The incidence of TB and HIV/TB coinfection rates continues to be major challenges in the developing world. Demographic, socioeconomic trends as well as risk factors remain unchanged. Increased HIV screening and HAART coverage offers hope for the future.

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Background: Peripartum cardiomyopathy (PPCM) is an uncommon form of cardiomyopathy that affects young women at the end of pregnancy or in the first few months following delivery, and is associated with increased morbidity and mortality. In selected patients with cardiogenic shock (CS), mechanical circulatory support (MCS) devices improve outcomes. However, data comparing outcomes of patients with PPCM who develop CS and receive mechanical circulatory support (MCS) vs. those treated medically remains limited. Methods: Using the National Inpatient Database (NIS) we identified patients with PPCM who were treated for CS from 2012 to 2017. Primary outcome was in-hospital mortality. Multivariate analysis models were adjusted for statistically significant differences in baseline characteristics between the groups. Results: A total of 4686 patients were admitted with a diagnosis of PPCM, of these 199 patients developed cardiogenic shock. Only 50 (25.1%) patients received MCS. Patients who received MCS were less likely to have a prior ICD in place (6% vs. 23%, p = 0.008), and were more likely to suffer from end-stage renal disease (6% vs. 0.67%, p = 0.020). There were no other major differences in baseline characteristics among the two groups. The incidence of ICD implant prior to discharge (4% vs. 7.4%, p = 0.243, OR 0.39) and cardiac arrest (16% vs. 7.4%, p = 0.173, OR 2.01) was not significantly different between the groups. There was no significant difference in in-hospital mortality between those who received MCS devices and those treated medically (22% vs 10.1%, p = 0.256, OR 1.73). LOS was longer for the MCS group (23.2% vs. 13.4 mean days, p = 0.001). Conclusions: The use of MCS in PPCM patients who developed cardiogenic shock appears to offer similar survival benefit compared to those treated medically, despite being associated with longer length of stay This finding may be related to the complexity and acuity level of patients receiving MCS compared to those treated medically.

Background: Chronic heart failure (CHF) affects more than 5 million Americans and accounts for approximately 1 million hospitalizations annually. Readmission in CHF patients is associated with higher mortality and consumes a significant portion of hospital resources. Readmission rates may be higher when socioeconomic factors limit medication compliance and follow-up. In light of the high prevalence of CHF and the penalties associated with readmission rates, our study aims to identify factors that place our veterans with CHF at higher risk for readmission and in so doing, develop a profile for patients with a high risk of readmission that will benefit from focused intervention. Our goal is to use the information acquired in this study to reduce CHF readmission in the Miami VAMC by 10% over a 12-month period. Methods: This is an ongoing retrospective study conducted at the Miami VAMC. The Strategic Analysis for Improvement and Learning (SAIL) report was used to identify patients with CHF who were admitted to the Miami VAMC over fiscal year 2019 (FY19), the period from September 2018 to August 2019. Data was collected on various clinical baseline characteristics and social determinants of health from the patients' electronic health records for those admitted as well as for those with recurrent admissions within FY19. Using a previously validated questionnaire, identified patients will undergo further interview, in person or by phone, to identify social factors that may place them at higher risk for readmission. Results/Anticipated Results: A total of 185 patients were admitted during FY19 and of these, 38 had recurrent admissions. The mean time to readmission was 82 days. 76% of the patients readmitted had heart failure with reduced ejection fraction. Multiple co-morbidities were seen in the readmitted group, the commonest being hypertension (82%), diabetes (63%) and chronic kidney disease (39%). Thirty percent of those readmitted had a history of illicit drug use compared to 26% of those who were not readmitted. This population was also found to have multiple psychiatric co-morbidities - depression, anxiety and post-traumatic stress disorder. The odds of having one or more readmission within 12 months was 25% greater in those with psychiatric illness than in those without. Conclusion: Preliminary data analysis shows that psycho-social factors may play a role in recurrent admission in CHF patients. Further data will be collected to determine the impact of factors such as housing, education level and income on readmission risk so that patients at high risk can be identified and targeted with improved care co-ordination services to reduce this risk. As a unified health system, the VAMC is uniquely equipped with resources to address these disparities.