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Socioeconomic disparities in In-hospital outcomes and readmission rates among patients hospitalized with infective endocarditis: A national analysis from the United States
No full textBackground: Contemporary data elucidates an association between adverse outcomes and low socioeconomic status (SES) in patients with cardiovascular related hospitalizations. Despite this, the impact of SES status on infective endocarditis (IE) outcomes remains unknown.
Objectives: To assess the impact of SES on hospitalized IE cases.
Methods: We queried the Nationwide Readmission Database (2016-2020) to identify adult patients with IE and stratified them based on mean income quartiles (≤2 quartile vs. ≥3 quartiles). The primary outcome was in-hospital mortality. Secondary outcomes included 30-day and 90-day readmissions, sepsis, mechanical circulatory support (MCS) use, acute kidney injury (AKI), pacemaker and valve replacement interventions, length of stay (LOS), and total hospital charges. Multivariable regression models adjusted for confounders.
Results: Among 41,175 IE hospitalizations, 24,581 (59.7 %) included patients with low income. Low income was associated with higher odds of in-hospital mortality (aOR 1.21, 95 % CI 1.04-1.41, p = 0.012), 30-day readmissions (aOR 1.09, 95 % CI 1.01-1.17, p = 0.021), 90-day readmissions (aOR 1.1, 95 % CI 1.02-1.19, p = 0.012), sepsis (aOR 1.11, 95 % CI 1.03-1.19, p = 0.008), MCS use (aOR 1.48, 95 % CI 1.04-2.09, p = 0.027) and lower odds of stroke (aOR 0.86, 95 % CI 0.78-0.96, p = 0.005) compared with high-income. No differences were observed in odds of AKI, valve replacement intervention, pacemaker use, mean LOS and total hospital charges between both income groups.
Conclusion: Among IE hospitalizations, lower income was associated with higher odds of in-hospital mortality and non-fatal adverse outcomes compared to higher income individuals.
Keywords: Healthcare disparities; Infective endocarditis; Nationwide readmission database
Sex Differences in Cardiovascular Outcomes of Intravascular Imaging-Guided PCI: A Meta-Analysis of Randomized Controlled Trials
No full textBackground: Disparities in cardiovascular disease presentation and outcomes between men and women are well-documented. While intravascular imaging (IVI) improves percutaneous coronary intervention (PCI) outcomes, its potential sex-specific benefits remain unclear.
Objectives: The purpose of this study was to determine sex differences in adverse cardiovascular events in coronary artery disease patients undergoing PCI with IVI guidance vs angiography alone.
Methods: Systematic review of PubMed, Scopus, and Cochrane databases was conducted to identify randomized controlled trials comparing major adverse cardiovascular events (MACE) in men and women with coronary artery disease (presenting with acute or chronic coronary syndrome) undergoing IVI-guided vs angiography-guided PCI. Risk ratios (RRs) with 95% CIs were calculated using random-effects models.
Results: Eight randomized controlled trials, comprising 14,812 patients (76.1% men and 23.9% women) were included. IVI-guided PCI significantly reduced MACE in both men (RR: 0.69; 95% CI: 0.58-0.81; P \u3c 0.001) and women (RR: 0.64; 95% CI: 0.49-0.82; P \u3c 0.001) compared with angiography alone (Pinteraction = 0.62). Intravascular ultrasound-guided PCI reduced MACE in men and women compared with angiography alone (Pinteraction = 0.86). Optical coherence tomography-guided PCI reduced MACE in men but not in women compared with angiography alone (Pinteraction = 0.86).
Conclusions: Despite the underrepresentation of women in IVI-guided PCI trials, this meta-analysis demonstrates that IVI-guided PCI confers a comparable reduction in MACE for both men and women, suggesting its potential to mitigate the long-standing sex-specific disparities in coronary intervention outcomes and supports its broader implementation in clinical practice.
Keywords: cardiovascular outcomes; intravascular imaging; intravascular ultrasound; optical coherence tomography; percutaneous coronary intervention; sex differences
Global Uptake of GLP-1 Receptor Agonists in Obese, Non-Diabetic Patients with Cardiovascular Disease
No full textPresence of type 1 hiatal hernia affects the clinical efficacy of per-oral endoscopic myotomy
No full textBackground: Per-oral endoscopic myotomy (POEM) is a valuable treatment option for achalasia and non-achalasia esophageal motility disorders, but little is known about the effect of type 1 hiatal hernias (T1HH) on POEM outcomes. We hypothesized there would be no difference in technical success or pre- or post-POEM Eckardt scores between those with and without T1HH.
Methods: This single-institution, retrospective review analyzed consecutive POEM cases from 6/10/2011-7/16/2024. T1HH were defined by esophagogastroduodenoscopy, manometry, contrast esophagram, or computed tomography imaging. Technical success included an 8 cm myotomy including the esophagogastric junction and extending 2 cm distal. Clinical success was defined as post-POEM Eckardt score ≤ 3. Demographics, T1HH, and pre- and post-procedural Eckardt scores were analyzed using descriptive, univariate, and multivariable logistic regression statistics.
Results: There were 173 POEM cases. Of these, 95(55%) were female, 34(20%) had T1HH, 148(86%) were performed for achalasia, median Eckardt scores were 7[IQR:5.3-9] pre-POEM and 0[IQR:0-1] post-POEM, with clinical success in 146(86%), length of myotomy was median 12[IQR:12-13]cm with technical success in 170(98%). There were no differences found between those with and without T1HH in terms of sex, achalasia diagnosis, previous interventions, pre-POEM Eckardt scores, length of myotomy, or technical success. Compared to those without T1HH, those with T1HH had higher median post-POEM Eckardt scores (median 0[IQR:0-1] vs. 0[IQR:0-0], p = 0.043), lower rates of clinical success (n = 26(76%) vs n = 120(86%), p = 0.01), and had a shorter distance from incisors to EGJ (40[IQR:38.3-41] vs 41[39-43]cm, p = 0.044). After adjustment, presence of T1HH was the only significant factor, conferring 0.13 odds (95%CI: 0.02-0.93, p = 0.042) of clinical success.
Conclusions: POEM produces excellent outcomes in patients with and without T1HH. T1HH did not affect technical success of POEM, but decreased clinical success rate and was associated with higher post-POEM Eckardt scores. POEM practitioners should be cognizant of T1HH and advise patients of its potential implications in their treatment plan.
Keywords: Achalasia; Hiatal hernia; Per-oral endoscopic myotomy
Together or separated in time? Two simultaneous cervical ripening agents perform better than one for labor induction
No full textThe Role of Impella in Cardiogenic Shock in the Post-DanGer Shock Era
No full textThe microaxial flow pump (mAFP) is a mechanical circulatory support device designed to directly unload the left ventricle, restore cardiac output, and improve systemic perfusion in the setting of cardiogenic shock (CS). CS is a devastating complication of acute myocardial infarction (AMI) and advanced heart failure, characterized by systemic hypoperfusion and myocardial dysfunction, carrying an in-hospital mortality of 30-50%. However, there has been controversy about whether these theoretical physiological mechanisms behind mAFP translate into actual survival or recovery in this patient population that has historically been difficult to study in prospective trials. The lack of consensus has resulted in differing national guidelines, resource allocation, and clinical decision-making in time-sensitive clinical scenarios. Earlier studies were limited to retrospective analyses and a single small, underpowered randomized trial, none of which showed a mortality benefit. In 2024, the DanGer Shock trial emerged as the first multi-center trial to demonstrate mortality benefit in patients with STEMI complicated by CS treated with Impella CP, albeit at the cost of increased risk of major bleeding, hemolysis, and vascular complications, an effect sustained in the 10 year outcomes published in 2025. In this review, we examine reasons for the differing results of preceding studies and compare how multinational guidelines have reacted to this new evidence. Finally, we provide practical considerations regarding the use, complications, and troubleshooting of this technology, and identify gaps in evidence regarding patient selection and timing of placement.
Keywords: Impella; cardiogenic shock; mechanical circulatory support; microaxial flow pump; myocardial infarction
Implementing ASH\u27s Guidelines for Acute Medical Care for Children and Adults with Sickle Cell Disease in Custody
No full textBetween 2019 and 2021, the American Society of Hematology (ASH) developed clinical guidelines for managing sickle cell disease (SCD), covering acute pain, acute neurological events, and other complications. However, these guidelines lacked implementation strategies for incarcerated individuals, a vulnerable group with unique challenges. In 2024, an ASH special panel of SCD and carceral health experts convened to address acute SCD care in custody settings, emphasizing timely access to emergency care, including acute management for acute strokes, pain management, and fever evaluation. The ASH special panel recommended pre-arranged emergency plans for transfer to specialized facilities, continuity of care with SCD specialists, and adherence to community-level care standards. Limitations included insufficient population data and absent chronic care guidelines. The ASH special panel urged that future ASH guidelines address SCD management tailored to carceral settings to reduce morbidity and ensure equitable care
Clinical Risk Assessment and Treatment of a Man Attacked by a Rabid North American Beaver (Castor canadensis) in the Connecticut River: Case Report
No full textA 46-y-old male was swimming in the Connecticut River near Hatfield, Massachusetts, when he suffered an unprovoked attack from a North American beaver (Castor canadensis). The beaver attacked the man 3 separate times, inflicting multiple bite wounds to his arms and torso, ultimately attaching itself to his arm without releasing. The patient was brought to our emergency department, where the wounds were treated, and rabies postexposure prophylaxis was begun. The beaver tested positive for rabies shortly thereafter. Here we review the case of an unprovoked attack by a beaver and clinical risk assessment for rabies, along with management including postexposure prophylaxis, tetanus immunization, and wound care
Clinical knowledge for hospital medicine through structured clinical offerings
No full textSociety of Hospital Medicine Rapid Clinical Updates (RCUs) was developed as a tool for healthcare professionals to bridge the gap between the latest advancements and standard clinical practice. An online seminar series with nationally recognized speakers was developed with input from hospitalists and literature review. For each session, a subspecialist was paired with a hospitalist to present the latest medical research and practical implementation into clinical practice. Active audience participation was encouraged, and survey data were collected on the quality of the sessions and their impact on clinical practice. Over the past 4 years, this virtual platform has consistently been rated as high-quality and impacting clinical practice
