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Prognostic impact of atrial fibrillation on clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease

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World Journal of Cardiology 2015年第7期7卷 397-403页

作者： Nileshkumar J patel Aashay patel Kanishk Agnihotri Dhaval Pau Samir patel Badal Thakkar Nikhil Nalluri Deepak Asti Ritesh Kanotra Sabeeda Kadavath Shilpkumar Arora nilay patel Achint patel Azfar Sheikh Neil patel Apurva O Badheka Abhishek Deshmukh Hakan Paydak Juan Viles-Gonzalez Cardiovascular Division Staten Island University Hospital Cardiovascular Division Lankenau Institute of Medical Research Cardiovascular Division Saint Peters University Hospital Cardiovascular Division Western Reserve Health Education Cardiovascular Division Tulane University School of Public Health and Tropical Medicine Cardiovascular Division Lincoln Medical and Mental Health Center Cardiovascular Division St. Lukes Roosevelt Hospital Cardiovascular Division Icahn School of Medicine at Mount Sinai Cardiovascular Division Yale School of Medicine Cardiovascular Division Mayo Clinic Cardiovascular Division University of Arkansas for Medical Sciences Cardiovascular Division University of Miami Miller School of Medicine

Atrial fibrillation(AF) is the most common type of sustained arrhythmia,which is now on course to reach epidemic proportions in the elderly population. AF is a commonly encountered comorbidity in patients with cardiac and major non-cardiac diseases. Morbidity and mortality associated with AF makes it a major healthcare burden. The objective of our article is to determine the prognostic impact of AF on acute coronary syndromes,heart failure and chronic kidney disease. Multiple studies have been conducted to determine if AF has an independent role in the overall mortality of such patients. Our review suggests that AF has an independent adverse prognostic impact on the clinical outcomes of acute coronary syndromes,heart failure and chronic kidney disease.

关键词： Atrial fibrillation Heart failure Chronic kidney disease Acute coronary syndromes Prognostic impact

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Influence of hospital volume and outcomes of adult structural heart procedures

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World Journal of Cardiology 2016年第4期8卷 302-309页

作者： Sidakpal S Panaich nilay patel Shilpkumar Arora Nileshkumar J patel Samir V patel Chirag Savani Vikas Singh Rajesh Sonani Abhishek Deshmukh Michael Cleman Abeel Mangi John K Forrest Apurva O Badheka Interventional Cardiology Borgess Medical Center Internal Medicine Saint Peter’s University Hospital Internal Medicine Mount Sinai St.Luke’s Roosevelt Hospital Department of Cardiology University of Miami Miller School of Medicine Internal Medicine Western Reserve Health Education Internal Medicine New York Medical College Public Health Department Emory University School of Medicine Department of Cardiology Mayo Clinic Department of Cardiology Yale School of Medicine Department of Cardiology the Everett Clinic

Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicated and less commonly performed procedures such as structural heart disease interventions. Seminal work on hospital volume relationships was done by Luft et al more than 4 decades ago, when they demonstrated that hospitals performing > 200 surgical procedures a year had 25%-41% lower mortality than those performing fewer procedures. Numerous volume-outcome studies have since been done for varied surgical procedures. An old adage "practice makes perfect" indicating superior operator and institutional experience at higher volume hospitals is believed to primarily contribute to the volume outcome relationship. Compelling evidence from a slew of recent publications has also highlighted the role of hospital volume in predicting superior post-procedural outcomes following structural heart disease interventions. These included transcatheter aortic valve repair, transcatheter mitral valve repair, septal ablation and septal myectomy for hypertrophic obstructive cardiomyopathy, left atrial appendage closure and atrial septal defect/patent foramen ovale closure. This is especially important since these structural heart interventions are relatively complex with evolving technology and a steep learning curve. The benefit was demonstrated both in lower mortality and complications as well as better economics in terms of lower length of stay and hospitalization costs seen at high volume centers. We present an overview of the available literature that underscores the importance of hospital volume in complex structural heart disease interventions.

关键词： Hospital volume Transcatheter mitral valve repair Septal ablation Septal myectomy Transcatheter aortic valve repair Left atrial appendage closure

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