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Heart failure–related recurrent hospitalizations are widely recognized as a source of burden to both patients and the health system. Hospital discharges represent a transition of care and can often become a catalyst for readmission. One strategy in reducing this burden is the implementation of dedicated heart failure clinics. We conducted a retrospective review of all patients discharged from an inner city safety-net public hospital with a discharge diagnosis of heart failure. Patients followed in the Heart Clinic (HC) were compared to those with standard follow-up. All included cases were followed for 30 days after discharge to determine whether an all-cause readmission occurred. There were 258 patient discharges with an overall sicker population in the HC cohort. The HC group had a better event-free survival with a 67.1% reduction in readmission (log rank *p < .05). In concluding, a dedicated heart failure clinic reduced 30-day readmissions for patients who were discharged after having an acute exacerbation of heart failure.

Atrial fibrillation (AF) is the most common clinically significant arrhythmia worldwide, and its incidence is increasing. There has been increasing interest in ablation therapy to treat atrial fibrillation. One reason some patients undergo AF ablation might be to obviate the need for warfarin therapy, although current guidelines do not support this rationale. The current review shows that it is difficult to define a true “cure” postablation, as many of these patients will go on to experience future paroxysms of AF (either symptomatic or silent). The mechanism underlying embolism in patients with AF is not completely understood, and no long‐term evidence exists that “successfully ablated” patients return to a baseline risk of stroke comparable to an AF‐naive population. The authors recommend continued long‐term anticoagulation post–AF ablation in patients satisfying CHADS criteria for elevated stroke risk.

Editorial CommentThe specter of an unprecedented expansion of implantable cardioverter defibrillator (ICD) usage following in the wake of seminal primary prevention clinical trials in high risk populations 1,2 has generated renewed interest in noninvasive risk stratification. The underlying premise is that greater accuracy of risk prediction is necessary to limit ICD use to patients who have a substantial likelihood of the ICD delivering necessary therapy. The gauntlet has been thrown down, but the task at hand is challenging.The key defining clinical characteristic for prophylactic ICD indication is left ventricular (LV) dysfunction, which has been further refined by degrees of severity or manifest heart failure. The mortality rate using these criteria in clinical trials 1,2 was sufficiently high, with significant contribution by arrhythmic death events, that ICD benefit was definitively established with an observed absolute risk reduction of 5.6-7.2% and a relative reduction of 23-31% during the course of the trials. 1-3 Appropriate ICD therapy occurred in 21-35% 2,4 of patients, among whom were the patients whose lives were saved. Some patients likely received ICD therapy that was not life saving, a "necessary evil" of relatively conservative ICD programming and placement.Ideally, close to 100% of ICD recipients eventually would be treated by therapy that terminates a potentially fatal arrhythmia, a hope that will be challenged by competing risk (especially heart failure). The complementary ideal (especially for public health financing concerns) is that ICD placement will be spared in patients who have little likelihood of arrhythmic death, a virtual impossibility in the setting of the basic criteria described above. Thus, some compromise and reality testing is necessary to embark on the mission to achieve refined risk prediction.After the publication of MADIT II, there was a great deal of interest in using the standard ECG-derived QRS duration as a key qualifying hurdle for ICD placement, a strategy that was enthusiastically embraced by federal third party payers in the United States. 5 Concerns that this variable was derived from a post hoc analysis and was statistically weak were subsequently borne out, 6 and thus this "gatekeeper" has been removed. Additional trials that coupled LV dysfunction with the results of signal-averaged ECG (SAECG) 7 and heart rate variability 8 failed to show benefit for the ICD. The reasons for the negative results of these trials are likely related to complexities of the respective clinical milieu in addition to

Despite the lack of direct evidence that hypertension increases the likelihood of new infections, hypertension is known to be the most common comorbid condition in COVID-19 patients and also a major risk factor for severe COVID-19 infection. The literature review suggests that data is heterogeneous in terms of the association of hypertension with mortality. Hence, it remains a topic of interest whether hypertension is associated with COVID-19 disease severity and mortality. Herein, we perform a multicenter retrospective analysis to study hypertension as an independent risk for in-hospital mortality in hospitalized COVID-19 patients. This multicenter retrospective analysis included 515 COVID-19 patients hospitalized from March 1, 2020 to May 31, 2020. Patients were divided into two groups: hypertensive and normotensive. Demographic characteristics and laboratory data were collected, and in-hospital mortality was calculated in both groups. The overall mortality of the study population was 25.3% (130 of 514 patients) with 96 (73.8%) being hypertensive and 34 (26.2%) being normotensive (p-value of 0.01, statistically non-significant association). The mortality rate among the hypertensive was higher as compared to non-hypertensive; however, hypertensive patients were more likely to be old and have underlying comorbidities including obesity, diabetes mellitus, coronary artery disease, congestive heart failure, stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and cancer. Therefore, multivariable logistic regression failed to show any significant association between hypertension and COVID-19 mortality. To our knowledge, few studies have shown an association between hypertension and COVID-19 mortality after adjusting confounding variables. Our study provides further evidence that hypertension is not an independent risk factor for in-hospital mortality when adjusted for other comorbidities in hospitalized COVID-19 patients.

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Background and objectiveThe prevalence of heart failure (HF) is on the rise; currently, it affects around five million people in the United States (US) and the prevalence is expected to rise from 2.42% in 2012 to 2.97% in 2030. HF is a leading cause of hospitalizations and readmissions, accounting for a major economic burden to the US healthcare system. Obesity is a widely accepted risk factor of HF; however, data regarding its independent association with HF mortality and morbidity is heterogeneous. Globally, more than two-thirds of deaths attributable to high body mass index (BMI) are due to cardiovascular diseases (CVD). This study aimed to investigate the potential role of obesity (BMI >30 Kg/m 2 ) in HF patients in terms of 30-day readmissions, in-hospital mortality, and the use of noninvasive positive pressure ventilation (NIPPV). MethodsIn this single-center, retrospective study, all adult (age: >18 years) patients who were hospitalized with a primary diagnosis of HF at the Abington Jefferson Hospital from January 2015 to January 2018 were included. Demographic characteristics were collected manually from electronic medical records. Outcomes were 30day readmission due to HF, all-cause in-hospital mortality, and requirement for NIPPV. Multivariable logistic regression analysis was conducted to investigate the association of obesity with HF outcomes. ResultsA total of 1,000 patients were initially studied, of these 800 patients were included in the final analysis based on the inclusion criteria. Obese patients showed higher odds for 30-day readmissions and the use of NIPPV compared to non-obese patients. There was no significant difference in in-hospital mortality in obese vs. non-obese patients. ConclusionsBased on our findings, BMI >30 Kg/m 2 is an independent risk factor for HF readmissions. Additionally, our results highlight the importance of guidelines-directed medical therapy (GDMT) for HF exacerbation, a low threshold for use of NIPPV in obese patients, promotion of lifestyle modifications including weight loss, and early follow-up after discharge to prevent HF readmissions in the obese population.