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ObjectiveThis study determines the trend of acute myocardial infarction (AMI) in cannabis users. Demographic characteristics, hospitalization outcomes, and utilization of primary treatment modalities were evaluated in AMI inpatient population.MethodsThe study used data from the nationwide inpatient sample (NIS) for the years 2010-2014. We identified patients with AMI as the primary diagnosis (N = 379,843) and patients with cannabis use disorder as the secondary diagnosis. We used Pearson’s chi-square (χ2) test and independent sample t-test for measuring the categorical and continuous data, respectively.ResultsInpatient admissions for AMI among cannabis users increased by 32% (P = 0.001). The overall mean age of cannabis users with AMI (41 years) remained stable with no significant differences observed across age groups. AMI was predominant in male cannabis users (79.1%), and there was a 38.3% increase in the prevalence in female cannabis users over five years (P < 0.001). About one-third of the cannabis users with AMI were covered by medicaid with a 70.5% pike (21% in 2010 to 37.5% in 2014; P < 0.001). There was a strong linear trend in nonelective admissions for AMI in cannabis users (P = 0.003) along with a moderate-to-severe morbidity (P = 0.001). Mean length of inpatient stay had a decreasing linear trend (P = 0.003), whereas hospitalization costs were increasing (P = 0.024), averaging $65,879 per admission for AMI. Cannabis users had a strong linear increasing trend (P = 0.007), with a 60% increase in in-hospital mortality (1.0% in 2010 to 1.6% in 2014).ConclusionDue to the risk of AMI, as seen in numerous case reports, the trend of emergency admission and severe morbidity due to AMI in cannabis users is also increasing. Also, cannabis users have a higher healthcare cost to manage AMI, yet the in-hospital mortality has risen tremendously over the last few years. It is imperative to know that chronic cannabis worsens the outcomes in AMI patients, and more clinical studies are needed to show the association of episodic use in cannabis abusers and AMI.

ObjectiveThis study determines trends in demographics and hospitalization outcomes among patients admitted for systemic sclerosis (SScl) and evaluates the differences between comorbidities.MethodsThe study used data from the Nationwide Inpatient Sample (NIS) for the years 2010–2014. We identified SScl as the primary diagnosis and the associated medical and psychiatric comorbidities using validated International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9­CM) codes. The differences in comorbidities and in-hospital mortality were quantified using multinomial logistic regression (odds ratio (OR)).ResultsInpatient admissions for SScl decreased over the period 2010-2014 by 15.9% (p < 0.001). There was an increasing trend in the 61-80 years age group as they had a 29% increase in admissions and a higher risk of in-hospital mortality (OR = 2.113; p = 0.020). The differences between races showed weaker linear trends, with Caucasians (57.5%) showing an increasing trend, and African Americans (24.3%) and Hispanics (11.8%) having a decreasing trend (p < 0.001). However, Hispanics had the highest risk of mortality (OR = 1.295; p = 0.001) during hospitalization. In-hospital mortality had a linear decreasing trend, with a 10.3% decrease in deaths in 2010, and a 9.1% decrease in 2014 (p < 0.001). Hypertension (47.3%), pulmonary circulation disorders (40.1%), pulmonary fibrosis (29.7%), and congestive heart failure (24.4%) constituted the majority of comorbidities. Comorbid diabetes increased the risk of in-hospital mortality in SScl patients by four times (OR = 3.914; p = 0.003). Esophageal reflux disorder was present in only 6.7% of SScl patients, but it increased the risk of in-hospital mortality (OR = 2.643: p < 0.001). Among psychiatric comorbidities, depression (OR = 1.526; p = 0.001) and psychosis (OR = 1.743; p = 0.039) both increased the risk of in-hospital mortality.ConclusionWe observed the various comorbidities that were associated with substantial and significant differences in the risk of in-hospital mortality. We assert that these findings indicate that comorbid conditions are influential factors that must be considered in models of health-related quality of life (HRQOL) in SScl. More attention needs to be paid to the elderly population at risk of having a higher risk of inpatient death. Further research to guide the development of clinical care models for targeting early diagnosis and treatment of comorbidities in SScl is necessary to reduce both mortality and morbidity, as well as improve the quality of care for these patients.

Baksh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

ObjectiveTo evaluate the demographic predictors of major depressive disorder (MDD) in hospitalized congestive heart failure (CHF) patients and measure the differences in hospital stay and cost per comorbidities and the associated risk of in-hospital mortality.MethodsThis retrospective cross-sectional study used nationwide inpatient data from the healthcare cost and utilization project (HCUP). We identified patients with CHF as the primary diagnosis and MDD as the secondary diagnosis using ICD-9-CM codes and compared with the CHF patient without MDD. The differences in comorbidities were quantified using chi-square tests and the logistic regression model was used to evaluate mortality risk among comorbidities using odds ratio (OR).ResultsElder CHF patients, 36–50-year-old (OR: 1.324) and whites (OR: 1.673), have a higher likelihood of a co-diagnosis of MDD. Females with heart failure have two-fold higher odds of MDD (OR: 2.332). Majority of the medical comorbidities were seen in a higher proportion of CHF patients without MDD. Hypothyroidism (10.2%) and drug abuse (15.2%) were seen more in depressed patients comparatively. Among substance use disorder, patients with drug abuse stayed longer and had a higher hospitalization total cost ($51,828). And, hypothyroidism was associated with longer inpatient stay (5.6 days) and cost ($64,726), and four-fold higher odds of in-hospital mortality (OR: 4.405). Though alcohol abuse was seen only in 7.4% of CHF patients with MDD, it was associated with the three-fold higher likelihood of deaths during hospitalization (OR: 3.195).ConclusionA middle-aged, white female with comorbid depression has a higher risk of hospitalization for heart failure. Depressed CHF patients with comorbid hypothyroidism were hospitalized for a longer duration with higher inpatient cost and four times higher risk of mortality during hospitalization stay. Further studies are required to evaluate the underlying cause of worse hospital outcomes in depressed CHF patients with alcohol abuse and hypothyroidism. An integrated healthcare model is required for early diagnosis and treatment of depression and associated comorbidities in CHF patients to reduce mortality and improve post-CHF outcomes.