Laursen McGraw (deskberry4)

BACKGROUND Limited national US data are available regarding the prevalence of and trends in different arrhythmias and the use of electrophysiological procedures in patients with alcoholic cardiomyopathy. METHODS This was a cross-sectional study that used the Nationwide Inpatient Sample database (2007-2014). Hospitalizations of adults with alcoholic CMP were identified with the ICD-9 code (425.5). CAD and other causes of cardiomyopathy were excluded. Chi-square test, t-test, mixed-effect logistic regression and quantile regression were used. RESULTS Among 75,430 hospitalizations, 48% had arrhythmias. Individuals with a co-diagnosis of arrhythmia tended to be older (56.9 vs 53.2-year-old) and male (89.5% vs 81.9%). The most prevalent arrhythmias were atrial fibrillation/flutter (31.5%), followed by ventricular tachycardia (7.9%). The prevalence of arrhythmias increased from 44% to 50% (2007-2014) (p less then 0.001) and this increase was mainly secondary to the increasing prevalence AFib/AFL. Excluding cardiac arrest, arrhythmias were not associated with increased in-hospital mortality. The median length of stay and total charges for arrhythmia vs no-arrhythmia hospitalizations were 5 vs 4 days (p less then 0.001) and $31,127 vs $24,199 respectively (p less then 0.001). EP procedures were performed in 5.6% of all hospitalizations and it increased from 5.2% to 6% (2007-2014) (p = 0.2). The most common procedures were cardioversion (2.7%), ICD placement (2.2%) and PPM placement (1.1%). CONCLUSION Arrhythmias were reported in 48% of hospitalizations. There was an increasing burden of arrhythmias secondary to increasing atrial fibrillation. Excluding cardiac arrest, arrhythmias were not associated with increased in-hospital mortality but were associated with longer hospital stays and higher total charges. BACKGROUND Whether the prognostic impact of comorbidity on myocardial infarction (MI) mortality is due to comorbidity alone or/and its interaction effect is unknown. METHODS We used Danish medical registries to conduct a nationwide cohort study of all first-time MIs during 1995-2016 (n = 179,515) and a comparison cohort matched on age, sex, and individual comorbidities (n = 880,347). We calculated age-standardized 5-year all-cause mortality rates. Interaction was examined on an additive scale by calculating interaction contrasts (difference in rate differences). RESULTS Among individuals without comorbidity, the 30-day mortality rate per 1000 person-years was 1851 (95% CI 1818-1884) for MI patients and 22 (21-24) for comparison cohort members (rate difference = 1829). For individuals with low comorbidity, corresponding baseline mortality rates were 2498 (2436-2560) in the MI and 54 (50-57) in the comparison cohort (rate difference = 2444). The interaction contrast (616) indicated that the interaction accounted for 25% (616/2498) of the total 30-day mortality rate in MI patients with low comorbidity. This percentage increased further for moderate (35%) and severe (45%) comorbidity levels. Absolute and relative interaction effects were largest within the first 30 days and younger individuals. Dose-response patterns were also observed during 31-365 days and 1-5 years of follow-up (p-values for trends less then 0.002). The interaction differed substantially between individual types of cardiac and non-cardiac comorbidities. CONCLUSION Cardiac and non-cardiac comorbidities interact with MI to increase short- and long-term mortality beyond that explained by their additive effects. The interaction had a dose-response relation with comorbidity burden and a magnitude of clinical importance. This work discusses challenges we have encountered in acquiring reproducible measurements of shear wave speed (SWS) in the median nerve and suggests methods for improving reproducibility. First, procedural acquisition challenges are described, including nerve echogenicity, transducer pressure