free article with cme_ cardiac complications after asah _ neurosurgery repor
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Free Article with CME: Cardiac Complications after aSAH | NEUROSURGERY Report
http://neurosurgerycns.wordpress.com/2013/08/26/free-article-with-cme-cardiac-complications-after-asah/#more-10481[26-08-2013 23:04:52]
Written by NEUROSURGERY® Editorial
Office
August 26, 2013 at 8:00 AM
Posted in CME, Free
Tagged with Cardiac failure, Myocardial infarction, subarachnoid hemorrhage
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Background: Cardiac dysfunction is a well-known complication of aneurysmal subarachnoid hemorrhage
(aSAH). However, the clinical significance of cardiac complications is largely unknown.
Objective: To determine whether cardiac complications are independently related to outcomes and to identify
potential predictors associated with these complications.
Methods: We extracted all hospitalizations for aSAH from the National Inpatient Sample database for years
2002 to 2009. We used generalized estimating equations to determine whether cardiac complications were
associated with the patient outcomes and to evaluate potential predictors of cardiac complications.
Results: Among 53 713 cases of aSAH, there were 3609 (6.72%) and 151 (0.28%) incidences of cardiac failure
(CF) and myocardial infarction (MI), respectively. The overall in-hospital mortality rate was 24.8%, whereas the
mortality rate for patients with CF was 34.4% and the mortality rate for patients with MI was 29.8%. Patients
who experienced CF were significantly more likely than other patients to die in the hospital (odds ratio: 1.6,
95% confidence interval: 1.47-1.68; P < .001). The difference in mortality rates between MI patients and
other patients, however, was not statistically significant. The generalized estimating equation model
identified 7 factors that were predictive of CF: age, sex, race, primary payer, diabetes, smoker, and cardiac
disease. For MI, the model identified age, race, and primary payer as significant predictors of MI.
Conclusion: Our results suggest that an important association exists between cardiac complications and
mortality/morbidity in aSAH patients. aSAH patients with CF appear to have a higher mortality rate, longer
hospital length of stay, and higher hospitalization costs compared with those without CF.
From: Risk Factors, Incidence, and Effect of Cardiac Failure and Myocardial Infarction in Aneurysmal
Subarachnoid Hemorrhage Patients by Kim et al.
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