Background: Heart failure (HF) remains one of the leading causes of death in the United States. While many large-scale studies show a positive relationship between cardiovascular mortality and body mass index (BMI), several studies have also observed lower mortality rates among obese HF patients. Therefore, we sought to assess the impact of BMI on in-hospital outcomes in patients admitted with HF.Methods: Patients hospitalized with congestive heart failure (CHF) diagnosis between 2005 and 2014 were identified from the US National Inpatient Sample database using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic and procedural codes. The sample was divided into three groups based on their BMI. In-hospital outcomes were assessed in different groups and sub-groups.Results: We identified 8,674,190 patients admitted with a primary diagnosis of HF, out of which 1.8% had BMI between 30 and 39.9 kg/m 2 and 3.7% had BMI >40 kg/m 2 . In-hospital mortality was reported in 5.6% of patients with BMI <30 kg/m 2 , compared to 2.3% in those with BMI 30-39.9 kg/m 2 and 3.1% in the group with BMI >40 kg/m 2 . After adjusting for various confounders, in-hospital mortality was lower in those with BMI 30-39.9 kg/m 2 than those with BMI <30 kg/m 2 (OR 0.56; CI 0.51-0.62). Similarly, in-hospital mortality was lower in those with BMI >40 kg/m 2 than those with BMI <30 (OR 0.87; CI 0.81-0.92). Conclusion:Even though this study supports the findings of previous smaller studies illustrating the existence of the "obesity paradox" in HF hospitalizations, the pathogenesis behind this paradoxical effect is still unclear.

BackgroundSubstance use is widely prevalent among young adults and is associated with increased cardiovascular morbidity and mortality such as sudden cardiac arrest, acute coronary syndrome, arrhythmias, and cardiomyopathy. However, they are limited studies analyzing the impact of substance use disorder on inhospital outcomes among young patients with cardiovascular events. MethodsAll patients aged 18-39 years admitted primarily for major cardiovascular events including acute myocardial infarction (AMI), arrhythmia, cardiac arrest, acute ischemic stroke, and venous thromboembolic events in 2019 were identified in the National Inpatient Sample database. They were then categorized into those with and without concomitant substance use disorder (SUD). The primary outcome was in-hospital mortality. Unadjusted and adjusted analysis was performed on appropriate variables of interest. ResultsOf 57,985 hospitalizations with cardiac events, 12,115 (20%) of young adults had concomitant SUD. SUD was significantly associated with cardiac arrest (OR 3.3; CI 2.4-4.4), atrial fibrillation (OR 1.5; CI 1.3-1.7), AMI (OR 1.3; CI 1.2-1.6), heart failure (OR 2.6; CI 2.4-3.0) (all p<0.05) despite a lower prevalence of traditional cardiovascular risk factors than non-users. Logistic regression showed acute kidney injury (aOR 1.5; CI 1.3-1.8; p<0.001) and inpatient mortality (aOR 1.6; CI 1.2-2.2; p<0.001) were also significantly higher in young patients presenting with cardiac events and concomitant SUD. There was no difference in the length of stay or incidence of gastrointestinal bleed between the two groups. ConclusionIn young patients presenting with a cardiovascular event, concurrent substance use disorder was associated with increased in-hospital mortality despite significantly lower comorbidities.

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Background: It is well-known that African American (AA) patients with Atrial Fibrillation (AF) have a higher incidence of stroke in comparison to the general population. To our knowledge, limited data exist on gender disparities in risk factors contributing to a higher incidence of stroke among AA patients. The objective of this study is to identify gender disparities in risk factors for AF by comparing AA females and males with AF. Methods: AA patients aged 18 years old or above with a diagnosis of AF were included in this study. Patients were selected from the 2019 national inpatient sample. The primary outcome of interest was incidence of stroke. T-test was used to compare differences in continuous variables. For categorical variables, pearson chi-square was used to compare differences. Multivariate logistic regression was used to adjust for potential confounders. A 2-sided P<0.05 was considered significant throughout the analyses. Results: This study included 45,102 AA female patients with AF, and 46,768 AA male patients with AF. In our study, female patients had higher prevalence of Hypertension (HTN) (22.3% vs 19.0, P<0.001), Diabetes Mellitus (DM) (48.1 vs 46.0, P<0.001), Obesity (27.8 vs 20.8), Hyperlipidemia (HLD) (50.9% vs 49.1%, P<0.001), Hyperthyroidism (2.2% vs 1.2%, P<0.001), and Chronic Obstructive Pulmonary Disease (COPD) (24.8% vs 23.2%, P<0.001). AA female patients with AF experienced higher incidence of stroke compared to AA male patients with AF, (4.9% vs 4.1%, p-value <0.001) and the odds of stroke also showed higher in female patients (aOR=1.10, 95% CI: 1.03-1.18, p <0.005) after controlling for comorbidities. Only HTN and HLD showed statistically significant association with stroke in univariate analysis, (OR=2.02, 95% CI: 1.89-2.16 and OR=1.24, 95% CI:1.16-1.31, respectively) Conclusion: In our study, we identified that AA female patients with AF had a higher incidence of stroke compared to AA male patients with AF. Only HTN and HLD were significant risk factors contributing to the increased stroke incidence in the female group. The findings of our study are hypothesis-generating, and well-powered randomized controlled trials are needed to validate these findings.

Cryoglobulins can precipitate in the blood when exposed to lower temperatures. These abnormal immunoglobulins are more commonly affiliated with Hepatitis C infection but there have been cases reported with Hepatitis A association for which we present this case. The patient was treated with steroids which did show gradual improvement of symptoms but, ultimately, the patient developed renal failure and required temporary hemodialysis. Care should be taken to assess patients with cryoglobulins for other viral serologies besides Hepatitis C.