Impact of transfer from non-acute care centers on clinical outcomes in patients with congestive heart failure.

Study objective: To compare the clinical outcomes in patients with congestive heart failure who are transferred to an acute care hospital from non-acute care centers with patients who are admitted as regular hospital admissions. Design: This was a retrospective cohort study. Setting: We utilized the National Inpatient Sample database from 2016 to 2018. Participants: Our cohort consisted of hospitalized patients who were at least 18 years old with a primary diagnosis of congestive heart failure. Interventions: These patients were either transferred from non-acute centers or presented as regular hospital admissions. Main outcome measurements: We matched patients in a greedy nearest neighbor 1:1 model with caliper set at 0.2. Multivariable logistic regression, adjusted for age, sex, race and comorbidities, was used to compare mortality in our matched cohort. Results: This study included 35,010 non-acute care transfers and 951,189 regularly admitted patients. Compared to patients who were not transferred, non-acute care transfers were older, predominantly female, White and less racially diverse. After matching, there were 6689 patients in each cohort. When adjusted for age, race, sex and comorbidities, non-acute care transfers with congestive heart failure had 2.20 times higher odds of suffering in-hospital mortality compared to regular, non-transferred admissions (aOR 2.20, 95 % CI: 1.85-2.61; p < 0.001). Conclusion: Our findings illustrate that non-acute care transfers are a vulnerable population that require additional medical support in the acute care setting.

Clinical Characteristics and Implications of Bradycardia in COVID-19 Patients Treated with Remdesivir: A Single-Center Retrospective Cohort Study.

BACKGROUND AND OBJECTIVES: Remdesivir is an antiviral drug used to treat coronavirus disease 2019 (COVID-19) with a relatively obscure cardiac effect profile. Previous studies have reported bradycardia associated with remdesivir, but few have examined its clinical characteristics. The objective of this study was to investigate remdesivir associated bradycardia and its associated clinical characteristics and outcomes. METHODS: This is a single-institution retrospective study that investigated bradycardia in 600 patients who received remdesivir for treatment of COVID-19. A total of 375 patients were included in the study after screening for other known causes of bradycardia (atrioventricular [AV] nodal blockers). All patients were analyzed for episodes of bradycardia from when remdesivir was initiated up to 5 days after completion, a time frame based on the drug's putative elimination half-life. Univariate and multivariate statistical tests were conducted to analyze the data. RESULTS: The mean age of the sample was 56.63 ± 13.23 years. Of patients who met inclusion criteria, 49% were found to have bradycardia within 5 days of remdesivir administration. Compared to the cohort without a documented bradycardic episode, patients with bradycardia were significantly more likely to experience inpatient mortality (22% vs 12%, p = 0.01). The patients with bradycardia were found to have marginally higher serum D-dimer levels (5.2 vs 3.4 µg/mL, p = 0.05) and were more likely to undergo endotracheal intubation (28% vs 14%, p = 0.008). Male sex, hyperlipidemia, and bradycardia within 5 days of completing remdesivir were significant predictors of inpatient mortality. No significant differences in length of stay were found. CONCLUSIONS: Bradycardia that occurs during or shortly after remdesivir treatment in COVID-19 patients may be associated with an increased rate of in-hospital mortality. However, COVID-19 and its cardiac complications cannot be excluded as potential contributors of bradycardia in the present study. Future studies are needed to further delineate the cardiac characteristics of COVID-19 and remdesivir.

Subvalvular aortic stenosis: a review of current literature.

Subvalvular aortic stenosis (SAS) is one of the common adult congenital heart diseases, with a prevalence of 6.5%. It is usually diagnosed in the first decade of life. Echocardiography is the test of choice to diagnose SAS. Surgical correction is the best treatment modality, and the prognosis is usually excellent. In this review, we describe the pathophysiology, diagnosis, prognosis, and management of SAS with a focus on different pathophysiologic mechanisms, diagnostic approach, and prognosis of the disease by reviewing the current literature.