Validity of self-reported drug use during pregnancy

Introduction: Epidemiology studies often rely on maternal self-reports for drug use information, however, the degree of drug use under-reporting among pregnant women is largely unknown. The purpose of this study is to assess the accuracy of self-reports for methadone, buprenorphine, opioids (prescription opioids and heroin), marijuana, benzodiazepines, amphetamines/methamphetamines, and cocaine/crack-cocaine in a population of pregnant women. Methods: Analysis was based on 102 pregnant women enrolled in the \u27Biomarkers in Pregnancy Study\u27 (BIPS) cohort at the University of New Mexico. Women attending the UNM Milagro clinic, designated to pregnant women with the current or past history of substance abuse, were enrolled during one of the first prenatal care visits and followed up to term. Self-reported information about drug use was compared with the results of the urine drug screens conducted during the third trimester. Simple kappa and prevalence-and-bias-adjusted kappa coefficients were calculated as measures of agreement. Sensitivity and specificity of self-reports for each drug class were also estimated using urine toxicology screening as the gold standard. In addition, logistic regression was conducted to evaluate the effect of number of toxicology screens on agreement. Results: The mean maternal age of the sample was 26.4 ± 4.9 years and included a large proportion of ethnic minority (78% Hispanics/Latina) and socially disadvantaged (51% \u3c less than high school education and 95% Medicaid-insured) pregnant women. On average, these patients had 4.8 ± 3.0 urine drug screens in the third trimester. For methadone-maintenance therapy, there was a perfect agreement between self-reports and urine screens (k and PABAK =1.0, 100% sensitivity and specificity). Simple kappa coefficients for other classes of drugs revealed varied levels of agreement, however, PABAK coefficients indicated moderate to almost perfect agreement for other classes of drugs. Sensitivity of self-reports was low for all classes of drugs, with marijuana and opioids more acceptable than other classes of drugs. The specificity of self-report was high for classes of drugs. Logistic regression revealed no association between number of toxicology screens and agreement. Discussion: These results indicated that sensitivity of self-reports for all classes of drugs was low with opioids and marijuana more acceptable than other drugs

Acute kidney injury requiring dialysis and in‐hospital mortality in patients with chronic kidney disease and non–ST‐segment elevation acute coronary syndrome undergoing early vs delayed percutaneous coronary intervention: A nationwide analysis

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141458/1/clc22828.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/141458/2/clc22828_am.pd

Cardiac resynchronization therapy in continuous flow left ventricular assist device recipients: A systematic review and meta-analysis from ELECTRAM investigators

Introduction: Whether cardiac resynchronization therapy (CRT) continues to augment left ventricular remodeling in patients with the continuous-flow left ventricular assist device (cf-LVAD) remains unclear. Methods: We performed a systematic review and meta-analysis of all clinical studies examining the role of continued CRT in end-stage heart failure patients with cf-LVAD reporting all-cause mortality, ventricular arrhythmias, and ICD shocks. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data. Results: Eight studies (7 retrospective and 1 randomized) with a total of 1,208 unique patients met inclusion criteria. There was no difference in all-cause mortality (RR 1.08, 95% CI 0.86-1.35, p = 0.51, I2=0%), all-cause hospitalization (RR 1.01, 95% CI 0.76-1.34, p = 0.95, I2=11%), ventricular arrhythmias (RR 1.08, 95% CI 0.83-1.39, p = 0.58, I2 =50%) and ICD shocks (RR 0.87, 95% CI 0.57-1.33, p = 0.52, I2 =65%) comparing CRT versus non-CRT. Subgroup analysis demonstrated significant reduction in ventricular arrhythmias (RR 0.76, 95% CI 0.64-0.90, p = 0.001) and ICD shocks (RR 0.65, 95% CI 0.44-0.97, p = 0.04) in CRT on group versus CRT off group. Conclusion: CRT was not associated with a reduction in all-cause mortality or increased risk of ventricular arrhythmias and ICD shocks compared to non-CRT in cf-LVAD patients. It remains to be determined which subgroup of cf-LVAD patients benefit from CRT.The findings of our study are intriguing, and therefore,larger studies in a randomized prospective manner should be undertaken to address this specifically

Active Implantable cardioverter-defibrillators in Continuous-flow Left Ventricular Assist Device Recipients

Introduction Implantable cardioverter-defibrillator (ICD) in patients with heart failure with reduced ejection fraction reduces mortality secondary to malignant arrhythmias. Whether end-stage heart failure (HF) with continuous-flow left ventricular assist device (cf-LVAD) derive similar benefits remains controversial. Methods We performed a systematic literature review and meta-analysis of all published studies that examined the association between active ICDs and survival in advanced HF patients with cfLVAD. We searched PubMed, Medline, Embase, Ovid, and Cochrane for studies reporting the association between ICD and all-cause mortality in advanced HF patients with cfLVAD. Mantel-Haenszel risk ratio (RR) random-effects model was used to summarize data. Results Ten studies (9 retrospective and one prospective) with a total of 7,091 patients met inclusion criteria. There was no difference in all-cause mortality (RR 0.84, 95% CI 0.65–1.10, p=0.20, I2 =62.40%), likelihood of survival to transplant (RR 1.07, 95% CI 0.98–1.17, p= 0.13, I2 =0%), RV failure (RR 0.74, 95% CI 0.44–1.25, p = 0.26, I2 =34%) between Active ICD and inactive/no ICD groups, respectively. Additionally, 27.5% received appropriate ICD shocks, while 9.5% received inappropriate ICD shocks. No significant difference was observed in terms of any complications between the two groups. Conclusions All-cause mortality, the likelihood of survival to transplant, and worsening RV failure were not significantly different between active ICD and inactive/no ICD in cf-LVAD recipients. A substantial number of patients received appropriate ICD shocks suggesting a high-arrhythmia burden. The risks and benefits of ICDs must be carefully considered in patients with cf-LVAD

Incidental Finding of the Anomalous Origin of Left Main Coronary Artery from Pulmonary Artery in an Adult Presenting with Arrhythmia-Induced Myocardial Ischemia

Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly with high mortality. It is associated with cardiovascular complications and is usually diagnosed soon after birth. Those who survive into adulthood can present with signs of myocardial infarction, heart failure, mitral regurgitation, severe pulmonary hypertension, or sudden cardiac death. We present a 53-year-old female presenting with atrial fibrillation and found to have an incidental diagnosis of ALCAPA who refused surgical correction. We also review the epidemiology, diagnosis, age-based clinical presentations, and treatment options for ALCAPA

Atrial Fibrillation Ablation in Heart Failure: Temporal Trends and Outcomes in Hospitalized Patients

Introduction: Recent studies have shown catheter ablation for atrial fibrillation (AF) in patients with heart failure (HF) to have better outcomes over medical therapy. While AF ablation is predominantly an outpatient procedure, some patients may require longer hospitalization. Limited literature exists describing the trends of hospitalizations for HF patients undergoing AF ablation. Methods: Using ICD-9 (diagnosis and procedure codes) in nationwide inpatient sample database 2003 to 2014, we identified all HF adults who were admitted with a principal diagnosis code of AF (427.31) (n= 4,670,400) (AF-HF). Among these, we identified those with a principal procedure code of catheter ablation (37.34) and studied the temporal trends of clinical characteristics and outcomes (in-hospital mortality and complications) for this cohort (Table). Results: The overall number of AF-HF patients undergoing AF ablation was 62,653; with an increase from 1,928 in 2003 to 6,860 in 2014 (p trend\u3c0.001). As shown in Table, over this 12-year period; mean age and proportion of females decreased, while there was an increase in blacks, clinical comorbidity burden, admissions to teaching hospitals and southern US region (all p trend\u3c0.001). The overall procedure related complications (vascular, cardiac, respiratory, neurologic) increased, the in-hospital mortality rate decreased from 1.7% to 0.5% (all p trend\u3c0.001). Conclusions: During 2003-2014, the annual incidence of AF ablation related hospitalizations in HF patients increased significantly. Despite increase in clinical comorbidities burden and procedural complication rates, the mortality rate declined

Percutaneous Embolectomy of Serpentine Thrombus from the Right Atrium in a 51-Year-Old Man.

Treatment of large, fresh thrombi in the vascular system can be challenging. AngioVac, a cardiopulmonary pump system, has been used to remove large thrombi and even some tumors by a percutaneous route. We report here a case of a 51-year-old man who presented with a large thrombus (7.5 × 1.5 cm) in his inferior vena cava, extending into his right atrium and right ventricle. Because the surgical risk was high, we attempted percutaneous embolectomy via the AngioVac aspiration system. We also review the literature concerning this emerging technique