The role of targeted temperature management in 30-day hospital readmissions in cardiac arrest survivors: A national population-based study.

Background: Targeted temperature management (TTM) implementation following resuscitation from cardiac arrest is controversial. Although prior studies have shown that TTM improves neurological outcomes and mortality, less is known about the rates or causes of readmission in cardiac arrest survivors within 30 days. We aimed to determine whether the implementation of TTM improves all-cause 30-day unplanned readmission rates in cardiac arrest survivors. Methods: Using the Nationwide Readmissions Database, we identified 353,379 adult cardiac arrest index hospitalizations and discharges using the International Classification of Diseases, 9th and 10th codes. The primary outcome was 30-day all-cause unplanned readmissions following cardiac arrest discharge. Secondary outcomes included 30-day readmission rates and reasons, including impacts on other organ systems. Results: Of 353,379 discharges for cardiac arrest with 30-day readmission, 9,898 (2.80%) received TTM during index hospitalization. TTM implementation was associated with lower 30-day all-cause unplanned readmission rates versus non-recipients (6.30% vs. 9.30%, p < 0.001). During index hospitalization, receiving TTM was also associated with higher rates of AKI (41.12% vs. 37.62%, p < 0.001) and AHF (20.13% vs. 17.30%, p < 0.001). We identified an association between lower rates of 30-day readmission for AKI (18.34% vs. 27.48%, p < 0.05) and trend toward lower AHF readmissions (11.32% vs. 17.97%, p = 0.05) among TTM recipients. Conclusions: Our study highlights a possible negative association between TTM and unplanned 30-day readmission in cardiac arrest survivors, thereby potentially reducing the impact and burden of increased short-term readmission in these patients. Future randomized studies are warranted to optimize TTM use during post-arrest care.

Negative Troponin I as a Predictor of Survival in Patients With Coronavirus Disease 2019.

Background: Despite a large amount of evidence evaluating elevated troponin I levels and adverse clinical outcomes, little is known about the role of a normal (negative) troponin I during the first 24 h of admission for risk stratification in patients with Coronavirus Disease 2019 (COVID-19). This study aims to evaluate the utility and negative predictive value of a serum troponin I level to predict in-hospital mortality. Methods: We retrospectively analyzed all adult patients (>18 years of age) with COVID-19 admitted to an HCA Healthcare facility between March 2020 and March 2021 who had a troponin I level drawn at admission. Patients were initially stratified into two groups based on their cardiac troponin I value in the first 24 h of admission (elevated vs negative). Results: A total of 65,580 patients were included in the final analysis. A negative troponin I value was associated with lesser odds of death during admission (OR = 0.32, 95 % CI 0.31-0.34, p < 0.01) and cardiac complications (OR = 0.38, 95 % CI 0.37-0.40, p < 0.01). The negative predictive value of a negative troponin value for all-cause in-hospital mortality was 85.7 %. Conclusions: Our study found a significant association between a negative troponin I value in the first 24 h of admission and decreased odds of death during admission in patients with confirmed COVID-19 infection, in addition to decreased odds of cardiac complications but no significant difference in hospital length of stay. Therefore, the authors suggest that the absence of troponin I elevation may serve as an indicator of a more benign hospital course.

Impact of left bundle branch block in Takotsubo Syndrome.

Background: Left bundle branch block (LBBB) causes left ventricular dyssynchrony, and its presence with concomitant left ventricular dysfunction has been proven to play a synergistic role, worsening ventricular function. Our study seeks to further explore the association between LBBB and various in-hospital outcomes in patients with takotsubo syndrome (TTS). Methods: The national inpatient sample was queried from 2016 to 2019 to identify all admissions with a primary diagnosis of TTS. International classification of diseases, tenth revision codes were used to divide patients based on the presence or absence of LBBB. Multivariate regression analysis was performed to assess the effect of LBBB among all the pre-specified outcomes. Results: A total of 26,615 admissions were included in the analysis. Admissions with LBBB were more likely to be older (72.2 vs. 66.2 years) and have a higher burden of comorbidities. The presence of a LBBB was associated with ventricular arrhythmias (OR = 1.97, 95% CI 1.08-3.61, p = 0.028) but not with sudden cardiac arrest (SCA), acute heart failure, cardiogenic shock, and all-cause intra-hospital mortality. Conclusions: Intraventricular dyssynchrony appears to play a significant role in ventricular arrhythmogenesis and SCA, as several trials have demonstrated that cardiac resynchronization therapy alone without defibrillator function reduces the rate of ventricular arrhythmias and SCA in patients with heart failure with systolic dysfunction and a widened QRS complex. The most likely mechanism of arrhythmia development in TTS is related to the elevated plasma levels of catecholamines and their proarrhythmic effects in the ventricular myocardium.