0.94 [95% CI (0.83-1.06)] for 3. The IPW-HRs for readmission were 0.95 [95% CI (0.93-0.96)] for 1 NHA, 0.89 [95% CI (0.86-0.91)] for 2, and 0.96 [95% CI (0.90-1.02)] for 3. The IPW-HRs for fall-related adverse events were 1.13 [95% CI (1.10-1.15)] for 1 NHA, 1.25 [95% CI (1.21-1.30)] for 2, and 1.64 [95% CI (1.54-1.76)] for 3. CONCLUSIONS: Initiating 1-2 NHAs among older adults within 90 days of HFrEF hospitalization was associated with lower mortality and lower readmission. However, initiating 3 NHAs was not associated with reduced mortality or readmission and was associated with a significant risk for fall-related adverse events

Biased Justice: Ethnicity, Gender, and Justice in Progressive Era Milwaukee

This capstone analyzes the relationships between the Irish, Italian, and German-Americans in Progressive Era Milwaukee in the context of the justice system. A particularly dramatic case, the 1914 trial of the Italian immigrant, Carmello Musso, for the murder of her husband, is analyzed. A closer examination of newspaper accounts, arrest records, trial transcripts, and the Wisconsin Governor’s pardon files reveal the local attitudes, alliances, and prejudices that existed in Progressive Era Milwaukee. Within the courtroom, tensions surfaced between German-American District Attorney, Edward Yockey, the Irish-American elected Sheriff of Milwaukee County, Lawrence McGreal, and the Italian immigrant community that fought to protect Carmello Musso. The Carmello Musso case exposes ethnic, religious, gender, class, and political conflicts which collectively resulted in a biased justice system in Milwaukee during the early twentieth century

Endings are Beautiful, too

https://www.exhibit.xavier.edu/art_of_expression/1020/thumbnail.jp

Short Chain Fatty Acids and the Gut-Brain Axis: A Look at Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by repetitive behaviors and defective social interactions. A link between the gut microbiome and autism has been found within the gut-brain-axis, with previous studies showing that patients with ASD have a significantly different gut composition and short chain fatty acid (SCFA) production. I examined the pathways to produce SCFAs most commonly utilized by bacteria in the gut microbiome by analyzing the enzymes and their amino acid sequence that codes for the reaction. The results indicate that there is high conservation within groups – both ASD-increased and ASD-decreased bacteria – but low conservation between groups, for both acetate and butyrate production pathways. Only one bacterial genus produced propionate using the pathway examined, which was within the ASD-increased group. My data suggests a close evolutionary relationship that separates bacteria from each other as it relates to SCFA production. It also proposes that there is an increase in propionate production by bacteria present in abundance in the ASD gut

Opposing forces of cardiogenic shock: left ventricular outflow obstruction, severe mitral regurgitation, and left ventricular dysfunction in Takotsubo cardiomyopathy

Abstract Rates of stress (Takotsubo) cardiomyopathy have increased during the coronavirus pandemic due to social stressors, even in patients who are not infected with the virus. At times, Takotsubo cardiomyopathy (TC) may present as cardiogenic shock. Herein, we present a case during the pandemic of shock from TC secondary to left ventricular outflow tract obstruction (LVOTO), mitral regurgitation (MR), and left ventricular (LV) dysfunction. The contrasting management strategy of LVOTO, MR, and LV failure was cause for clinical challenge, and we highlight the balance of treating these opposing forces