Introduction: HEART (History, Electrocardiogram, Age, Risk factors, Troponin) Score (HS) predicts MACE in patients presenting to the ED with chest pain. It was validated clinically but not radiologically. Coronary computed tomography angiography (CCTA) in the ED allows for rapid triaging of patients and carries prognostic value. Objective: study relationship between HS and the presence and severity of CAD on CCTA. Methods: In this retrospective cohort, we included patients undergoing CCTA in the ED for acute chest pain between January 2014 to July 2016. HS was calculated and classified as low-risk (score <=3) or high-risk (score >3). A certified specialist reviewed all CCTA studies and determined the presence and severity of CAD. Anatomic CAD was defined by coronary artery calcium score (CACS) >0 or the presence of any stenosis. Obstructive CAD was defined by CACS>100 or coronary stenosis >=50%. Multivariate regression analysis was performed to determine predictors of anatomic and obstructive CAD. We performed interaction analysis between HS and the presence of >=3 traditional CAD risk factors. Results: Of the 927 CCTA performed, 315 (34%) had anatomic CAD, 128 (14%) had obstructive CAD. Mean age was 51 years, 49% were males, mean HS was 2.6, and 71% of the cohort had a low-risk HS. High HS was associated with higher proportions of CAD only in patients who had >=3 traditional CAD risk factors [Fig 1]. Regression and interaction analyses showed that HS was an independent predictor of anatomic and obstructive CAD only in patient with >=3 traditional CAD risk factors [Fig 2]. Conclusion: HS is a predictor of radiographic CAD on CCTA when performed in patients with >=3 traditional risk factors.

Introduction: End-stage CHF (ES-CHF) poses a significant burden on healthcare system, DNR orders are often associated with comfort care measures, decreased pain and suffering, as well as healthcare resource utilization (cost and LOS). Objective: To quantify the discrepancy in cost and LOS between ES-CHF patients with DNR orders versus without DNR code status. Methodology: Nationwide Inpatient Sample (NIS) database years 2017-2018 was invoked for hospitalizations with primary or secondary diagnosis of ES-CHF, DNR status, comorbidities, and hospitalization outcome using ICD-10 codes. Characteristics of ES-CHF hospitalization with DNR versus no DNR code status were compared. Because of the nature of NIS database, timing of diagnoses and DNR code status could not be established, thus regression analysis for predictors of hospital charges, cost, and LOS was not feasible. Regression analyses were performed to explore predictors of mortality. Stata/MP 16.0 software was used. Results: 40,655 adult hospitalization had the diagnosis of ES-CHF in years 2017-2018 in the United States, among them, 12,300 (30%) had DNR code status, 35% were females, 83% of patients had >=3 comorbid conditions (Charlson comorbidity index>=3). Overall inpatient mortality rate was 12% (25% vs 7% in DNR vs no DNR group, respectively, p<0.001), mean LOS was 10+-15 days (8 vs 11 days in DNR vs no DNR group, respectively, p<0.001), mean total hospital charges was $159,122+-358,186 ($79,434 vs $193,873 in DNR vs no DNR group, respectively, p<0.001). Significantly higher rates of CABG history, atrial fibrillation, COPD, peripheral vascular disease, hypothyroidism, CKD, liver disease, electrolyte disturbances, AKI, and sepsis were found among DNR group. In all patients with ES-CHF, independent predictors of inpatient mortality included older age, DNR status, history of CABG, peripheral vascular disease, liver disease, electrolyte disturbances, smoking, AKI, and sepsis. Conclusion: The presence of DNR code status in ES-CHF patients admitted to the hospital for any was associated with had dramatically reduced hospital charges and cost by more than the half, and with significantly shorter LOS.

No abstract

No abstract

No abstract