Introduction:
Atrial fibrillation is a comorbidity often seen in patients with hypertrophic cardiomyopathy (HCM); however, contemporary data on its prevalence and clinical implications in the obstructive variant of HCM is scarce.
Hypothesis:
We sought to study the outcomes and implications of atrial fibrillation among patients hospitalized with hypertrophic obstructive cardiomyopathy (HOCM).
Methods:
Patients with a principal discharge diagnosis of HOCM between 2016 and 2019 were identified in the National Readmissions Database. Among those, patients with and without a diagnosis of atrial fibrillation were categorized. HOCM hospitalizations with atrial fibrillation were matched 1:1 fashion to HOCM without atrial fibrillation.
Results:
Of the 40,516 HOCM hospitalizations, 14,637 (36.12%) had a secondary diagnosis of atrial fibrillation. Propensity score-matched comparison between HOCM with and without atrial fibrillation (Figure 1) showed higher cardiogenic shock (2.69% vs. 1.98%, p-value <0.01), and acute stroke (3.85% vs 2.91%, p-value <0.01) as compared with HFpEF without atrial fibrillation (Table 1). Total charges were higher in HOCM with atrial fibrillation compared to patients without atrial fibrillation ($ ($86,392.6 vs. $83,762.21). The 30 days all-cause readmission rate among patients admitted with HOCM with AF was higher than those without AF (15.91% vs 14.80, p-value <0.01).
Conclusions:
In patients with HOCM presence of atrial fibrillation was associated with higher cardiogenic shock and acute stroke.
Background: Interns experience challenges in their transition from medical school to residency. Orientation is traditionally delivered by faculty and administrators and often does not address the intern’s daily duties.Objectives: Address traditional orientation gaps and improve incoming interns’ experience.Methods: We identified opportunities with our intern orientation using a quality improvement methodology. Plan Do Study Act (PDSA) cycle 1 consisted of a pilot boot camp. PDSA cycle 2 was conducted over two weeks, June 9-23, 2021, at the Detroit Medical Center, in Detroit, MI. Participation was voluntary. Residents were assigned incoming interns on a 1:1 basis. Five virtual sessions were conducted addressing: daily workflow, documentation, presentation skills, and utilization of the Electronic Health Records (EHR). All participants received pre- and post-program surveys.Results: 22 rising second-year and third-year residents (26%) and 22 incoming interns (58%) participated. There was a significant improvement in the understanding of daily workflow (mean improved by 0.957, p=0.003), and most tasks associated with EHR including comfort with the sign-out process (mean improved by 1.21; p=0.002), accessing specific team lists (mean improved by 1.75, p=0.001), writing orders (mean improved by 1.41; p=0.002), composing documentation (mean improved by 1.23; p=0.001). Writing notes improved significantly (mean improved by 0.52; p=0.04). Nearly all (93.2%) stated the program effectively achieved its overall goals and believed (92.9%) the program should be continued for each incoming class of interns.Conclusion: A targeted orientation boot camp led by near peers positively impacted the intern experience improving understanding of day-to-day responsibilities and comfort utilizing the electronic health record.
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