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Background The Measurement Tool to Assess systematic Reviews (AMSTAR) 2 is a critical appraisal tool for systematic reviews (SRs) and meta-analyses (MAs) of interventions. We aimed to perform the first AMSTAR 2-based quality assessment of heart failure-related studies. Methods Eleven high-impact journals were searched from 2009 to 2019. The included studies were assessed on the basis of 16 domains. Seven domains were deemed critical for high-quality studies. On the basis of the performance in these 16 domains with different weights, overall ratings were generated, and the quality was determined to be “high,” “moderate,” “low,” or “critically low.” Results Eighty-one heart failure-related SRs with MAs were included. Overall, 79 studies were of “critically low quality” and two were of “low quality.” These findings were attributed to insufficiency in the following critical domains: a priori protocols (compliance rate, 5%), complete list of exclusions with justification (5%), risk of bias assessment (69%), meta-analysis methodology (78%), and investigation of publication bias (60%). Conclusions The low ratings for these potential high-quality heart failure-related SRs and MAs challenge the discrimination capacity of AMSTAR 2. In addition to identifying certain areas of insufficiency, these findings indicate the need to justify or modify AMSTAR 2’s rating rules.

This study aimed to compare the outcomes of patients primarily admitted for atrial fibrillation (AF) with and without a secondary diagnosis of rheumatoid arthritis (RA). The primary outcome of interest was inpatient mortality. Hospital length of stay (LOS), total hospital charges, and odds of undergoing ablation and pharmacologic cardioversion were the secondary outcomes of interest.

Objectives: This study aims to compare the outcomes of patients admitted primarily for acute coronary syndrome (ACS) with and without a secondary diagnosis of rheumatoid arthritis (RA). Methods: Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 Database. The NIS was searched for hospitalizations of adult patients with ACS as principal diagnoses, with and without RA as a secondary diagnosis. The primary outcome was inpatient mortality. Secondary outcomes were hospitalization characteristics and cardiovascular therapies. Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders. Results: There were over 71 million discharges included in the combined 2016 and 2017 NIS database. Out of 1.3 million patients with ACS, 22,615 (1.7%) had RA. RA group was older (70.4 vs 66.8 years, P<0.001) as compared to the non-RA group, and had more females (63.7% vs 37.7%, P<0.0001). Patients with RA had a 16% reduced risk of in-hospital mortality: odds ratio (OR) 0.84, 95% confidence interval (CI) (0.72-0.99), P=0.034; less odds of undergoing intraaortic balloon pump (IABP): OR 0.78, 95% CI (0.64-0.95), P=0.015; and 0.18 days shorter hospital length of stay (LOS): 95% CI (0.32-0.05), P=0.009. However, odds of undergoing percutaneous coronary intervention with drug-eluting stent (PCI DES) at OR 1.14, 95% CI (1.07-1.23), P<0.0001 was significantly higher in the RA group compared to ACS without RA. Conclusions: Patients admitted for ACS with co-existing RA had lower adjusted inpatient mortality, less odds of undergoing IABP, shorter adjusted LOS, and greater adjusted odds of undergoing PCI DES compared to those without RA.