Saraschandra Vallabhajosyula1, Shannon M Dunlay2, Kianoush Kashani3, Shashaank Vallabhajosyula4, Saarwaani Vallabhajosyula5, Pranathi R Sundaragiri6, Allan S Jaffe5, Gregory W Barsness5. 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America. Electronic address: Vallabhajosyula.Saraschandra@mayo.edu. 2. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America; Department of Health Science Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America. 3. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America; Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America. 4. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America. 5. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America. 6. Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, United States of America.
Abstract
BACKGROUND: There are limited data on prolonged invasive mechanical ventilation (IMV) and tracheostomy use in intubated acute myocardial infarction with cardiogenic shock (AMI-CS) patients. METHODS: Using the National Inpatient Sample, all admissions with AMI-CS requiring IMV between January 1, 2000, and December 31, 2014, were included. Prolonged IMV was defined as IMV use >96 h. Outcomes of interest included temporal trends in use of prolonged IMV and tracheostomy, in-hospital mortality, and resource utilization. RESULTS: In this 15-year period, 185,589 intubated AMI-CS admissions met the inclusion criteria. Prolonged IMV (>96 h) and tracheostomy use were noted in 68,544 (36.9%) and 10,645 (5.7%), respectively. Prolonged IMV and tracheostomy were used more commonly in younger patients. The cohort with prolonged IMV had higher organ failure and greater use of cardiac and non-cardiac organ support. Temporal trends showed a decline in prolonged IMV (adjusted odds ratio {aOR} 0.61 [95% confidence interval {CI} 0.57-0.65]) and tracheostomy use (aOR 0.80 [95% CI 0.70-0.90]) in 2014 compared to 2000. Prolonged IMV (aOR 0.45 [95% CI 0.44-0.47]; p < 0.001) and tracheostomy (aOR 0.28 [95% CI 0.27-0.29]; p < 0.001) were associated with lower in-hospital mortality with a decreasing trend between 2000 and 2014 in intubated AMI-CS admissions. Patients with prolonged IMV and tracheostomy use had nearly three-fold higher health care costs, and four-fold longer hospital stays. CONCLUSIONS: In this cohort of intubated AMI-CS admissions, prolonged IMV and tracheostomy showed a temporal decrease between 2000 and 2014. Prolonged IMV and tracheostomy use was associated with high resource utilization.
BACKGROUND: There are limited data on prolonged invasive mechanical ventilation (IMV) and tracheostomy use in intubated acute myocardial infarction with cardiogenic shock (AMI-CS) patients. METHODS: Using the National Inpatient Sample, all admissions with AMI-CS requiring IMV between January 1, 2000, and December 31, 2014, were included. Prolonged IMV was defined as IMV use >96 h. Outcomes of interest included temporal trends in use of prolonged IMV and tracheostomy, in-hospital mortality, and resource utilization. RESULTS: In this 15-year period, 185,589 intubated AMI-CS admissions met the inclusion criteria. Prolonged IMV (>96 h) and tracheostomy use were noted in 68,544 (36.9%) and 10,645 (5.7%), respectively. Prolonged IMV and tracheostomy were used more commonly in younger patients. The cohort with prolonged IMV had higher organ failure and greater use of cardiac and non-cardiac organ support. Temporal trends showed a decline in prolonged IMV (adjusted odds ratio {aOR} 0.61 [95% confidence interval {CI} 0.57-0.65]) and tracheostomy use (aOR 0.80 [95% CI 0.70-0.90]) in 2014 compared to 2000. Prolonged IMV (aOR 0.45 [95% CI 0.44-0.47]; p < 0.001) and tracheostomy (aOR 0.28 [95% CI 0.27-0.29]; p < 0.001) were associated with lower in-hospital mortality with a decreasing trend between 2000 and 2014 in intubated AMI-CS admissions. Patients with prolonged IMV and tracheostomy use had nearly three-fold higher health care costs, and four-fold longer hospital stays. CONCLUSIONS: In this cohort of intubated AMI-CS admissions, prolonged IMV and tracheostomy showed a temporal decrease between 2000 and 2014. Prolonged IMV and tracheostomy use was associated with high resource utilization.
Authors: Saraschandra Vallabhajosyula; Sri Harsha Patlolla; Shannon M Dunlay; Abhiram Prasad; Malcolm R Bell; Allan S Jaffe; Bernard J Gersh; Charanjit S Rihal; David R Holmes; Gregory W Barsness Journal: Circ Heart Fail Date: 2020-02-14 Impact factor: 8.790
Authors: Saraschandra Vallabhajosyula; Viral K Desai; Pranathi R Sundaragiri; Wisit Cheungpasitporn; Rajkumar Doshi; Vikas Singh; Allan S Jaffe; Amir Lerman; Gregory W Barsness Journal: Ann Transl Med Date: 2021-07
Authors: Saraschandra Vallabhajosyula; Saarwaani Vallabhajosyula; Shannon M Dunlay; Sharonne N Hayes; Patricia J M Best; Jorge A Brenes-Salazar; Amir Lerman; Bernard J Gersh; Allan S Jaffe; Malcolm R Bell; David R Holmes; Gregory W Barsness Journal: Mayo Clin Proc Date: 2020-09 Impact factor: 7.616
Authors: Saraschandra Vallabhajosyula; Lina Ya'Qoub; Mandeep Singh; Malcolm R Bell; Rajiv Gulati; Wisit Cheungpasitporn; Pranathi R Sundaragiri; Virginia M Miller; Allan S Jaffe; Bernard J Gersh; David R Holmes; Gregory W Barsness Journal: Circ Heart Fail Date: 2020-09-29 Impact factor: 8.790
Authors: Saraschandra Vallabhajosyula; Sri Harsha Patlolla; Dhiran Verghese; Lina Ya'Qoub; Vinayak Kumar; Anna V Subramaniam; Wisit Cheungpasitporn; Pranathi R Sundaragiri; Peter A Noseworthy; Siva K Mulpuru; Malcolm R Bell; Bernard J Gersh; Abhishek J Deshmukh Journal: Am J Cardiol Date: 2020-04-06 Impact factor: 2.778
Authors: Saraschandra Vallabhajosyula; Abhiram Prasad; Malcolm R Bell; Gurpreet S Sandhu; Mackram F Eleid; Shannon M Dunlay; Gregory J Schears; John M Stulak; Mandeep Singh; Bernard J Gersh; Allan S Jaffe; David R Holmes; Charanjit S Rihal; Gregory W Barsness Journal: Circ Heart Fail Date: 2019-12-12 Impact factor: 8.790
Authors: Saraschandra Vallabhajosyula; Stephanie R Payne; Jacob C Jentzer; Lindsey R Sangaralingham; Kianoush Kashani; Nilay D Shah; Abhiram Prasad; Shannon M Dunlay Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2021-02-08
Authors: Saraschandra Vallabhajosyula; Dhiran Verghese; Malcolm R Bell; Dennis H Murphree; Wisit Cheungpasitporn; Paul Elliott Miller; Shannon M Dunlay; Abhiram Prasad; Gurpreet S Sandhu; Rajiv Gulati; Mandeep Singh; Amir Lerman; Bernard J Gersh; David R Holmes; Gregory W Barsness Journal: ESC Heart Fail Date: 2021-03-11
Authors: Saraschandra Vallabhajosyula; Jacob C Jentzer; Abhiram Prasad; Lindsey R Sangaralingham; Kianoush Kashani; Nilay D Shah; Shannon M Dunlay Journal: ESC Heart Fail Date: 2021-04-09