Background: According to past studies, recovery and survival following severe vascular events such as acute myocardial infarction and stroke are negatively impacted by vitamin D deficiency. However, the national estimate on disability-related burden is unclear. We intend to evaluate the prevalence and outcomes of vitamin D deficiency (VDD) among patients with cardiovascular disease (CVD) and cerebrovascular disorder (CeVD). Methods: We performed a cross-sectional study on the Nationwide Inpatient Sample data (2016–2017) of adult (≥18 years) hospitalizations. We identified patients with a secondary diagnosis of VDD and a primary diagnosis of CVD and CeVD using the 9th revision of the International Classification of Diseases, clinical modification code (ICD-10-CM) codes. A univariate and mixed-effect multivariable survey logistic regression analysis was performed to evaluate the prevalence, disability, and discharge disposition of patients with CVD and CeVD in the presence of VDD. Results: Among 58,259,589 USA hospitalizations, 3.44%, 2.15%, 0.06%, 1.28%, 11.49%, 1.71%, 0.38%, 0.23%, and 0.08% had primary admission of IHD, acute MI, angina, AFib, CHF, AIS, TIA, ICeH, and SAH, respectively and 1.82% had VDD. The prevalence of hospitalizations due to CHF (14.66% vs. 11.43%), AIS (1.87% vs. 1.71%), and TIA (0.4% vs. 0.38%) was higher among VDD patients as compared with non-VDD patients (p < 0.0001). In a regression analysis, as compare with non-VDD patients, the VDD patients were associated with higher odds of discharge to non-home facilities with an admission diagnosis of CHF (aOR 1.08, 95% CI 1.07–1.09), IHD (aOR 1.24, 95% CI 1.21–1.28), acute MI (aOR 1.23, 95% CI 1.19–1.28), AFib (aOR 1.21, 95% CI 1.16–1.27), and TIA (aOR 1.19, 95% CI 1.11–1.28). VDD was associated with higher odds of severe or extreme disability among patients hospitalized with AIS (aOR 1.1, 95% CI 1.06–1.14), ICeH (aOR 1.22, 95% CI 1.08–1.38), TIA (aOR 1.36, 95% CI 1.25–1.47), IHD (aOR 1.37, 95% CI 1.33–1.41), acute MI (aOR 1.44, 95% CI 1.38–1.49), AFib (aOR 1.10, 95% CI 1.06–1.15), and CHF (aOR 1.03, 95% CI 1.02–1.05) as compared with non-VDD. Conclusions: CVD and CeVD in the presence of VDD increase the disability and discharge to non-home facilities among USA hospitalizations. Future studies should be planned to evaluate the effect of VDD replacement for improving outcomes.
Introduction: COVID-19 has multiorgan involvement and it is believed that outcomes are poor amongst patients with hypertension (HTN) and pre-existing cardiovascular disorders (CVD). Hypothesis: The objective of this meta-analysis is to evaluate outcomes [mortality and invasive mechanical ventilation (IMV) utilization] of COVID-19 in patients with pre-existing HTN and CVD. Methods: English full-text-observational studies having data on epidemiological characteristics of patients with COVID-19 were identified searching PubMed using MeSH-terms from December 1, 2019, to April 30, 2020. Studies having CVD or HTN as one of the pre-existing comorbidities and described outcomes including IMV and mortality were selected with a consensus of three reviewers. 29 studies met these criteria. Following MOOSE protocol, data on patients’ characteristics especially age and history of CVD, HTN, IMV, and mortality were pooled using a random-effects model. The pooled prevalence of CVD and HTN were calculated. Meta-regression was performed and correlation coefficient (r) and odds ratio (OR) were estimated to evaluate the effects of pre-existing CVD and HTN on outcomes of COVID-19 patients. Results: Out of 29 studies with COVID-19 epidemiology data, 21, 17, 18 and 19 studies have details on mortality, IMV, HTN, and pre-existing CVD, respectively. Pooled prevalence of HTN was 28.2% [95%CI:22.1%-35.1%; p<0.001; 4858/11626 patients; Heterogeneity (I 2 ):97.8%] and pre-existing CVD was 12.2% [8.9%-16.6%; p<0.001; 2044/11664 patients; I 2 :96.8%]. In age-adjusted meta-regression analysis, IMV was significantly higher among COVID-19 patients with pre-existing CVD [r:0.28; OR:1.3 (1.1-1.6); I 2 :89.7%; p=0.0028] without significant association with HTN [r:0.01; OR:1.0 (0.9-1.1); I 2 :95.9%; p=0.8161]. HTN [r:0.001; OR:1.0 (0.9-1.1); I 2 :96%; p=0.9685] and pre-existing CVD [r:-0.01; OR:0.9 (0.9-1.1); I 2 :96.3%; p=0.8772] had no significant association with mortality amongst COVID-19 patients. Conclusion: In the age-adjusted analysis, though we identified pre-existing CVD as a risk factor for higher utilization of IMV, pre-existing CVD and HTN had no independent role in increasing mortality.
Background: At least one-fourth of all stroke survivors experience language impairments. Many recover within a few months after the stroke, but up to 60% still have language impairments more than six months after a stroke, known as chronic aphasia. We aimed to look the outcomes, cost, a length of stay (LOS), and predictors of utilization of speech rehabilitation therapy (SRT) in stroke patients. Methods: We performed a cross-sectional study using the Nationwide Inpatient Sample (NIS) (years 2003-2013) in adult hospitalizations for AIS who had undergone SRT. We performed weighted analyses using chi-square, Cochran-Armitage Trend-test, and t-test to find outcomes, trend, and cost and LOS respectively. Multivariate survey logistic regression was done to evaluate the predictors of utilization of SRT. Results: Amongst 4,566,282 AIS hospitalizations, 23,597 had SRT. There was a decrease in trend (0.9% in 2003 to 0.55% in 2013, p<0.001). The mean LOS was longer by 2 days, the cost of hospitalization was higher by $11517, and outcomes were poor in AIS patients on SRT compared to those without (Table). The predictors for higher utilization in AIS patients on SRT included African American (aOR: 1.64; 95% CI: 1.48-1.82), Hispanic (aOR: 1.78; 95% CI: 1.52-2.09), Asian/pacific islander (aOR: 2.04; 95% CI: 1.56-2.67), urban teaching hospitals (aOR: 1.40; 95% CI: 1.23-1.60), depression (aOR: 1.16; 95% CI: 1.01-1.35), tPA treatment (aOR: 1.47; 95% CI: 1.20-1.81), alcohol (aOR: 1.33; 95% CI: 1.07-1.64), and atrial fibrillation (aOR: 1.17; 95% CI: 1.05-1.31). Significant predictors for lower utilization included emergency admission type, urban non-teaching hospital, medium bed-size hospitals, large bed-size hospitals, and private insurance. Conclusion: High cost and LOS might be responsible for declined utilization of SRT in private insurance payers but poor outcomes even after SRT need further research to evaluate the cost-effectiveness of therapy.
Background: Patients with transient ischemic attack (TIA) or minor stroke are at increased risk of recurrent stroke, and therefore require urgent evaluation and treatment since immediate intervention may substantially reduce the risk of recurrent stroke and improve the outcome. We hypothesized that AIS hospitalizations with previously identified/personal medical history (PMH) of TIA are associate with lower all cause in-patient mortality, likelihood of death and disability. Methods: We performed a population-based retrospective analysis of the Nationwide Inpatient Sample (NIS) (years 2007-2013) in adult hospitalizations for AIS to compare the outcomes [Death, APRDRG Risk Mortality (likelihood of dying), and APRDRG Severity (loss of function)] amongst TIA patients using ICD-9-CM codes. We performed weighted analyses using Chi-square and Jonckheere-Terpstra trend test. Multivariate survey logistic regression was done to evaluate the association of PHO TIA with poor outcomes and predictors of fatal stroke in PHO TIA patients. Results: Between years 2007 to 2013, total 3,082,973 patients with stroke were hospitalized. Of these admissions, 315,026(10.22%) patients also had PMH of TIA as a concurrent diagnosis. There was a substantial increase in rates of PMH TIA among stroke patients; 1.28% in 2007 to 13.34% in 2013 (p<0.0001). On multivariate regression analysis, there was a statistically significant lower mortality (OR:0.8; 95%CI:0.75-0.85), Risk Mortality (OR:0.85; 95%CI:0.82-0.88), and Risk Severity (OR:0.87; 95%CI:0.84-0.89) in stroke patients with PMH TIA compared to those without PMH TIA or unidentified TIA. Independent predictors of fatal stroke in PMH of TIA patients included age >80 (aOR:3.98; 95%CI:1.15-13.76), comorbid congestive heart failure (aOR:1.79; 95%CI:1.53-2.09), coagulopathies (aOR:1.47; 95%CI:1.06-2.04), hemorrhage transformation (aOR:4.65; 95%CI:3.49-6.19), and atrial fibrillation (aOR:1.77; 95%CI:1.54-2.03). Conclusion: We observed better outcomes amongst pre-identified TIA patients during stroke hospitalization than previously non-reported. That’s why risk stratification and secondary prevention play a very crucial role to improve outcomes of stroke by identifying and managing TIA.
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