Background: Secondary pulmonary hypertension (SPH) is a predictor of poor outcomes in obstructive sleep apnea (OSA) patients. In this study, we examined sex/racial disparities, predictors and inpatient mortality in SPH-related hospitalizations among OSA patients. Methods: We used the National Inpatient Sample (2019) and ICD-10 codes to identify OSA-related hospitalizations with SPH. The burden of SPH and disparities by sex/race were assessed. We also compared the odds and predictors of in-hospital mortality in OSA patients with vs. without SPH. Results: Of total adult OSA hospitalizations (n=2317136, median age 66[56-74] years, males: 57.2%), 9.4% (218795/2317136) had SPH. Females vs Males (11.3% vs. 8.1%) and Blacks vs. other race groups (13.5%) with OSA had a higher prevalence of SPH [Fig. 1] . The SPH cohort often consisted of females (51 vs 41.9%), blacks (20.9 vs 14.0%), patients from lowest income quartile (29.7 vs 27.6%), Medicare insured (73.4 vs 60.6%), and non-elective admissions (89.2 vs 74.4%) vs. non-SPH cohort. SPH cohort also had a higher burden of complicated HTN (52.9 vs 36.3%), DM with complications (42.7 vs 32.4%), hyperlipidemia (59.4 vs 57.6%), COPD (52.5 vs 36.9%), history of prior MI (11.4 vs 9.6%) and venous thromboembolism (10.4 vs 8.4%). However, in-hospital mortality was more likely to be in males (OR 1.12 95%CI 1.00-1.25, p=0.048) vs Females, and OSA patients with metastatic cancer (OR 2.73 95%CI 2.04-3.65), solid non-metastatic tumors (OR 1.65 95%CI 1.26-2.15) (p<0.001). Our analysis also showed black ethnicity, hyperlipidemia, obesity, tobacco use, and history of venous thromboembolism and TIA were protective against inpatient mortality in SPH-OSA patients. Conclusions: The prevalence of SPH with OSA was greater in females and blacks, whereas males and whites had higher subsequent inpatient mortality. More prospective studies are needed to understand the role of co-morbidities on survival outcomes.
Background: The risk of fatal and recurrent cardiovascular complications in Hypertrophic Cardiomyopathy (HCM) warrant data to identify the rate, causes and predictors of readmission on a large scale. We conducted the first-ever meta-analysis to evaluate the pooled rate of short-term and long-term readmissions after index HCM admissions. Methods: PubMed/Medline, EMBASE and SCOPUS databases were systematically reviewed to find studies through May 2022 reporting rates and causes of readmission following index HCM admissions. Random effects models were used to estimate pooled rates and causes of readmissions and I 2 statistics were used to report inter-study heterogeneity. Results: This meta-analysis included 17860 index HCM admissions (Mean age: 46-67 years, median follow up duration: 321.6 days, Female 53.11%) from 17 studies, which revealed a 14.8% [95% CI 12.2%-17.4%, I 2 =96%] pooled rate of readmission (Fig. 1) . Studies published from China (23.5% vs. 10.5%) had a higher readmission rate than the USA (Fig. 2) . The long-term readmission rate was highest within 1-3 years (26.6%) and in patients who underwent alcohol septal ablation procedure (10% vs 7.6%) compared to those who underwent surgical myectomy (Fig. 3) . The readmission rate was higher in cohorts with smaller sample sizes (19.2% vs 10.2%) (n<1000 vs. n>1000). Among the readmission events, congestive heart failure, and acute decompensated heart failure were the leading causes of readmission, accounting for up to 66% of the readmission cases [95%CI 32.5%-100.4%, p<0.001] following index admissions. Conclusions: In this global meta-analysis, the pooled rate of readmission following index HCM hospitalizations was nearly 15% over a year's follow-up, with heart failure accounting for two-thirds of the readmissions.
Background: The role of Cannabis in autoimmune diseases (AD) has been previously discussed due to its anti-inflammatory properties, however, cardiovascular events in elderly patients with AD are not well studied with habitual recreational cannabis usage or cannabis use disorder (CUD). Methods: We queried the National Inpatient Sample (2016-2019) for geriatric AD patients with vs. without CUD. Propensity score-matched analysis (1:1) was used to compare comorbidities, major adverse cardiac and cerebrovascular events [MACCE: all-cause mortality, acute myocardial infarction (AMI), cardiac arrest and acute ischemic stroke (AIS)], and healthcare resource utilization in the CUD vs. non-CUD cohort with AD. Results: Of 11350 elderly admissions with AD, propensity-matched cohorts consisted of 5675 patients with CUD (49.1% male) and without CUD (26.7% male). Both groups had comparable ages (median 69 years), racial groups (>70% white), and income quartiles. CUD cohort showed higher rates of hypertension, PVD, smoking, alcohol abuse, drug abuse, depression, and prior MI (p<0.005) compared to the non-CUD cohort. The CUD cohort had higher rate of transfers to other care facilities (2.6% vs. 1.9%, p≤0.001), prolonged hospital stays, and higher cost, the adjusted odds were not significant for MACCE (OR 1.22, 95%CI 0.88-1.69, p=0.24), all-cause mortality (OR 0.74, 95%CI 0.37-1.46, p=0.34), AMI (OR 1.52, 95%CI 0.95-2.43, p=0.08), AIS (OR 1.19, 95%CI 0.69-2.17, p=0.57), or cardiac arrest (OR 1.34, 95%CI 0.55-3.26, p=0.51), compared to non-CUD elderly AD cohort. The CUD cohort often had routine discharges (52.7% vs. 47.4%, p≤0.001) compared to the non-CUD cohort. Conclusions: This nationwide propensity-matched analysis did not reveal worse cardiovascular outcomes in older AD patients with CUD. Future large-scale prospective studies are needed to validate these findings and evaluate the long-term effects of medicinal/recreational cannabis usage in these individuals.
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