Prediabetes: An overlooked risk factor for major adverse cardiac and cerebrovascular events in atrial fibrillation patients.

BACKGROUND: Prediabetes is a well-established risk factor for major adverse cardiac and cerebrovascular events (MACCE). However, the relationship between prediabetes and MACCE in atrial fibrillation (AF) patients has not been extensively studied. Therefore, this study aimed to establish a link between prediabetes and MACCE in AF patients. AIM: To investigate a link between prediabetes and MACCE in AF patients. METHODS: We used the National Inpatient Sample (2019) and relevant ICD-10 CM codes to identify hospitalizations with AF and categorized them into groups with and without prediabetes, excluding diabetics. The primary outcome was MACCE (all-cause inpatient mortality, cardiac arrest including ventricular fibrillation, and stroke) in AF-related hospitalizations. RESULTS: Of the 2965875 AF-related hospitalizations for MACCE, 47505 (1.6%) were among patients with prediabetes. The prediabetes cohort was relatively younger (median 75 vs 78 years), and often consisted of males (56.3% vs 51.4%), blacks (9.8% vs 7.9%), Hispanics (7.3% vs 4.3%), and Asians (4.7% vs 1.6%) than the non-prediabetic cohort (P < 0.001). The prediabetes group had significantly higher rates of hypertension, hyperlipidemia, smoking, obesity, drug abuse, prior myocardial infarction, peripheral vascular disease, and hyperthyroidism (all P < 0.05). The prediabetes cohort was often discharged routinely (51.1% vs 41.1%), but more frequently required home health care (23.6% vs 21.0%) and had higher costs. After adjusting for baseline characteristics or comorbidities, the prediabetes cohort with AF admissions showed a higher rate and significantly higher odds of MACCE compared to the non-prediabetic cohort [18.6% vs 14.7%, odds ratio (OR) 1.34, 95% confidence interval 1.26-1.42, P < 0.001]. On subgroup analyses, males had a stronger association (aOR 1.43) compared to females (aOR 1.22), whereas on the race-wise comparison, Hispanics (aOR 1.43) and Asians (aOR 1.36) had a stronger association with MACCE with prediabetes vs whites (aOR 1.33) and blacks (aOR 1.21). CONCLUSION: This population-based study found a significant association between prediabetes and MACCE in AF patients. Therefore, there is a need for further research to actively screen and manage prediabetes in AF to prevent MACCE.

Rising trends in the burden of cardiovascular comorbidities and major adverse cardiovascular events among young female smokers in two national cohorts studied ten years apart (2017 vs. 2007).

BACKGROUND: Ample evidence suggests that female smokers face a greater risk of smoking-related health problems than male smokers. Due to the growing number of young smokers in the United States, there has been limited information on the effects of smoking on young female smokers over the past decade. METHODS: Hospitalizations of young (18-44 years) female tobacco smokers were identified using the National Inpatient Sample datasets from 2007 and 2017. We compared differences in admission frequency, comorbidity burden, in-hospital outcomes [all-cause mortality and major adverse cardiac events (MACE)], and resource utilization between two young cohorts separated by 10 years. RESULTS: In 2007, there were 665,901 admissions among young female smokers (median age: 35), compared to 1,224,479 admissions (median age: 32) in 2017. In both cohorts, white female smokers accounted for most admissions, followed by blacks. In 2017, the prevalence of alcohol abuse, hyperlipidemia, uncomplicated diabetes, and chronic pulmonary disease decreased relative to the 2007 cohort, whereas the prevalence of deficiency and chronic blood loss anemias, diabetes with complications, drug abuse, hypertension, congestive heart failure, depression, liver disease, and obesity increased significantly (p<0.001). The 2017 cohort had significantly higher odds of all-cause mortality [aOR 1.25 (95%CI: 1.16-1.35)] and a higher risk of MACE [aOR 1.17 (95%CI:1.14-1.20)] upon multivariable adjustment. (p<0.001). Comparatively, the 2017 cohort had fewer routine discharges and higher home healthcare needs than the 2007 cohort. CONCLUSIONS: In this decade-apart analysis, the study reveals rising trends in the burden of comorbidities, MACE, and healthcare resource utilization in admissions (regardless of the primary cause) among relatively younger female smokers. It is crucial to educate young female smokers about the detrimental effects of tobacco and polysubstance abuse on cardiovascular outcomes.

Timing and choice of intervention influences outcome in acute cholecystitis: a prospective study.

PURPOSE: Determine which management strategy is ideal for patients with acute cholecystitis. MATERIALS AND METHODS: Prospective enrollment between August 2009 and March 2011. Large academic center. Patients with acute cholecystitis. Laparoscopic cholecystectomy, intravenous antibiotics followed by laparoscopic cholecystectomy or percutaneous cholecystostomy. Primary endpoints were postoperative complications and 30-day mortality. RESULTS: A total of 162 patients were enrolled, 53 (33%) with simple acute cholecystitis and 109 (67%) with complex acute cholecystitis. Of the 109 patients with complex cholecystitis, 77 (70.6%) underwent successful laparoscopic cholecystectomy during the same hospital admission and 6 patients (5.5%) had an unsuccessful laparoscopic cholecystectomy requiring conversion to cholecystostomy. Radiology performed cholecystostomy in 19 (11.7%) patients with complex acute cholecystitis and 4 (2.5%) patients with simple acute cholecystitis for a total 23 patients of the 162 patients in the study. Nine of the 23 patients had dislodged tubes (39.1%). Two of the 23 patients (8.7%) had significant bile leaks resulting in either sepsis or emergency surgery. One patient (4.3%) had a wound infection. Overall, patients with complex acute cholecystitis had a higher morbidity rate (31.2%) compared with patients with simple acute cholecystitis (26.4%). CONCLUSIONS AND RELEVANCE: A high complication rate seen with radiology placed percutaneous cholecystostomy tubes prompted our center to reevaluate the treatment algorithm used to treat patients with complex acute cholecystitis. Although laparoscopic cholecystectomy is considered to be the gold standard in the treatment of acute cholecystitis, if laparoscopic cholecystectomy is not felt to be safe due to gallbladder wall thickening or symptoms of >72 hours' duration, we now encourage the use of intravenous antibiotics to "cool" patients down followed by interval laparoscopic cholecystectomy approximately 6 to 8 weeks later. Patients who do not respond to antibiotics should undergo attempted laparoscopic cholecystectomy and if unable to be performed safely, a laparoscopic cholecystostomy tube can be placed under direct visualization for decompression followed by interval laparoscopic cholecystectomy at a later date.