Abstract Background In accordance with the 2007 American College of Cardiology and American Heart Association infective endocarditis (IE) guideline update, antibiotic prophylaxis is now being ...restricted to a smaller number of cardiac conditions with very high risk for adverse outcomes from IE. However, there is scant data on IE trends since this major practice change in the United States. Objectives The aim of this study was to compare temporal trends in IE incidence, microbiology, and outcomes before and after the change in the 2007 IE prophylaxis guideline in the United States. Methods The NIS (Nationwide Inpatient Sample) database was used to investigate IE hospitalization rates in the United States from 2000 through 2011. The mean annual rates of IE before and after the 2007 guideline change were compared using segmented regression analysis. Results There were 457,052 IE-related hospitalizations in the United States from 2000 to 2011, with a steady increase in incidence (p < 0.001). The trend in IE hospitalization rates from 2000 to 2007 and from 2008 to 2011 was not significantly different (p = 0.74). The increases in the number of Staphylococcus IE cases per million population during the study periods 2000 to 2007 and 2008 to 2011 were similar (p = 0.13), but Streptococcus IE hospitalization rates were significantly higher after the release of new guidelines (p = 0.002). Finally, valve replacement rates for IE steadily increased from 2000 to 2007 (p = 0.03) but showed a plateau from 2007 to 2011. Overall, there was no significant difference in the rates of valve replacement for IE before and after the release of new guideline (p = 0.23). Conclusions These results show that IE incidence has increased in the United States over the past decade. With regard to the microbiology of IE, there has been a significant rise in the incidence of Streptococcus IE since the 2007 guideline revisions. However, the rates of hospitalization and valve surgery for IE have not increased since the change in IE prophylaxis guideline in 2007.
Wireless Sensor Network (WSN) has wide range of applications including next generation intelligent IoT applications. Sensor nodes in WSNs don't allow replacing batteries as phenomenon under ...consideration is not frequently accessible or inaccessible. Resource constrained WSN nodes run on batteries with limited capacity. For long running of the WSNs, energy consumption on each node and lifetime of overall network is a concern for IoT applications. To prolong lifetime of WSNs, use of energy efficient method is necessary and a challenging task. Most of the on-demand routing protocols use metrics like number of hops for the selection of path from the source node to the destination node. Purely hop count-based metrics leads to frequent broken paths as well as more energy consumption and results into reduced lifetime of IoT applications. Method proposed in this paper is a cross layer variant of AODV by replacing hop count metric with link quality and collision count. To establish a path, proposed method fetches link quality information from Physical layer and collision information from MAC layer to aid Network layer for making intelligent routing decisions using ZScore method. Using this information, proposed routing metric caters to select stable and sustainable routing path. Method proposed in this paper is implemented in well-known network simulator, NS-2 by incorporating necessary changes into existing physical and MAC layers as well as AODV protocol. A comparative analysis with existing methods is an indicator of improved performance in terms of energy efficiency, network lifetime, path stability and delay.
Abstract Heart failure (HF) is the most common discharge diagnosis across the US and these patients are particularly vulnerable to readmissions, increasing attention to potential ways to address the ...problem. The study cohort was derived from the HCUP’s National Readmission Data (NRD) 2013, sponsored by the AHRQ. HF was identified using appropriate ICD-9-CM codes. Readmission was defined as a subsequent hospital admission within 30-days following discharge day of index admission. Readmission causes were identified by using ICD-9 codes in primary diagnosis filed. The primary outcome was 30-day readmission. Hierarchical two level logistic models were used to evaluate study outcomes. From a total 301,892 principle admissions (73.4% age≥65 years and 50.6% male), 55,857(18.5%) patients were readmitted with a total of 64,264 readmissions during the study year. Among the etiologies of readmission, cardiac causes (49.8%) were most common (HF being most common followed by CAD and arrhythmias), while pulmonary causes were responsible for 13.1% and renal causes for 8.9% of the readmissions. Significant predictors of increased 30-day readmission included diabetes (Odds Ratio, 95%-CI, p-value) (1.06, 1.03-1.08, p<0.001), chronic lung disease (1.13, 1.11-1.16, p<0.001), renal failure/electrolyte imbalance (1.12, 1.10-1.15, p<0.001), discharge to facilities (1.07, 1.04-1.09, p <0.001), lengthier hospital stay and transfusion during index admission. In conclusion, readmission after a hospitalization for HF is common. Although it may be necessary to readmit some patients, the striking rate of readmission demands efforts to further clarify the determinants of readmission and develop strategies in terms of quality of care and care transitions to prevent this adverse outcome.
Correspondence to Dr Nileshkumar J Patel, Division of Cardiovascular Medicine, Department of Medicine, University of Miami-Miller School of Medicine, Jackson Memorial Hospital, Miami, FL 33136, USA; ...dr.nilesh.j.patel@gmail.com Atrial fibrillation (AF) is the most common arrhythmia worldwide and the estimated global age adjusted prevalence was 0.5% in 2010, representing nearly 33.5 million individuals.1 The prevalence is likely underestimated as a large proportion of asymptomatic individuals and those having transient symptoms remain undiagnosed. ...the analysis of utilisation of hospitalisation is key to allocate resources accordingly. The present analysis does not include utilisation of outpatient resources, so the prevalence and cost are underestimated. ...the mean length of stay was significantly longer in Korea than other regions of the world. ...Kim and colleagues highlighted the growing epidemic of AF causing significant increase in hospital use in South Korea.
Ventricular septal myomectomy (VSM) is the primary modality for left ventricular outflow tract gradient reduction in patients with obstructive hypertrophic cardiomyopathy with refractory symptoms. ...Comprehensive postprocedural data for VSM from a large multicenter registry are sparse. The primary objective of this study was to evaluate postprocedural mortality, complications, length of stay (LOS), and cost of hospitalization after VSM and to further appraise the multivariate predictors of these outcomes. The Healthcare Cost and Utilization Project's Nationwide Inpatient Sample was queried from 1998 through 2010 using International Classification of Diseases, Ninth Revision, procedure codes 37.33 for VSM and 425.1 for hypertrophic cardiomyopathy. The severity of co-morbidities was defined using the Charlson co-morbidity index. Hierarchical mixed-effects models were generated to identify independent multivariate predictors of in-hospital mortality, procedural complications, LOS, and cost of hospitalization. The overall mortality was 5.9%. Almost 9% (8.7%) of patients had postprocedural complete heart block requiring pacemakers. Increasing Charlson co-morbidity index was associated with a higher rate of complications and mortality (odds ratio 2.41, 95% confidence interval 1.17 to 4.98, p = 0.02). The mean cost of hospitalization was $41,715 ± $1,611, while the average LOS was 8.89 ± 0.35 days. Occurrence of any postoperative complication was associated with increased cost of hospitalization (+$33,870, p <0.001) and LOS (+6.08 days, p <0.001). In conclusion, the postoperative mortality rate for VSM was 5.9%; cardiac complications were most common, specifically complete heart block. Age and increasing severity of co-morbidities were predictive of poorer outcomes, while a higher burden of postoperative complications was associated with a higher cost of hospitalization and LOS.
BACKGROUND—Atrial fibrillation ablation has made tremendous progress with respect to innovation, efficacy, and safety. However, limited data exist regarding the burden and trends in adverse outcomes ...arising from this procedure. The aim of our study was to examine the frequency of adverse events attributable to atrial fibrillation (AF) ablation and the influence of operator and hospital volume on outcomes.
METHODS AND RESULTS—With the use of the Nationwide Inpatient Sample, we identified AF patients treated with catheter ablation. We investigated common complications including cardiac perforation and tamponade, pneumothorax, stroke, transient ischemic attack, vascular access complications (hemorrhage/hematoma, vascular complications requiring surgical repair, and accidental arterial puncture), and in-hospital death described with AF ablation, and we defined these complications by using validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes. An estimated 93 801 AF ablations were performed from 2000 to 2010. The overall frequency of complications was 6.29% with combined cardiac complications (2.54%) being the most frequent. Cardiac complications were followed by vascular complications (1.53%), respiratory complications (1.3%), and neurological complications (1.02%). The in-hospital mortality was 0.46%. Annual operator (<25 procedures) and hospital volume (<50 procedures) were significantly associated with adverse outcomes. There was a small (nonsignificant) rise in overall complication rates.
CONCLUSIONS—The overall complication rate was 6.29% in patients undergoing AF ablation. There was a significant association between operator and hospital volume and adverse outcomes. This suggests a need for future research into identifying the safety measures in AF ablations and instituting appropriate interventions to improve overall AF ablation outcomes.
BACKGROUND—Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. The associated morbidity and mortality make AF a major public health burden. Hospitalizations account for the ...majority of the economic cost burden associated with AF. The main objective of this study is to examine the trends of AF-related hospitalizations in the United States and to compare patient characteristics, outcomes, and comorbid diagnoses.
METHODS AND RESULTS—With the use of the Nationwide Inpatient Sample from 2000 through 2010, we identified AF-related hospitalizations using International Classification of Diseases, 9th Revision, Clinical Modification code 427.31 as the principal discharge diagnosis. Overall AF hospitalizations increased by 23% from 2000 to 2010, particularly in patients ≥65 years of age. The most frequent coexisting conditions were hypertension (60.0%), diabetes mellitus (21.5%), and chronic pulmonary disease (20.0%). Overall in-hospital mortality was 1%. The mortality rate was highest in the group of patients ≥80 years of age (1.9%) and in the group of patients with concomitant heart failure (8.2%). In-hospital mortality rate decreased significantly from 1.2% in 2000 to 0.9% in 2010 (29.2% decrease; P<0.001). Although there was no significant change in mean length of stay, mean cost of AF hospitalization increased significantly from $6410 in 2001 to $8439 in 2010 (24.0% increase; P<0.001).
CONCLUSIONS—Hospitalization rates for AF have increased exponentially among US adults from 2000 to 2010. The proportion of comorbid chronic diseases has also increased significantly. The last decade has witnessed an overall decline in hospital mortality; however, the hospitalization cost has significantly increased.
Transcatheter aortic valve implantation (TAVI) is associated with a significant learning curve. There is paucity of data regarding the effect of hospital volume on outcomes after TAVI. This is a ...cross-sectional study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample database of 2012. Subjects were identified by International Classification of Diseases, Ninth Revision, Clinical Modification procedure codes, 35.05 (Trans-femoral/Trans-aortic Replacement of Aortic Valve) and 35.06 (Trans-apical Replacement of Aortic Valve). Annual hospital TAVI volumes were calculated using unique identification numbers and then divided into quartiles. Multivariate logistic regression models were created. The primary outcome was inhospital mortality; secondary outcome was a composite of inhospital mortality and periprocedural complications. Length of stay (LOS) and cost of hospitalization were assessed. The study included 1,481 TAVIs (weighted n = 7,405). Overall inhospital mortality rate was 5.1%, postprocedural complication rate was 43.4%, median LOS was 6 days, and median cost of hospitalization was $51,975. Inhospital mortality rates decreased with increasing hospital TAVI volume with a rate of 6.4% for lowest volume hospitals (first quartile), 5.9% (second quartile), 5.2% (third quartile), and 2.8% for the highest volume TAVI hospitals (fourth quartile). Complication rates were significantly higher in hospitals with the lowest volume quartile (48.5%) compared to hospitals in the second (44.2%), third (39.7%), and fourth (41.5%) quartiles (p <0.001). Increasing hospital volume was independently predictive of shorter LOS and lower hospitalization costs. In conclusion, higher annual hospital volumes are significantly predictive of reduced postprocedural mortality, complications, shorter LOS, and lower hospitalization costs after TAVI.
Percutaneous ventricular assist devices (PVAD) have been used at an increasing rate in patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). Recent evidence has ...demonstrated that use of invasive hemodynamic monitoring with right-sided heart catheterization (RHC) was associated with improved survival in recipients of PVAD in AMI-CS. We sought to examine the utilization of RHC in patients receiving PVAD in AMI-CS. We queried the Nationwide Inpatient Sample database from 2008 to 2014 and identified patients using ICD-9-CM codes for AMI-CS (410, 785.51), PVAD (37.68), and RHC (37.21, 37.23). Temporal trends were analyzed using Cochrane Armitage test. In 5,925 patients who were treated with PVAD for AMI-CS, 1,691 (28.5%) underwent RHC. The mean (SD) age was 63.9 (12.3) years; majority were males (72.8%) and white (63.3%). Patients receiving RHC had higher baseline burden of co-morbidities, Charlson Co-morbidity Index ≥2 (56.1%). From 2008 to 2014, there was decrease in the utilization of RHC in patients receiving PVAD from 40.4% to 29.8% (ptrend = 0.0005). Mortality decreased in patients who received RHC (56% to 42.6%, ptrend = 0.005), whereas mortality increased in patients without RHC (44.4% to 48.4%, ptrend = 0.001). In conclusion, in patients who present with AMI-CS and were treated with PVAD, there was a progressive decline in the utilization of RHC, despite a temporal decrease in mortality in patients receiving RHC. Novel strategies should be explored to increase the use of RHC in this high-risk patient population.
The Internet of Things (IoT) is empowering the field of agriculture. The IoT application helps the farmer and makes him aware about all the latest information which is related to agriculture. In this ...study, authors have found that the implementation of IoT is very important in the field of agriculture that makes farming smarter. IoT applications make farmers smarter with the latest information about the crop and weather. By using the IoT application the farmer can prepare a plan for next season's crop. With the help of IoT based agriculture application the farmers already know the information about the weather, soil, wind speed and direction, relative humidity, and temperature. The farmers know about the disease of crops and then consult the expert and get an appropriate solution to the disease. The experts may advise the farmer how farmers can protect the crop from the disease. The IoT agriculture application helps to increase the production of crops and reduce the loss of crops from the disease. The IoT based agriculture application is like a friend of a farmer because the IoT based agriculture applications are helping the farmer at every moment of agriculture activities. India has set a food grain production target of 298.3 million tonnes for the current fiscal year 2020-21 which is 2.5% higher compared to previous fiscal year's targets. Agriculture sector contribution to Indian economy is 17%. To empower Indian farmers and in turn to empower Indian economy, IoT based agriculture applications are essential for the farmers.
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