ABSTRACT
Objectives
To describe the use of transcatheter aortic valve implantation (TAVI) and conventional surgery (SAVR) among hospitalized patients with and without COPD, to compare the in‐hospital ...mortality (IHM), length of hospital stay (LOHS) and cost between patients with COPD undergoing TAVI and SAVR and to identify factors associated to IHM among these patients.
Background
TAVI would be expected to be less invasive and safer than SAVR among COPD patients.
Methods
We analyzed patients whose medical procedures included TAVI and SAVR included in the Spanish National Hospital Discharge Database, 2014–2015. We stratified analysis by COPD status. Propensity score matching (1:2) was performed to assess the outcomes of TAVI vs. SAVR among COPD patients.
Results
We identified 2,141 and 16,013 patients who underwent TAVI (27.60% with COPD) and SAVR (19.31% with COPD) respectively. For TAVI, we found no differences in IHM according to COPD status. Patients undergoing SAVR and suffering COPD had higher IHM than patients without COPD (adj.OR 1.32; 95%CI 1.10–1.58). After propensity score matching, IHM (8.35% vs. 5.83%, p = .040) and LOHS (18.62 days vs. 13.62; p < .001) were higher in COPD patients who underwent SAVR than those who underwent TAVI.
Conclusions
COPD patients undergoing TAVI did not have a worse prognosis compared to non‐COPD patients during hospitalization. However, for SAVR, patients with COPD had significantly higher mortality than patients without this condition. COPD patients who underwent SAVR had higher IHM and LOHS than propensity score matched TAVI patients.
Aims
The aim of this study was to test whether a newly designed polypharmacy‐based scale would perform better than Charlson's Comorbidity Index (CCI) to predict outcomes in chronic complex adult ...patients after a reference Emergency Department (ED) visit.
Methods
We built a polypharmacy‐based scale with prespecified drug families. The primary outcome was 6‐month mortality after the reference ED visit. Predefined secondary outcomes were need for hospital admission, 30‐day readmission, and 30‐day and 90‐day mortality. We evaluated the ability of the CCI and the polypharmacy‐based scale to independently predict 6‐month mortality using logistic regression, receiver operating characteristic (ROC) curves, and cumulative survival curves using Kaplan–Meier estimates and the log‐rank test for three‐category distributions of the polypharmacy‐based scale and the CCI. Finally, we sought to replicate our results in two different external validation cohorts.
Results
We included 201 patients (53.7% women, mean age = 81.4 years), 162 of whom were admitted to the hospital at the reference ED visit. In separate multivariable analyses accounting for gender, age and main diagnosis at discharge, both the polypharmacy‐based scale (P < .001) and the CCI (P = .005) independently predicted 6‐month mortality. The polypharmacy‐based scale performed better in the ROC analyses (area under the curve AUC = 0.838, 95% confidence interval CI = 0.780–0.896) than the CCI (AUC = 0.628, 95% CI = 0.548–0.707). In the 6‐month cumulative survival analysis, the polypharmacy‐based scale showed statistical significance (P < .001), whereas the CCI did not (P = .484). We replicated our results in the validation cohorts.
Conclusions
Our polypharmacy‐based scale performed significantly better than the CCI to predict 6‐month mortality in chronic complex patients after a reference ED visit.
Diabetes mellitus has long been associated with cardiovascular events. Nevertheless, the higher burden of traditional cardiovascular risk factors reported in high-income countries is offset by a more ...widespread use of preventive measures and revascularization or other invasive procedures. The aim of this investigation is to describe trends in number of cases and outcomes, in-hospital mortality (IHM) and length of hospital stay (LHS), of hospital admissions for major cardiovascular events between type 2 diabetes (T2DM) and matched non-diabetes patients.
Retrospective study using National Hospital Discharge Database, analyzed in 4 years 2002, 2006, 2010, 2014, in Spain. We included patients (≥ 40 years old) with a primary diagnosis of myocardial infarction, ischemic and hemorrhagic stroke, aortic aneurysm and dissection and acute lower limb ischemia in people with T2DM. Cases were matched with controls (without T2DM) by ICD-9-CM codes, sex, age, province of residence and year.
We selected 130,011 matched couples (50,427 with myocardial infarction, 60,236 with stroke, 2599 with aortic aneurysm and dissection and 16,749 with acute lower limb ischemia. Among T2DM patients we found increasing numbers of admissions overtime for stroke (10,794 in 2002 vs 17,559 in 2014), aortic aneurysm and dissection (390 vs 841) and acute lower limb ischemia (3854 vs. 4548). People were progressively older (except for myocardial infarction), had more comorbidities (especially T2DM patients), and were more frequently coded overtime for cardiovascular risk factors (smoking, obesity, hypertension, lipid disorders) and renal diseases. LHS and IHM declined overtime, though IHM only did it significantly in T2DM patients. Multivariable adjustment showed that T2DM patients had a significantly 15% higher mortality rate during admission for myocardial infarction, a 6% higher mortality for stroke, and a 6% higher mortality rate for "all cardiovascular events combined", than non-diabetic matched controls.
The number of hospital admissions for stroke, aortic aneurysm and dissection and acute lower limb ischemia increased overtime, but remained stable for myocardial infarction. T2DM is associated to higher IHM after major cardiovascular events. Further research is needed to help us understand the reasons for an apparently increased mortality in T2DM patients when admitted to hospital for some major cardiovascular events.
We analyzed temporal trends, demographic and clinical characteristics and hospital mortality rates of postoperative pneumonia among type 2 diabetes mellitus (T2DM) patients in Spain from 2001 to ...2015. We also compared the incidence, comorbidities and mortality between patients with and without T2DM suffering from postoperative pneumonia. Finally, we analyzed the factors involved in the prediction of in-hospital mortality among patients suffering postoperative pneumonia.
We used the Spanish National Hospital Discharge Database for the period 2001-2015. We analyzed patients aged 40 years or over who had been hospitalized for a surgical procedure and suffered pneumonia or ventilator-associated pneumonia during their hospital admission. We compared patients with and without T2DM. The main outcome measures were the type of surgical procedure, the presence of a comorbidity, the type of isolated pathogens, admission to the emergency room (ER) and in-hospital mortality (IHM).
We selected 117,665 hospitalized patients who suffered postoperative pneumonia (16.9% with T2DM). After multivariable adjustment, T2DM patients had a 21% higher incidence of postoperative pneumonia than nondiabetic patients (IRR 1.21, 95% CI 1.03-1.42). The IHM was approximately 31% in both groups. Predictors of IHM included age, the presence of comorbidities, treatment with a pleural drainage tube, dialysis, blood transfusion, mechanical ventilation and admission to the ER. From 2001 to 2015, the IHM decreased significantly in both populations. Suffering from T2DM was not a predictor of IHM (OR 0.99, 95% CI 0.96-1.03) in our investigation.
T2DM patients have a higher incidence of postoperative pneumonia than those without this disease. The IHM decreased from 2001 to 2015, regardless of T2DM status. T2DM did not predict a higher IHM after suffering from postoperative pneumonia.
Background
Previous research has revealed sex‐related differences in outcomes for people admitted to hospitals for ischemic stroke. We aimed to analyse the incidence, use of invasive procedures and ...in‐hospital outcomes of ischemic stroke in Spain (2016‐2018) using the Spanish National Hospital Discharge Database. We sought sex‐related differences in incidence and in‐hospital outcomes over time.
Methods
We estimated the incidence of ischemic stroke in men and women. We analysed comorbidities (Charlson's comorbidity index, cardiovascular risk factors, alcohol abuse and atrial fibrillation), procedures (mechanical ventilation, endovascular thrombectomy and thrombolytic therapy) and outcomes. We matched each woman with a man with identical age, type of ischemic stroke and year of hospitalisation. We built Poisson regression models to obtain adjusted incidence rate ratios (IRRs). We tested in‐hospital mortality (IHM) with logistic regression analyses.
Results
Ischemic stroke was coded in 172 255 patients aged ≥35 years (92 524 men 53.7%). Men showed higher incidence rates (216.9 vs. 172.3/105; P < .001; IRR = 1.57 (95% CI:1.55‐1.59) than women. After matching, the use of endovascular thrombectomy (5.1% vs. 4.0%; P < .001) and thrombolytic therapy (7.6% vs. 6.8%; P < .001) was higher among women. IHM was significantly higher in women than in matched men (11.2% vs. 10.4%; P < .001). Women had a lower IHM than matched men when endovascular thrombectomy (9.4% vs. 12.1%; P = .001) or thrombolytic therapy (6.7% vs. 8.3%; P = .003) was coded. Patients of both sexes admitted for ischemic stroke who received thrombolytic therapy had lower IHM (OR = 0.76; 95% CI:0.68‐0.85 among men; and OR = 0.58; 95% CI:0.52‐0.64 among women), but endovascular thrombectomy was associated with a lower IHM only among women (OR = 0.58; 95% CI:0.51‐0.66). After multivariable adjusting, women admitted to the hospital for ischemic stroke had a significantly higher IHM than men (OR = 1.16; 95% CI:1.12‐1.21).
Conclusion
Men had higher incidence rates of ischemic stroke than women. Women more often underwent thrombolytic therapy and endovascular thrombectomy but had a higher IHM.
Abstract
We aimed to analyze the influence of atrial fibrillation (AF) prior to hospital admission (“prevalent”) and AF diagnosed during hospital admission (“incident”) on in-hospital mortality (IHM) ...in women and men admitted for community-acquired pneumonia (CAP) in Spain (2016–2019). We used the Spanish Register of Specialized Care‐Basic Minimum Database. We analyzed 519,750 cases of CAP in people ≥ 18 years (213,631 women (41.1%)), out of which people with prevalent AF represented 23.75% (N = 123,440), whereas people with incident AF constituted 0.60% (N = 3154). Versus no AF, crude IHM was significantly higher for prevalent AF (15.24% vs. 11.40%,
p
< 0.001) and for incident AF (23.84% vs. 12.24%,
p
< 0.001). After propensity score marching, IHM in women and men with prevalent AF neared IHM in women and men with no AF (15.72% vs. 15.52%,
p
= 0.425; and 14.90% vs. 14.99%,
p
= 0.631, respectively), but IHM in women and men with incident AF was higher than IHM in women and men with no AF (24.37% vs. 13.36%,
p
< 0.001; and 23.94% vs. 14.04%,
p
< 0.001, respectively). Male sex was associated with a higher IHM in people with prevalent AF (OR 1.06; 95% CI 1.02–1–10), but not in people with incident AF (OR 0.93; 95% CI 0.77–1–13). AF diagnosed during hospital admission was associated with a higher IHM, irrespectively of sex.
Few studies have analyzed the relationship between glucose variability (GV) and adverse health outcomes in patients with differences in glycemic status. The present study tests the hypothesis that GV ...predicts all-cause mortality regardless of glycemic status after simple adjustment (age and sex) and full adjustment (age, sex, cardiovascular disease, hypertension, use of aspirin, statins, GLP-1 receptor agonists, SGLT-2 inhibitors and DPP-4 inhibitors, baseline FPG and average HbA1c). A total of 1,223 patients (657 men, 566 women) died after a median of 9.8 years of follow-up, with an all-cause mortality rate of 23.35/1,000 person-years. In prediabetes or T2DM patients, the fourth quartile of CV-FPG exerted a significant effect on all-cause mortality after simple and full adjustment. A sensitivity analysis excluding participants who died during the first year of follow-up revealed the following results for the highest quartile in the fully adjusted model: overall, HR (95%CI) = 1.54 (1.26-1.89); dysglycemia (prediabetes and T2DM), HR = 1.41 (1.15-1.73); T2DM, HR = 1.36 (1.10-1.67). We found CV-FPG to be useful for measurement of GV. It could also be used for the prognostic stratification of patients with dysglycemia.
Summary
Aim
To examine incidence and in‐hospital outcomes of Clostridium difficile infection (CDI) among patients with type 2 diabetes (T2DM); compare clinical variables among T2DM patients with ...matched non‐T2DM patients hospitalised with CDI and identify factors associated with in‐hospital mortality (IHM) among T2DM patients.
Methods
We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001‐2015. We included patients that had CDI as primary or secondary diagnosis in their discharge report. For each T2DM patient, we selected a gender, age, readmission status and year‐matched non‐diabetic patient.
Results
We identified 44 695 patients with CDI (21.19% with T2DM). We matched 3040 and 5987 couples with a primary and secondary diagnosis of CDI, respectively. Incidence of CDI was higher in T2DM patients (IRR per hospital admission 1.12; 95% CI 1.09‐1.14, IRR per population 1.26; 95% CI 1.22‐1.29). IHM decreased over time in T2DM and non‐T2DM patients (from 15.36% and 13.35%, in 2001‐2003 to 10.36% and 11.73% in 2013‐2015), despite a concomitant increase in CDI diagnoses overtime. Among those with CDI as secondary diagnosis IHM was higher in nondiabetic 16.17% than in T2DM patients 13.19% (P < 0.001). In T2DM patients higher mortality rates were associated with older age, comorbidities, severe CDI, and readmission. Primary diagnosis of CDI was associated with lower IHM (OR 0.71; 95% CI 0.60‐0.84) than secondary diagnosis.
Conclusions
Incidence of CDI was higher in T2DM patients. IHM decreased over time, regardless of the existence or not of T2DM. IHM was significantly lower in T2DM patients with CDI as primary diagnosis than non diabetic patients.
We examined trends, characteristics and in-hospital outcomes in mechanical and bioprosthetic surgical mitral valve replacement (SMVR) among patients with and without chronic obstructive pulmonary ...disease (COPD) in Spain from 2001 to 2015. We also identified factors associated with in-hospital mortality (IHM) in both groups of patients according to the implanted valve type.
We analyzed data from the Spanish National Hospital Discharge Database for patients aged 40 years or over. We selected admissions of patients whose medical procedures included SMVR. We grouped hospitalizations by COPD status.
Over 43,024 patients identified, 83.63% underwent mechanical mitral valve replacement and 16.37% bioprosthetic valve (6.71% and 7.78% with COPD, respectively). The incidence of SMVR decreased for mechanical valves and increased for bioprosthetic valves over time in both groups of patients. The incidence of SMVR admissions was lower among COPD patients than in those without COPD, both for mechanical and bioprosthetic valves. IHM decreased significantly over time, regardless of the type of valve, in both groups of patients. COPD was associated with a significant increase in IHM, but only among patients who underwent bioprosthetic SMVR (OR 1.32, 95% CI 1.01-1.73).
The incidence of mechanical SMVR decreased while that of bioprosthetic SMVR increased over time in both groups of patients. COPD patients were less surgically operated than non-COPD patients for both valve types. In COPD patients, bioprosthetic SMVR was proportionally more used than mechanical SMVR. Mortality decreased over time for both valve types in patients with and without COPD. COPD increased in-hospital mortality among patients undergoing a biological SMVR.
Summary
Aims
To describe trends and outcomes during admission for solid organ transplant in people with or without type 2 diabetes in Spain, 2001‐2015.
Methods
We used national hospital discharge ...data to select all hospital admissions for kidney, lung, heart, and liver transplant. We estimated admission rates stratified by type 2 diabetes status. We built Poisson regression models to compare the adjusted time trends in admission rates. We tested in‐hospital mortality (IHM) in logistic regression analyses.
Results
We identified 50 964 transplants (16.7% in people with type 2 diabetes): kidney, 30 919; lung, 2810; heart, 3649; liver, 13 586. The overall adjusted incidence rate ratios (95% confidence intervals) of admission in people with type 2 diabetes vs no diabetes were 2.4 (2.32‐2.48) for kidney, 1.51 (1.33‐1.70) for lung, 2.87 (2.63‐3.13) for heart, and 4.16 (3.99‐4.33) for liver transplant. In the multivariate analysis, IHM decreased significantly over time for all types of transplant. Type 2 diabetes independently predicted lower IHM during admission only for heart (Odds ratio, OR 95% CI = 0.62 0.47‐0.81) and liver transplant (OR 95% CI = 0.69 0.58‐0.82).
Conclusions
Admission rates for solid organ transplant were higher in people with type 2 diabetes than in people without diabetes. Type 2 diabetes was associated with lower in‐hospital mortality during admission for heart and liver transplant.
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