Juan F Viles-Gonzalez1, Shilpkumar Arora2, Abhishek Deshmukh3, Varunsiri Atti4, Kanishk Agnihotri5, Nileshkumar Patel6, Mihir Dave2, Elad Anter7, Fermin Garcia8, Pasquale Santangeli8, Jeffrey J Goldberger6, Srinivas Dukkipati9, Andre d'Avila10, Andrea Natale11, Luigi Di Biase12. 1. Miami Cardiovascular Institute, Baptist Health, Miami, Florida. Electronic address: jfvilzalez@gmail.com. 2. Department of Cardiology, Mount Sinai St Luke's Hospital and Mount Sinai West Hospital, New York, New York. 3. Department of Cardiology, Mayo Clinic, Rochester, Minnesota. 4. Department of Cardiology, Michigan State University, Lansing, Michigan. 5. Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 6. Department of Cardiology, University of Miami, Miami, Florida. 7. Department of Cardiology, Harvard Medical School, Boston, Massachusetts. 8. Department of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. 9. Department of Cardiology, Mount Sinai Hospital, New York, New York. 10. Department of Cardiology, Cardio SOS Hospital, Florianopolis, Santa Catarina, Brazil. 11. Department of Cardiology, St. David's Medical Center, Austin, Texas. 12. Department of Cardiology, Montefiore Medical Center, New York, New York.
Abstract
BACKGROUND: Mortality caused by ventricular arrhythmias (VAs) remains a problem of epidemic proportions. Understanding current trends on admission of VA, patient characteristics, morbidity, mortality, and health care utilization could help us improve allocation of health care resources and risk prediction. OBJECTIVE: The purpose of this study was to investigate clinical outcomes of VA, including ventricular tachycardia (VT), implantable cardioverter-defibrillator (ICD) shocks, and sudden cardiac death (SCD); and to identify predictors of morbidity and mortality, patterns of utilization of ICD and VT ablation, and the impact of such metrics on overall health care utilization. METHODS: From 2010-2015, we identified 290,998 VA hospitalizations, which were stratified into group 1: normal heart; group 2: ischemic heart disease (IHD); group 3: nonischemic heart disease (non-IHD); group 4: ICD shocks; and group 5: SCD (cardiac arrest without ICD shock). RESULTS: The number of admissions for VA decreased during the study period (except for patients with SCD and ICD shock, which increased); in-hospital mortality in patients admitted with VA and SCD increased; utilization of VT ablation in patients with ICD shocks and IHD increased; ICD implantation decreased in non-IHD patients and IHD patients; and admission for SCD was the strongest predictor of in-hospital mortality, followed by patients with non-IHD, patients with ICD shocks, and all patients with a Charlson comorbidity index ≥2. CONCLUSION: We report a decrease in admissions for VA, decreased ICD utilization, a change in pattern of VT ablation utilization, and an increase of in-hospital mortality in SCD patients. Predictors of adverse outcomes identified in our study should be considered when developing risk models for patients undergoing risk assessment for SCD.
BACKGROUND: Mortality caused by ventricular arrhythmias (VAs) remains a problem of epidemic proportions. Understanding current trends on admission of VA, patient characteristics, morbidity, mortality, and health care utilization could help us improve allocation of health care resources and risk prediction. OBJECTIVE: The purpose of this study was to investigate clinical outcomes of VA, including ventricular tachycardia (VT), implantable cardioverter-defibrillator (ICD) shocks, and sudden cardiac death (SCD); and to identify predictors of morbidity and mortality, patterns of utilization of ICD and VT ablation, and the impact of such metrics on overall health care utilization. METHODS: From 2010-2015, we identified 290,998 VA hospitalizations, which were stratified into group 1: normal heart; group 2: ischemic heart disease (IHD); group 3: nonischemic heart disease (non-IHD); group 4: ICD shocks; and group 5: SCD (cardiac arrest without ICD shock). RESULTS: The number of admissions for VA decreased during the study period (except for patients with SCD and ICD shock, which increased); in-hospital mortality in patients admitted with VA and SCD increased; utilization of VT ablation in patients with ICD shocks and IHD increased; ICD implantation decreased in non-IHD patients and IHD patients; and admission for SCD was the strongest predictor of in-hospital mortality, followed by patients with non-IHD, patients with ICD shocks, and all patients with a Charlson comorbidity index ≥2. CONCLUSION: We report a decrease in admissions for VA, decreased ICD utilization, a change in pattern of VT ablation utilization, and an increase of in-hospital mortality in SCDpatients. Predictors of adverse outcomes identified in our study should be considered when developing risk models for patients undergoing risk assessment for SCD.
Authors: Wadih El Khoury; Joseph Al Aaraj; Anthony Gebran; Marwan Hajjar; Rawad Abbas; Hussein Daoud; Maurice Khoury; Bernard Abi-Saleh; Ghanem F Oweis; Marwan M Refaat Journal: J Innov Card Rhythm Manag Date: 2022-07-15