RESUMEN
There is limited data regarding the leading causes of hospitalization among heart transplant (HT) recipients and the characteristics of these hospitalizations. We conducted a retrospective analysis of the National Inpatient Sample weighted data between January 1, 2004, and December 31, 2018, which included hospitalized adults ≥18 years with a history of HT. Primary outcomes were the 10 most common primary causes of hospitalizations, clinical characteristics, inpatient mortality, length of stay, and inflation-adjusted care costs. We divided the study population in two period (2004-2014 and 2016-2018) to report the most common causes of hospitalizations. We identified a total of 209,771 weighted hospitalizations with a history of HT between January 1, 2004, and December 31, 2018. Between 2004 and 2014, pneumonia (6.21%), acute or unspecified renal failure (4.94%), complication of device, implant or graft (4.66%), sepsis (4.56%), and congestive heart failure (2.94%) were the most common causes of hospitalizations for HT recipient. Between 2016 and 2018, sepsis (9.03%), acute or unspecific renal failure (6.27%), complication of device, implant or graft (5.16%), pneumonia (4.92%), and complications of surgical procedure or medical device (3.86%) were the most common causes of hospitalizations for HT recipient. Sepsis had the highest inpatient mortality accounting for 11.32% of inpatient mortality in the 2004-2014 period and 6% in the 2016-2018 period. In summary, infections, acute renal failure, and other transplant complications are the leading causes of hospitalization among HT recipients. Sepsis carries the highest inpatient mortality.
Asunto(s)
Insuficiencia Cardíaca , Trasplante de Corazón , Neumonía , Insuficiencia Renal , Sepsis , Adulto , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Hospitalización , Humanos , Neumonía/epidemiología , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
AIM: To determine the trends in hospitalizations for heart failure (HF), acute myocardial infarction (AMI), and stroke in the United States (US). METHOD AND RESULTS: A retrospective analysis of the National Inpatient Sample weighted data between January 1, 2004 and December 31, 2018 which included hospitalized adults ≥18 years with a primary discharge diagnosis of HF, AMI, or stroke using International Classification of Diseases-9/10 administrative codes. Main outcomes were hospitalization for HF, AMI, and stroke per 1000 United States adults, length of stay, and in-hospital mortality. There were 33.4 million hospitalizations for HF, AMI, and stroke, with most being for HF (48%). After the initial decline in HF hospitalizations (5.3 hospitalizations/1000 US adults in 2004 to 4 hospitalizations/1000 US adults in 2013, P < .001), there was a progressive increase in HF hospitalizations between 2013 and 2018 (4.0 hospitalizations/1000 US adults in 2013 to 4.9 hospitalizations/1000 US adults in 2018; P < .001). Hospitalization for AMI decreased (3.1 hospitalizations/1000 US adults in 2004 to 2.5 hospitalizations/1000 US adults in 2010, P < .001) and remained stable between 2010 and 2018. There was no significant change for hospitalization for stroke between 2004 and 2011 (2.3 hospitalizations/1000 US adults in 2004 vs 2.3 hospitalizations per 1000 US adults in 2011, P = .614); however, there was a small but significant increase in hospitalization for stroke after 2011 that reached 2.5 hospitalizations/1000 US adults in 2018. Adjusted length of stay and in-hospital mortality decreased for HF, AMI, and stroke hospitalizations. CONCLUSIONS: In contrast to the trend of AMI and stroke hospitalizations, a progressive increase in hospitalizations for HF has occurred since 2013. From 2004 to 2018, in-hospital mortality has decreased for HF, AMI, and stroke hospitalizations.
Asunto(s)
Insuficiencia Cardíaca , Infarto del Miocardio , Accidente Cerebrovascular , Adulto , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Mortalidad Hospitalaria , Hospitalización , Humanos , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Estudios Retrospectivos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia , Estados Unidos/epidemiologíaRESUMEN
In this report, we aim to provide an updated meta-analysis of the sodium-glucose cotransporter 2 (SGLT2) inhibitors trial data with the new trial data on sotagliflozin, a first-in-class dual SGLT1 and SGLT2 inhibitor. We searched Medline, Cochrane library, and Embase databases for randomized clinical trials comparing cardiovascular and kidney outcomes between SGLT2 and dual SGLT1/2 inhibitors and placebo. Nine randomized clinical trials with a total of 60,914 patients with type 2 diabetes were included. In patients with type 2 diabetes, the use of SGLT2 and dual SGLT1/2 inhibitors improves the cardiovascular and kidney outcome.
Asunto(s)
Sistema Cardiovascular/efectos de los fármacos , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Glicósidos/farmacología , Riñón/efectos de los fármacos , Transportador 1 de Sodio-Glucosa/antagonistas & inhibidores , Inhibidores del Cotransportador de Sodio-Glucosa 2/farmacología , Compuestos de Bencidrilo/farmacología , Causas de Muerte , Tasa de Filtración Glomerular/efectos de los fármacos , Glucósidos/farmacología , Hospitalización , Humanos , Enfermedades Renales/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Sodium-glucose cotransporter 2 inhibitor (SGLT2i) use is associated with improved cardiovascular and kidney outcomes. However, the magnitude and potential heterogeneity of effect across patients with varying types of cardiometabolic and kidney disease is unclear. To examine the effect of SGLT2i on cardiovascular and kidney outcomes among patients with type 2 diabetes mellitus (T2DM), and independent of T2DM status, among patients with heart failure (HF), and chronic kidney disease. METHOD: Medline, Embase, Cochrane library and scientific conferences were searched from inception till September 24, 2020 for randomized controlled trials comparing cardiovascular and kidney outcomes between SGLT2i and placebo. Random effects hazard ratios (HR) with 95% confidence intervals (CIs) were calculated. RESULTS: Eight trials with a combined 59,747 patients were included. In the overall population, SGLT2i reduced the risk of all-cause mortality (HR 0.84; 95% CI [0.78-0.91]), cardiovascular mortality (HR 0.84; 95% CI [0.76-0.93]) hospitalization for HF (HR 0.69; 95% CI [0.64-0.74]), myocardial infarction (HR 0.91; 95% CI [0.84-0.99]), and composite kidney outcome (HR 0.62; 95% CI [0.56-0.70]). There was no significant effect on the risk of stroke (HR 0.98; 95% CI [0.86-1.11]). Results were consistent across subgroups stratified by diabetes and HF status. SGLT2i use was not associated with a greater risk of hypoglycemia (OR 0.92; 95% CI [0.84-1.01]) or amputation (OR 1.25; 95% CI [0.97-1.62]). There were 64 diabetic ketoacidosis events with SGLT2i use and 18 with placebo (OR 2.86; 95% CI [1.39-5.86]). CONCLUSIONS: In patients with cardiometabolic and kidney disease, SGLT2i improved cardiovascular and kidney outcomes, regardless of T2DM, HF, and/or CKD status. The magnitude of risk reduction was largest for hospitalization for HF and progression of kidney disease, more modest for mortality and MI and absent for stroke.