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Atrial Fibrillation: Exploring Hospitalization Drivers

Atrial Fibrillation: Exploring Hospitalization Drivers

The prevalence of atrial fibrillation (AF) is projected to double over the next 30 years and has been linked to significant morbidity and mortality. The current annual cost of caring for AF is about $6 billion in the United States, with most of this cost resulting from inpatient care. Research has suggested that costs are likely to rise in the future because the risk of developing AF increases with age. “With greater recognition that the burden of AF is increasing, more attention is being paid to identifying factors that drive hospitalizations for these patients,” says Benjamin A. Steinberg, MD, MHS. Addressing Frequency & Predictors Although it is well known that AF admissions are common, few studies have assessed all-cause and cause- specific hospitalization rates among U.S. patients with AF. In a study published in the American Heart Journal , Dr. Steinberg and colleagues sought to assess the frequency and predictors of hospitalization in patients with AF. The study group used data from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF), a prospective observational study of U.S. outpatients with AF. “ORBIT-AF involved many thought leaders in cardiology throughout the country,” explains Dr. Steinberg. “It included AF patients who were being managed by primary care physicians, cardiologists, and/or electrophysiologists.” The researchers used ORBIT-AF data from more than 9,400 participants with 1-year follow-up to assess the burden of hospitalization in patients with AF and described the cause-specific rates of hospitalizations. They also sought to identify baseline factors that significantly predicted cause- specific hospitalizations in patients with AF. Examining Key Findings The study by Dr. Steinberg and colleagues found that...

ISET 2015

New research was presented at ISET 2015, the annual International Symposium on Endovascular Therapy, from January 31 to February 4 in Hollywood, FL. The features below highlight some of the studies that emerged from the conference. Comparing Treatments for Femoro-Popliteal PAD The Particulars: Previous studies have shown that drug-coated balloons (DCBs) may be promising for improving outcomes among patients with peripheral artery disease (PAD). However, comparisons of DCBs to percutaneous transluminal angioplasty (PTA) for the treatment of symptomatic femoro-popliteal disease are lacking. Data Breakdown: For a study, patients with intermittent claudication or ischemic rest pain due to femoro- popliteal PAD were randomized to DCB or PTA. Primary patency rates were higher for DCB than PTA (82.2% vs 52.4%), but PTA was better for clinically driven target lesion revascularization (20.6% vs 2.4%). Vessel thrombosis occurred in 3.7% of PTA cases, compared with 1.4% for DCB. There were no device- or procedure-related mortalities or major amputations in the study. Take Home Pearl: Among patients with symptomatic femoro-popliteal PAD, DCB appears to be superior to PTA as a treatment option. Covered Stents for Visceral Aneurysms The Particulars: Few studies have evaluated the mid- and long-term safety and effectiveness of covered stents for the endovascular exclusion of visceral aneurysms. Data Breakdown: Study investigators implanted 25 covered stents in 24 patients affected by aneurysms of the splenic, hepatic, gastroduodenal, and renal arteries. Immediate aneurysm exclusion was obtained in 21 of 24 aneurysms. Ischemic injuries to distal organs were observed postoperatively in six patients. Among 21 successfully treated aneurysms, 18 stents remained patent from 24 to 72 months, and three were occluded at 6 and...
I Am Not a Patient Advocate

I Am Not a Patient Advocate

People have commented on some of my posts, expressing appreciation for my ‘patient advocacy.’ I hate that term. Let’s get something straight. I am not a patient advocate. Patient advocates are nurses and social workers with a Mother Teresa complex who see their mission as protecting the patient from evil uncaring doctors who would subject them to unnecessary pain and indignity. I have little tolerance for such people. If I am anything, I am an honest craftsman. When a patient comes to my office seeking surgical care, I am making a pact with them, a contract if you will. I pledge my honor as a surgeon, as an honest man, that I will do the right thing for them. The right operation for the right reason at the right time. I will be conscientious in the operating room and will do my utmost to give them a smooth and uneventful recovery. To the extent that I do these things, my patient will do well and recover. If there is a complication, the first question I ask is “What did I do wrong?” Note that in all of that, the real issue is my personal duty and integrity. If I do all those things right, the patient will recover and do well. But in the end, it’s not about the patient—it’s about the integrity of the work. The patient’s recovery is a happy side effect. It is the work that is the real motivation. My personal integrity is at stake each time I go to the operating room. I have pledged to that patient to do my best. I don’t...
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