Etiologies and Predictors of 30-Day Readmission in Heart Failure: An Updated Analysis

BACKGROUND AND OBJECTIVES: Readmissions in heart failure (HF), historically reported as 20%, contribute to significant patient morbidity and high financial cost to the healthcare system. The changing population landscape and risk factor dynamics mandate periodic epidemiologic reassessment of HF readmissions. METHODS: National Readmission Database (NRD, 2019) was used to identify HF-related hospitalizations and evaluated for demographic, admission characteristics, and comorbidity differences between patients readmitted vs. those not readmitted at 30-days. Causes of readmission and predictors of all-cause, HF-specific, and non-HF-related readmissions were analyzed. RESULTS: Of 48,971 HF patients, the readmitted cohort was younger (mean 67.4 vs. 68.9 years, p≤0.001), had higher proportion of males (56.3% vs. 53.7%), lowest income quartiles (33.3% vs. 28.9%), Charlson comorbidity index (CCI) ≥3 (61.7% vs. 52.8%), resource utilization including large bed-size hospitalizations, Medicaid enrollees, mean length of stay (6.2 vs. 5.4 days), and disposition to other facilities (23.9% vs. 20%) than non-readmitted. Readmission (30-day) rate was 21.2% (10,370) with cardiovascular causes in 50.3% (HF being the most common: 39%), and non-cardiac in 49.7%. Independent predictors for readmission were male sex, lower socioeconomic status, nonelective admissions, atrial fibrillation, chronic obstructive pulmonary disease, chronic kidney disease, anemia, and CCI ≥3. HF-specific readmissions were significantly associated with prior coronary artery disease and Medicaid enrollment. CONCLUSIONS: Our analysis revealed cardiac and noncardiac causes of readmission were equally common for 30-day readmissions in HF patients with HF itself being the most common etiology highlighting the importance of addressing the comorbidities, both cardiac and non-cardiac, to mitigate the risk of readmission

Left atrial appendage doppler velocity as a predictor of recurrence of atrial fibrillation after transesophageal echocardiogram guided electrical cardioversion

Background: There is a paucity of data on average left atrial appendage emptying velocity (LAAV) measured by doppler during transesophageal echocardiogram (TEE) being able to predict the risk of AF recurrence after electrical cardioversion (ECV). Methods: Using electronic medical records from a community hospital, retrospective study was conducted after identifying all patients that received TEE-guided ECV. Data pertaining to LAAV, AF recurrence, and variables were obtained and analyzed. Results: Out of 625 patients receiving TEE-guided ECV, 94 were excluded, and 51 did not convert to sinus rhythm. 480 patients had a successful ECV; out of these, 201 (41.87%) and 243 (50.62%) had a recurrence of atrial fibrillation at the end of 1 month and 3 months, respectively. Low LAAV (<=30 cm/s) was independently associated with an increased risk of AF recurrence at the end of 1 month (aOR 2.37, 95CI 1.5–3.73; p < 0.001) and 3 months (aOR 2.51, 95CI 1.59–3.96; p < 0.001) after TEE-guided ECV. Conclusions: Low LAAV is associated with a high risk of AF recurrence. Identifying a specific subgroup of individuals at high risk of AF recurrence with the help of pre-ECV LAAV will facilitate the early institution of alternate treatment strategies and the plan for additional therapies

Halcyon - In Nature

In a concert of Contemporary Art Chamber Music, In Nature featured four world premieres by Larry Sitsky, Elena Kats Chernin, Melissa Hui and Madeleine Isaksson, the Australian premiere of Andrew Ford's new song cycle, "Nature" and Matthew Hindson's engaging "Insect Songs". The works, drawn from three continents and relationships old and new, featured texts and poetry from Australia, the UK, Finland, Sweden, France, Japan and China, performed by mezzo soprano Jenny Duck-Chong, soprano Jane Sheldon, flautist Sally Walker, cellist Geoffrey Gartner, guitarist Vladimir Gorbach, percussionist Tim Brigden and tabla player Maharshi Raval. Program: Andrew Ford "Nature", Elena Kats-Chernin's "Moondust" (Commissioned by flautist Sally Walker and dedicated to Dr Philip Spradbery, the renowned entomologist, CSIRO scientist and passionate environmental advocate) Madeleine Isaksson "Blad över blad", Larry Sitsky "The Bamboo Flute" Catherine Milliken "Kazuko", Nigel Butterley "Nature changes", Melissa Hui "Two songs on Poems from Longfellow"

A Review of Recent Advances in the Diagnosis of Cardiac Amyloidosis, Treatment of Its Cardiac Complications, and Disease-Modifying Therapies

Cardiac amyloidosis (CA), a significant condition resulting in infiltrative cardiomyopathy and heart failure with preserved ejection fraction (HFpEF), is caused by extracellular deposition of amyloid fibrils in the heart. Even though this has been known for an extended period, its prevalence in elderly patients with heart failure is increasingly being recognized. Recent advances in diagnosis with non-invasive methods like technetium pyrophosphate-labeled cardiac scintigraphy (i.e., Tc-PYP scan) and treatment options with tafamidis have played a pivotal role in awareness of the burden of this disease. Management of cardiac complications like heart failure, atrial arrhythmias, conduction block, ventricular arrhythmias, coronary artery disease, and aortic stenosis is now more critical than ever. We aim to review and outline the recent advances in diagnoses of CA. We also review management strategies for cardiac complications of CA with a brief summary of disease-modifying therapies

Role of Intravascular Ultrasound in Pulmonary Embolism Patients Undergoing Mechanical Thrombectomy: A Systematic Review

Background: Traditionally, mechanical thrombectomy performed for pulmonary embolism (PE) necessitates the utilization of iodinated contrast. Intravascular ultrasound (IVUS) has been used as a diagnostic and therapeutic modality in the management of acute high and intermediate-risk PE. Recently, with the shortage of contrast supplies and the considerable incidence of contrast-induced acute kidney injury (CI-AKI), other safer and more feasible IVUS methods have become desirable. The purpose of this systematic review was to evaluate the importance of IVUS in patients with PE undergoing thrombectomy. Methods: Medline/PubMed, Embase, Scopus, and Google Scholar were searched for review studies, case reports, and case series. Clinical characteristics, outcomes and the usage of IVUS-guided mechanical thrombectomy during the treatment of acute high and intermediate-risk PE were examined in a descriptive analysis. Results: In this systematic review, we included one prospective study, two case series, and two case reports from July 2019 to May 2023. A total of 39 patients were evaluated; most were female (53.8%). The main presenting symptoms were dyspnea and chest pain (79.5%); three patients (7.9%) presented with syncope, one with shock and one with cardiac arrest. Biomarkers (troponin and BNP) were elevated in 94.6% of patients. Most patients (87.2%) had intermediate-risk PE, and 12.8% had high-risk PE. All patients presented with right-heart strain (RV/LV ratio ≥ 0.9, n = 39). Most patients (56.4%) had bilateral PE. Mechanical thrombectomy was performed using IVUS without contrast utilization in 39.4% of the patients. After the initial learning curve, contrast usage decreased gradually over time. There was a significant decrease in the composite mean arterial pressure immediately following IVUS-guided thrombectomy from 35.1 ± 7.2 to 25.2 ± 8.3 mmHg (p < 0.001). Post-procedure, there was no reported (0%) CI-AKI, no all-cause mortality, no major bleeding, or other adverse events. There was a significant improvement in symptoms and RV function at the mean follow-up. Conclusions: New evidence suggests that IVUS-guided mechanical thrombectomy is safe, with visualization of the thrombus for optimal intervention, and reduces contrast exposure