Impact of Bariatric Surgery on the Prevalence and Outcomes of Atrial Fibrillation in Obese Patients.

Obesity has been identified as a significant factor contributing to the development of numerous cardiovascular conditions and as a result, the cardiovascular community has prioritized efforts to address obesity and reduce its associated risks. However, despite these efforts, the prevalence of obesity continues to rise steadily, and is projected to double in the upcoming years. Atrial fibrillation is among the most prevalent and extensively researched cardiovascular comorbidities associated with obesity. Several mechanisms have been postulated, including scar tissue formation and fat deposition, which ultimately leads to atrial remodeling and subsequent arrhythmogenesis. Numerous strategies have been implemented to prevent and manage obesity, encompassing lifestyle adjustments, dietary modifications, pharmacological treatments, and surgical interventions. Bariatric surgery has garnered significant recognition over the years due to its promising outcomes, including a decrease in the overall prevalence of atrial fibrillation and other cardiovascular comorbidities in general in obese patients. This study focuses on the current trends regarding the impact of bariatric surgery on obese patients with atrial fibrillation.

Recent Trends in Heart Failure and Concomitant Depression, A Retrospective Study.

Depression has been shown to predispose to poorer prognosis and outcomes in patients with heart failure, including rehospitalization, poor functional status, and mortality. Our study aimed to decipher the recent trends in hospitalization and in-hospital mortality attributable to heart failure patients with depression in the United States. We analyzed data from the Nationwide Inpatient Sample (NIS) from 2016 to 2020. We obtained data from patients aged ≥18 years diagnosed with heart failure and depression. Death was defined within the NIS as in-hospital mortality. Diagnoses and comorbidities were identified using codes from the International Classification of Disease 10th edition. We used the chi-square test to compare baseline characteristics. Our primary outcome of interest was in-hospital mortality. The secondary outcome was in-hospital events. We studied a total of 726,193 hospitalizations of patients with heart failure and concomitant depression. The annual number of hospitalizations increased from (126,317 to 147,798) over the study period. The most common age groups were 65-74 years (16.06%) followed by 55-64 years (14.62%). The number of hospitalizations was highest among whites (77.02%), followed by blacks (13.03%) (p < 0.0001). Whites had the highest average in-hospital mortality (61.17%), followed by blacks (23.63%). Overall, racial trends of in-hospital mortality among patients remained similar from 2016 to 2020 (P = 0.8910). Over the study period, average hospitalization-related costs increased significantly ($34,954.00 to $44,151.50) (P < 0.0001); however, the median length of hospital stay remained similar (4-5 days). Rates of in-hospital events such as stroke, arrhythmia, and respiratory failure increased significantly (P < 0.0001). Hospitalization increased, while in-hospital mortality remained variable over the study period. The proportion of patients with in-hospital events such as stroke, arrhythmia, respiratory failure increased significantly over the study period.

Impact of day of admission on in-hospital outcomes of cardiogenic shock.

BACKGROUND: The management of cardiogenic shock (CS) requires attentiveness to details and in some cases, invasive interventions. In the past, studies have shown relationships between the day of admission and cardiovascular outcomes. We aim to analyze the trends and in-hospital outcomes of patients admitted with CS over the weekends compared to weekdays. METHOD: We identified all patients with CS from the National Inpatient Sample (NIS) database between 2016 and 2020. Using multivariate logistic regression analysis, baseline demographics and in-hospital outcomes were obtained and compared by weekend or weekday admission. RESULTS: Out of 854,684 CS admissions, 199,255 (23.6%) occurred on weekends. Patients admitted over the weekend had worse outcomes, including higher rates of mortality (aOR 1.09 CI 1.05 - 1.11, p<0.001), cardiac arrest (aOR 1.09 CI 1.04 -1.14, p<0.001), and respiratory failure. We also noted higher percutaneous coronary intervention (PCI) rates (aOR 1.2 CI 1.16 - 1.25, p<0.001) but lower rates of pulmonary artery catheterization (PAC) and post-procedure pneumothorax. Weekend admissions had shorter hospital lengths of stay, and they incurred lower charges ($223,222 vs. $247,908). Between 2016 and 2020, we observed a consistent downward trend in the mortality rates of the weekend and weekday CS admissions, with consistently higher weekend than weekday admissions. CONCLUSION: Weekend admissions for CS are associated with worse outcomes, which have persisted for years. This now begs the question of whether physician dissatisfaction, understaffing, or burn-out are responsible for this finding.