Frequency of takotsubo cardiomyopathy in epilepsy-related hospitalizations among adults and its impact on in-hospital outcomes: A national standpoint.

BACKGROUND: Literature remains constrained to case reports with respect to epilepsy-associated takotsubo cardiomyopathy (TC) or stress-induced cardiomyopathy and its impact on in-hospital outcomes remains largely obscure. METHODS: The National Inpatient Sample databases (2010-2014) were queried to identify and compare baseline characteristics and outcomes in adult hospitalizations for epilepsy with and without secondary TC using ICD-9-CM codes and propensity-matching. Primary outcomes were the frequency of TC, ensuing all-cause mortality, and complications. Secondary outcome was healthcare resource utilization. RESULTS: Of 981,571 epilepsy-related hospitalizations, 854 (0.1%, 1 in 1000) admissions (unspecified, 49.1%; grand mal/status epilepticus, 28.1% and generalized convulsive 11.7%) revealed associated in-hospital TC. Of the propensity-matched cohorts of epilepsy (TC = 793; mean 61.1 ±â€¯15.0 yrs. & 82.4% females vs. non-TC = 795; mean 60.7 ±â€¯14.2 yrs. & 84.2% females), the TC group consisted more often white (83.7% vs. 78.0%, p < 0.02) patients with higher cardiovascular risk factors. The all-cause inpatient mortality (3.7% vs <11; p = 0.002), arrhythmia (22.7% vs. 18.7%, p = 0.05), cardiac arrest (3.9% vs <11; p = 0.001), cardiogenic shock (3.2% vs <11, p < 0.001), stroke (3.5% vs 1.9%, p = 0.04), venous thromboembolism (4.4% vs. 1.9%, p = 0.004), and respiratory failure (29.4% vs. 14.8%, p < 0.001) were significantly higher in the TC cohort. The mean LOS (6.3 ±â€¯5.6 vs. 5.1 ±â€¯7.1 days), hospital charges ($77,908 vs. $45,881), transfers to other facilities (3.8% vs. 3.2%), and need of home healthcare (19.4% vs. 9.9%) were higher in the TC group (p < 0.001). CONCLUSION: In this nationwide population-based study, 1 in every 1000 epilepsy-related hospitalizations was associated with secondary TC which resulted in poor inpatient outcomes and higher healthcare resource utilization.

Rising Trends in Hospitalizations for Cardiovascular Events among Young Cannabis Users (18-39 Years) without Other Substance Abuse.

Background and objectives: Modern-day epidemiologic data on the risk and shifting landscape of occurrence of cardiovascular events in cannabis users remain inadequate and rather conflicting, especially amongst the young adult population. Furthermore, the problem of polysubstance use among youth is challenging for healthcare professionals and policy-makers. Previous studies report higher risk of concomitant use of tobacco, alcohol, cocaine, and amphetamine in young cannabis users. However, most of these studies did not eliminate the confounding effects of concomitant other substance abuse while assessing the incidence and outcome of cardiovascular events in cannabis users. Materials and methods: Using weighted discharge records from the National Inpatient Sample (NIS) from 2007-2014, we assessed the national trends in hospitalizations for major cardiovascular events including acute myocardial infarction (AMI), arrhythmia, stroke, and venous thromboembolic events (VTE) among young cannabis users (18-39 years), excluding cases with concomitant substance abuse with alcohol, tobacco, cocaine, and amphetamine. Results: Of 52.3 million hospitalizations without other substance abuse, 0.7 million (1.3%) young adults were current/former cannabis users. Among young adults without concomitant substance abuse, the frequency of admissions for AMI (0.23% vs. 0.14%), arrhythmia (4.02% vs. 2.84%), and stroke (0.33% vs. 0.26%) was higher in cannabis users as compared to non-users (p < 0.001). However, the frequency of admissions for VTE (0.53% vs. 0.84%) was lower among cannabis users as compared non-users. Between 2007 and 2014, we observed 50%, 79%, 300%, and 75% relative increases in hospitalizations for AMI, arrhythmias, stroke, and VTE, respectively, among young cannabis users as compared to non-users, showing relatively inferior or no ascent in the rates (ptrend < 0.001). Conclusions: The rising trends in hospitalizations for acute cardiovascular events among young cannabis users without concomitant other substance abuse call for future prospective well-designed studies to assess cannabis-related short-and long-term cardiovascular implications while simultaneously developing focused interventions towards raising awareness among the young population regarding the potential deleterious effects of cannabis use.

Primary Causes of Hospitalizations and Procedures, Predictors of In-hospital Mortality, and Trends in Cardiovascular and Cerebrovascular Events Among Recreational Marijuana Users: A Five-year Nationwide Inpatient Assessment in the United States.

Background Recent trends in the legalization of marijuana in many states are increasing the popularity of recreational marijuana use. Since current data on hospitalizations in marijuana users is sparse, we evaluated the primary reasons for admissions, procedures and associated healthcare burden in hospitalized recreational marijuana users. Methods The National Inpatient Sample (NIS) for the years 2010-2014 was queried for the hospitalizations with a history of recreational marijuana usage using applicable ICD-9 CM codes. Descriptive statistics were used to report frequency (N) and percentage (%). Discharge weights were applied to achieve national estimates. The predictors of in-hospital mortality in recreational marijuana users were assessed using a two-way hierarchical multivariate regression after adjusting for the confounders. Results  We analyzed 465,959 (weighted n=2,317,343) hospitalizations with a history of recreational marijuana use. Among psychiatric disorders, most prominent primary discharge diagnoses were mood disorders (20.6%), schizophrenia/other psychotic disorders (10.6%), and substance/alcohol-related disorders (10.4%). Suicide and intentional self-inflicted injury (3.6%) was the leading cause of emergency admission. The most common non-psychiatric primary discharge diagnoses were diabetes mellitus with chronic complications (2.2%), acute myocardial infarction (AMI) (1.2%), nonspecific chest pain (1.1%), congestive cardiac failure (CHF) (1%), arrhythmia (0.8%), and hypertension (0.8%). Acute cerebrovascular diseases were noted in 1.1% and epilepsy in 1.8% of patients. Alcohol/drug rehabilitation and detoxification (6.9%) and psychiatric evaluation/therapy (3.9%) were the most evident psychiatric procedures whereas most frequent non-psychiatric procedures were diagnostic coronary arteriography (1%), percutaneous transluminal coronary angioplasty (0.7%), and echocardiogram (0.7%). Top independent predictors of in-hospital mortality were coagulopathy (OR 5.94), AMI (OR 4.59), pulmonary circulation disorder (OR 2.95), CHF (OR 2.02), renal failure (OR 1.91), coronary atherosclerosis (OR 1.34) and peripheral vascular disorder (OR 1.31). Major cardiovascular and cerebrovascular events also showed increasing trends among users. Conclusion We established the most frequent psychiatric and non-psychiatric causes of admissions and procedures in recreational marijuana users, which may pose a significant healthcare burden and increase the odds of in-hospital mortality.