Percutaneous left atrial appendage occlusion in mitral valve disease: A Nationwide Readmission Database analysis.

BACKGROUND: Percutaneous left atrial appendage occlusion (LAAO) has emerged as a non-pharmacologic alternative to oral anticoagulation in reducing stroke risk in AF patients. However, patients with mitral valve disease (MVD), who are expected to have a significantly greater risk of left atrium (LA) thrombus formation and embolic stroke were excluded from randomized trials examining percutaneous LAAO. To address this gap, we present a national registry analysis of the use of LAAO among patients with MVD. METHODS: Using the National Readmissions Database, we performed a retrospective review of all hospitalizations for LAAO identified between September 2015 and November 2019. Of these, patients with ICD-10 codes for MVD were identified. Propensity matched (PSM) analysis was used to compare patients with MVD with a matched sample of patients undergoing LAAO with non-valvular AF. Outcomes examined included all-cause mortality, stroke, major bleeding, pericardial effusion (PE), and tamponade. RESULTS: 51,540 patients who underwent LAAO without a history of MVD and 3777 with a history of MVD were identified. Crude analysis demonstrated the odds of mortality, PE, and cardiac tamponade during index hospitalization to be higher in the MVD group. The length of stay and cost of index hospitalization were also slightly greater for the MVD group. A sample of 7649 patients (MVD: 3777 MVD and no MVD: 3872) were selected for PSM analysis with similar comorbidities across the two groups. In the PSM comparison, MVD was associated with higher risk of PE. The MVD group had a slightly higher rate of readmissions the association with PE remained at 30-day readmission (OR: 2.099 [1.360-3.238], p-value: <0.001). CONCLUSION: To our knowledge, this is the first study examining the use of LAAO among MVD patients. Our findings suggest that patients with MVD who underwent LAAO had a higher risk of post-procedural PE without an increase in mortality, stroke, or major bleeding. These results provide a rationale for considering LAAO as part of the stroke prevention strategy among patients with valvular AF.

The impact of introduction of Code-STEMI program on the reduction of door-to-balloon time in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: A single-center study in Saudi Arabia.

OBJECTIVES: This study was conducted to evaluate the effect of direct emergency department activation of the catheterization lab on door-to-balloon time (D2BT) and outcomes of acute ST-elevation myocardial infarction (STEMI) patients at a major tertiary care hospital in Riyadh, Saudi Arabia. METHODS: This was a retrospective cohort study that enrolled 100 consecutive patients with acute STEMI who underwent primary percutaneous coronary intervention between June 2010 and January 2015. The patients were divided into two groups of 50 patients each. The first group was treated prior to establishing the Code-STEMI protocol. The other group was treated according to the protocol, which was implemented in June 2013. The Code-STEMI protocol is a comprehensive program implementing direct activation of the catheterization lab team using a single call system, data monitoring and feedback, and standardized order forms. RESULTS: The mean age for both groups was 54 ±â€¯12 years. Males represented 86% (43) and 94% (47) of the patients in the two groups, respectively. In both groups, 90% (90) of patients had one or more comorbidities. The Code-STEMI group had a significantly lower D2BT, with 70% of patients treated within the recommended 90 minutes (median, 76.5 minutes; interquartile range, 63-90 minutes). By contrast, only 26% of pre-Code-STEMI patients were treated within this timeframe (median, 107 minutes; interquartile range, 74-149 minutes). In-hospital complications were lower in the Code-STEMI group; however, the only statistically significant reduction was in non-fatal re-infarction (8% vs. 0%, p = 0.043). CONCLUSION: Implementation of direct emergency department catheterization lab activation protocol was associated with a significant reduction in D2BT.

Diabetes and driving recommendations among healthcare providers in Saudi Arabia. A significant gap that requires action.

OBJECTIVES: To assess healthcare providers' knowledge and awareness of the recommendations for drivers with insulin-treated diabetes in Saudi Arabia. Methods: A cross-sectional study was conducted among healthcare providers working at 4 tertiary hospitals in Riyadh, Saudi Arabia between April 2016 and December 2016 using a self-administered questionnaire. Results: A total of 285 healthcare providers completed the survey (response rate 88.5%). Most (70.2%) were aware of the safe driving recommendations for patients with insulin-treated diabetes. However, the need to check blood glucose levels before driving was underestimated by almost one-third (30.2%). Only one-quarter (24.6%) identified the correct level of blood glucose level that is safe for a patient when driving, and 28.4% identified the recommended time for checking blood glucose before driving. Participants who were aware of the recommendations for safe driving had a significantly higher average knowledge score (68.8%) than those who were not aware (58.8%; p less than 0.001). There was a significant difference in the average knowledge score among medical specialties (p=0.002) and job levels (p less than 0.001). Conclusions: Most healthcare providers identified the importance of evaluating their patients for ability to drive safely, but we found some important areas of knowledge deficit. Professional intervention to improve healthcare providers' awareness and knowledge regarding diabetes and driving is the first step in improving detection and reporting high-risk drivers with diabetes to prevent future driving mishaps.