Rie Sakai Bizmark1, Ruey-Kang R Chang2, Yusuke Tsugawa3, Kenneth M Zangwill2, Ichiro Kawachi4. 1. Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Boston, MA; Department of Pediatrics, Harbor-UCLA Medical Center and the David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA. Electronic address: rsakaibizmark@g.ucla.edu. 2. Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Boston, MA; Department of Pediatrics, Harbor-UCLA Medical Center and the David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA. 3. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA. 4. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA.
Abstract
Use a nationally representative sample to assess impacts of new clinical guidelines issued by the American Heart Association (AHA) in 2007 for many types of invasive procedures, with recommendations for significant decreases in antimicrobial prophylaxis use. STUDY DESIGN: Interrupted time series analyses of pediatric hospitalizations for Infective Endocarditis (IE), using the Nationwide Inpatient Sample (NIS) ICD-9-CM diagnostic codes, identified IE hospitalizations for patients <18 years old from 2001 to 2012. Changes in IE incidence before and after 2007 AHA guidelines were evaluated, with differences in IE clinical severity assessed using in-hospital mortality and length of stay. Analyses were stratified by pathogen type and age group (0-9 y/o and 10-17 y/o). RESULTS: With 3,748 patients in the study, we observed rising trends in IE incidence, but no significant difference between pre- and post-guideline. There was a significant trend increase for IE due to viridans group streptococci (VGS) for ages >10 years old, comparing pre-guideline to post-guideline periods, but not in children 0-9 years of age. Neither in-hospital mortality nor length of stay changed significantly during study. CONCLUSIONS: The data did not demonstrate an impact of the 2007 guideline changes on overall incidence of pediatric IE. However, a significant increase in disease incidence trend due to VGS was observed for the 10-17 year-old group, compared pre- and post-guideline.
Use a nationally representative sample to assess impacts of new clinical guidelines issued by the American Heart Association (AHA) in 2007 for many types of invasive procedures, with recommendations for significant decreases in antimicrobial prophylaxis use. STUDY DESIGN: Interrupted time series analyses of pediatric hospitalizations for Infective Endocarditis (IE), using the Nationwide Inpatient Sample (NIS) ICD-9-CM diagnostic codes, identified IE hospitalizations for patients <18 years old from 2001 to 2012. Changes in IE incidence before and after 2007 AHA guidelines were evaluated, with differences in IE clinical severity assessed using in-hospital mortality and length of stay. Analyses were stratified by pathogen type and age group (0-9 y/o and 10-17 y/o). RESULTS: With 3,748 patients in the study, we observed rising trends in IE incidence, but no significant difference between pre- and post-guideline. There was a significant trend increase for IE due to viridans group streptococci (VGS) for ages >10 years old, comparing pre-guideline to post-guideline periods, but not in children 0-9 years of age. Neither in-hospital mortality nor length of stay changed significantly during study. CONCLUSIONS: The data did not demonstrate an impact of the 2007 guideline changes on overall incidence of pediatric IE. However, a significant increase in disease incidence trend due to VGS was observed for the 10-17 year-old group, compared pre- and post-guideline.
Authors: Nicola Fawcett; Bernadette Young; Leon Peto; T Phuong Quan; Richard Gillott; Jianhua Wu; Chris Middlemass; Sheila Weston; Derrick W Crook; Tim E A Peto; Berit Muller-Pebody; Alan P Johnson; A Sarah Walker; Jonathan A T Sandoe Journal: BMC Med Date: 2019-09-04 Impact factor: 8.775
Authors: Michael L Williams; Mathew P Doyle; Nicholas McNamara; Daniel Tardo; Manish Mathew; Benjamin Robinson Journal: Ther Adv Cardiovasc Dis Date: 2021 Jan-Dec