Objective: To subjectively identify low-risk ST-elevation myocardial infarction (STEMI) patients and triage this low-risk population to an intermediate level of care. Background: Many patients with STEMI are admitted to the intensive care unit (ICU), however, a large portion do not merit ICU admission. We sought to examine whether, among post-STEMI patients admitted to the ICU, if an easily obtainable subjective scoring system could predict low-risk patients and safely triage them to an intermediate level of care. Methods: Retrospective observational study at Christiana Hospital, a 900-bed regional referral center. Data were defined by the ACTION Registry and CathPCI Registry. Acute Physiology and Chronic Health Evaluation (APACHE) predictions were retrieved for all patients with STEMI and were analyzed for complications, length of stay, and inhospital mortality. We then examined subjective criteria to triage patients with STEMI out of the ICU. Results: Among 253 patients with STEMI, 179 (70.75%) were classified as low risk (intermediate level care appropriate) and 74 (29.25%) were classified as high risk (ICU appropriate). The mean age was 64.95 years. The APACHE III score was right skewed with a mean of 36.97 and a median of 31. There was a significant difference between the APACHE III score of low-risk patients and the APACHE III score of high-risk patients (P < .001). Conclusion: In conclusion, patients characterized as low risk, as defined by our criteria, had low APACHE III scores and a low likelihood of complications post-STEMI. This low-risk population could potentially be admitted to an intermediate level of care, avoiding the ICU altogether.
Atrial fibrillation (AF) is the most common arrhythmia and can lead to frequent healthcare encounters. Obesity is a rapidly growing epidemic, and greater than one third of all adults in the USA are obese. Additionally, obese patients have over twice the prevalence of AF compared to the non-obese. Despite the frequency of these conditions, there is limited research assessing the relationship between obesity and healthcare resource utilization (HRU) in AF patients.
We hypothesized that obese patients with new onset atrial fibrillation/flutter (AFL) would have higher AF/AFL related hospitalizations and procedures compared to non-obese patients.
We utilized MarketScan® claims data to select patients with new onset atrial fibrillation or atrial flutter in 2017 and 2018 and classified them according to diagnosis codes as obese or non-obese. We then stratified by the diagnosis of obesity.
There were 95,314 patients with new onset atrial fibrillation/flutter, which included 72,218 (76%) who were non-obese and 23,096 (24%) who were obese. There were significantly more males than females (64.4% vs. 35.6%). The average age was similar at 54.4 (+/- 0.04) in the non-obese and 54.6 (+/- 0.06) in the obese cohort. The rate of hospitalizations (35.9% vs. 24.8%, p<0.001), cardioversions (16% vs. 10%, p<0.001), and ablation procedures (10% vs. 7%, p<0.0001) were significantly higher in the obese versus non-obese cohort.
Obese patients with new onset AF/AFL had significantly higher HRU than non-obese patients. This increased health resource utilization increases the cost of care in such patients and future studies should concentrate on understanding the reasons for this difference.
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