4 research outputs found
Trends Over Time in Incidence of Bicuspid Aortic Valve Patients with Thoracic Aortic Aneurysms in New York
Aim: Bicuspid aortic valve (BAV) is one of the most common congenital cardiac malformations, with increased risk for early onset thoracic aortic aneurysms (TAA). This study aims to examine the trends over time in incidence of BAV patients with TAA, given imaging advancements and increased frequency of imaging.
Methods: Using administrative billing codes, this retrospective cohort study analyzed New York Statewide Planning and Research Cooperative System records from January 2007- December 2018, evaluating BAV+TAA incidence trends. Subgroups based on index admission were evaluated with a pre-identified 2014 inflection time point using an interrupted time series (ITS) analysis.
Results: Using a New York State-wide billing database, 3,294 BAV and TAA first-time encounters were classified into three diagnosis-related patient sub-groups, as patients with: historical BAV + new TAA diagnoses (24.74%); new BAV + historical TAA diagnoses (27.57%); and new BAV + new TAA diagnoses (47.69%). Total BAV and TAA diagnostic incidence increased from 7.93/1,000,000 residents in 2007, to 24.75/1,000,000 residents in 2018 (overall annual rate of 17.91/1,000,000, p\u3c .001). With a pre-established 2014 inflection point, the incidence rate dramatically changed for new BAV+ new TAA patients (slope = 0.7592, 95% CI 0.2332-1.2851)
Thoracic Aortic Aneurysm Patients’ Diagnosis, Treatments, and Outcomes: The New York Experience
IMPORTANCE: Traditionally, thoracic aortic aneurysms (TAA) were diagnosed upon complications arising or post-mortem examination. Following 2014, asymptomatic new TAA diagnoses noticeably rose at increasing rates. In parallel, reductions in the rates of urgent/emergent TAA-related treatments and adverse risk-adjusted short-term outcomes were observed.
OBJECTIVES: For New York State adult residents, the trends from 2005 to 2018 in new thoracic aortic aneurysm (TAA) diagnoses, surgical treatments, percutaneous treatments, and risk-adjusted outcomes were examined.
DESIGN: This retrospective cohort study documented the quality of TAA care provided to New York adult residents.
SETTING: Using the 2005 to 2018 New York Statewide Planning and Research Cooperative System (SPARCS) database, billing codes detected 74,118 newly diagnosed TAA patients; of these, 84.06% (n = 62,307) were non-ruptured diagnoses.
PARTICIPANTS: Overall, TAA patients’ mean age was 71.00 years + 19.00 years; 62.47% were male.
EXPOSURES: TAA patients’ baseline characteristics, TAA-related interventions, and adverse outcomes were reported.
MAIN OUTCOMES: Trends over time were evaluated for TAA diagnosis rates, TAA surgical and percutaneous treatment rates, and adverse clinical outcomes (e.g., 30-day mortality, and 30-day readmission).
RESULTS: Overall, new TAA diagnoses increased from 19.8/100,000 residents (2005) to 75.73/100,000 residents (2018); starting in 2014, a dramatic rise in detection of new non-ruptured TAA diagnoses was observed. In contrast, treatment rates decreased for surgical (19.33% in 2005 to 6.54% in 2018) and percutaneous (4.17% in 2006 to 1.53% in 2018) procedures. Comparing pre-2014 versus post-2014, TAA patients had greater chances of having an open surgery (odds ratio [OR] = 1.77; p \u3c 0.0001) or percutaneous procedure (OR = 1.79; p \u3c 0.0001). Over time, 30-day operative mortality decreased (OR = 0.94; p-value \u3c 0.0001). As an “at risk” patient sub-group, however, elderly women had very high 30-day mortality risk (OR: 1.87; p \u3c 0.0001).
CONCLUSIONS: Post-2014, the New York State rates of new non-rupture TAA diagnoses radically increased; serendipitously, the TAA-related treatment and short-term adverse outcome rates decreased. Given expanded chest imaging due (in part) to new lung cancer guidelines and transcatheter aortic valve procedures, the enhanced TAA diagnosis rates post-2014 appear to have resulted in overall TAA patients’ quality of care improvements
End-Stage Acute Thoracic Aortic Care Patients’ Interventions and Two-Year Survival: the New York State Experience
BACKGROUND:
Scarce US-based regional or State-specific reports exist recording the incidence, prevalence, or post-diagnosis clinical outcomes for end-stage thoracic aortic aneurysmal (TAA) disease. This retrospective cohort study of New York State (NYS) patients with newly diagnosed ruptured or dissected thoracic aortic aneurysms (TAA-RD) documents two-year follow-up after elective and emergent procedures.
METHODS:
Using hospital billing codes, NYS first-time TAA-RD encounters were extracted. As the primary study endpoint, the two-year composite included all-cause death, subsequent rupture or dissection, or non-elective intervention; individual composite sub-components were secondary study endpoints.
Multivariable logistic regression models estimated two-year intervention and composite outcome risks. Using multivariable regression models created for the composite endpoints, post-discharge elective TAA procedural impact was evaluated.
RESULTS:
Of the 5,789 NYS residents identified, 49.92% reached the two-year composite endpoint with 23.98% two-year deaths. Only 1902 (32.86%) of TAA-RD patients had an index intervention. Post-discharge elective TAA interventions dramatically reduced adverse outcome risk (odds ratio [O.R.] = 0.36; 95% confidence interval [C.I.] = 0.26 - 0.51). Multivariable regression models identified patient characteristics associated with the two-year adverse composite outcome including urgent/emergent status, increased Elixhauser comorbidity score, non-rheumatic aortic regurgitation, and carotid disease.
CONCLUSIONS:
Nearly 50% of NYS TAA-RD patients reached the two-year adverse endpoint. Post-2014, the TAA-RD diagnosis rates increased but emergent thoracic aortic surgery rates decreased. Surprisingly, under 50% of NYS TAA-RD patients received an index admission procedure; this rate is lower than anticipated. Beyond traditional morphologic metrics, “at risk” TAA patient-characteristics were identified. Post-discharge survivors had excellent post-procedural two-year durability rates
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Using multigenerational, single-cell tracking we explore the earliest events of biofilm formation by Pseudomonas aeruginosa During initial stages of surface engagement (≤20 h), the surface cell population of this microbe comprises overwhelmingly cells that attach poorly (∼95% stay <30 s, well below the ∼1-h division time) with little increase in surface population. If we harvest cells previously exposed to a surface and direct them to a virgin surface, we find that these surface-exposed cells and their descendants attach strongly and then rapidly increase the surface cell population. This "adaptive," time-delayed adhesion requires determinants we showed previously are critical for surface sensing: type IV pili (TFP) and cAMP signaling via the Pil-Chp-TFP system. We show that these surface-adapted cells exhibit damped, coupled out-of-phase oscillations of intracellular cAMP levels and associated TFP activity that persist for multiple generations, whereas surface-naïve cells show uncorrelated cAMP and TFP activity. These correlated cAMP-TFP oscillations, which effectively impart intergenerational memory to cells in a lineage, can be understood in terms of a Turing stochastic model based on the Pil-Chp-TFP framework. Importantly, these cAMP-TFP oscillations create a state characterized by a suppression of TFP motility coordinated across entire lineages and lead to a drastic increase in the number of surface-associated cells with near-zero translational motion. The appearance of this surface-adapted state, which can serve to define the historical classification of "irreversibly attached" cells, correlates with family tree architectures that facilitate exponential increases in surface cell populations necessary for biofilm formation