Medicine and Health Sciences Commons^™

Cardiac Arrest Clinical Outcomes In Patients Presenting With Opioid Overdose, Andrew Toron, Morgan Hutchinson, Md, David Gaieski

Phase 1

Introduction: Understanding opioids and their potential to cause cardiac arrests is integral in learning how to lower mortality rates in patients who overdose on them. Few studies have specifically examined the association of out-of-hospital cardiac arrests with opioid overdoses. We hypothesized that cardiac arrests caused by opioid overdoses will result in longer hospital stays and a higher mortality rate than other cardiac arrests.

Methods: This study is a secondary analysis of data from the Cardiac Arrest Registry to Enhance Survival. Data regarding 35 patients who presented to Jefferson and Methodist hospitals with out-of-hospital cardiac arrests due to opioid overdose …

Evaluating The Impact Of Kardiamobile On Healthcare Expenditures, Christopher Gerace, Mph, Daniel Frisch, Md

Phase 1

Background: KardiaMobile is a mobile ECG device, with smartphone connectivity, that is able to detect atrial fibrillation (a-fib). The device captures a 30 second reading and an algorithm differentiates a-fib from sinus rhythm. The mobile application can alert the user to an a-fib reading and also send the ECG output to their personal physician. By monitoring a-fib without accessing traditional care, KardiaMobile has the potential to reduce healthcare costs for patients with a-fib. This study looked to evaluate the effect of KardiaMobile on healthcare utilization for patients with suspected or diagnosed a-fib and who see a clinical cardiac electrophysiologist.

Methods: …

Pilot Evaluation Of The Usability And Utility Of A Wearable Technology To Monitor And Evaluate Health Condition, Drew Nielsen, David Shipon, Md, Facc, Facp

Phase 1

Introduction: Cardiac rehabilitation programs have particularly poor attrition and rehospitalization from cardiac-related events is a large burden on the medical system, as 8.9% of patients who have acute MI are rehospitalized within one year. External barriers may exist that prevent patients from adequately completing in-house cardiac rehabilitation, which makes them strong candidates for a home-based rehab program (HBCR). Previous randomized trials have generated evidence that HBCR can achieve similar cardiac improvements in 3- 12-month clinical outcomes. With the large-scale adoption of wearable technologies, with an estimated 8.2 million devices owned by individuals over 55, we have an opportunity to incorporate …

State-Level Cpr Education Legislation Associated With Higher Survival After Out-Of-Hospital Cardiac Arrest In Older Adults, Megan Barnes, David G. Buckler, Tyler D. Alexander, Marissa Lang, Alexis Zebrowski, Douglas J. Wiebe, Benjamin S. Abella, Brendan G. Carr

Phase 1

Introduction: State-level legislation requiring CPR education prior to high school graduation is associated with an increased likelihood of community-level CPR training. CPR Legislation has also been shown to be associated with increased bystander CPR. We hypothesized that states with CPR Legislation would be associated with higher survival following out-of-hospital cardiac arrest (OHCA).

Methods: Utilizing 2014 Medicare Claims data for emergency department visits and inpatient stays, we identified OHCA via ICD-9-CM code. CPR Legislation data was collected through online statute review. Exposure to CPR Legislation was assessed using the patient state of residence. All disposition categories were considered survival to discharge …

Effect Of Contrast-Enhanced Echocardiograms On The Prognosis Of Infective Endocarditis, D. Arias, E. Halpern, F. Forsberg, J. R. Eisenbrey

Phase 1

Objective - Infective endocarditis (IE) is an infectious disease of the cardiac valves where bacteria colonize the valves; typically, via the formation of vegetations. Recent research has shown that the microbubbles in a contrast-enhanced ultrasound (CEUS) examination can move and dislodge bacterial vegetations in vitro. This study investigated whether CEUS resulted in faster resolution of IE in vivo by dislodging the vegetations.

Methods - This IRB approved retrospective study reviewed 36 patients who were diagnosed with IE via echocardiography. Data was sourced from patients within the Jefferson University Hospital’s Cardiology EMR system by searching for contrast and vegetation from …

Cardiac Risk Factors Predicting 30/90 Day Readmission Rates In Lumbar Decompression Surgeries, Blake Nourie, Kevin Xiao, Joseph Bechay, Dhruv K.C. Goyal

Phase 1

Preoperative cardiopulmonary disease is known to be a risk factor for perioperative complications in deformity surgery and lumbar fusion procedures, however there is a lack of literature evaluating cardiac risk factors and their influence on readmission rates following lumbar decompression surgery. We want to determine whether preoperative cardiac risk factors influenced the 30 and 90-day readmission rates in patients undergoing lumbar decompression surgery. Patient charts from Rothman Institute between were reviewed for history of preoperative cardiac risk factors such as coronary artery disease, congestive heart failure, myocardial infarction, stroke, cardiac catheterization, stent placement, coronary artery bypass graft, aspirin and/or clopidogrel …

Evaluating Cardiac Anatomy As A Predictor For Success After Pulmonary Vein Isolation For The Treatment Of Atrial Fibrillation, Paul Richter, Evan Rochlis, Ethan Halpern

Phase 1

Introduction: Atrial Fibrillation is a condition characterized by the production of ectopic beats by the heart. One common treatment for Atrial Fibrillation is catheter guided pulmonary vein isolation (PVI), however this treatment is only effective in around 60-70% of the population. Our research hopes to elucidate a link between cardiac anatomy and successful treatment of A-fib by pulmonary vein isolation.

Methods: The medical records for 78 consecutive patients who underwent PVI for atrial fibrillation at Jefferson from July 2013 to March 2016 were gathered. Included in these charts were ECG-gated cardiac CT angiogram and two-year follow up history. Different variables …

Continuous-Flow Left Ventricular Assist Device Outflow Graft Stenting: Indications And Outcomes, Chelsey T. Wood, Mfa, Elizabeth J. Maynes, Md, Thomas J. O'Malley, Md, Rohinton J. Morris, Md, Louis E. Samuels, Md, H. Todd Massey, Md, Vakhtang Tchantchaleishvili

Phase 1

Introduction: Stenosis in the continuous-flow left ventricular assist device (CF-LVAD) outflow graft can be caused by various mechanical and anatomical factors. Increasingly, percutaneous management has been utilized to re-establish adequate CF-LVAD flow. We sought to evaluate indications for such interventions and their outcomes.

Methods: An electronic search was performed to identify all studies in the English literature reporting CF-LVAD outflow graft stenting for various etiologies. Twenty-one studies consisting of 26 patients were included in the analysis.

Results: Median patient age was 59 years [45.8-67.0] and 65.4% (17/26) were male. 58.3% (14/24) of patients had HeartWare HVAD, 37.5% (9/24) had HeartMate …

The Impact Of Native Language Status On The Frequency Of Heart Failure Readmissions, Cooper Blazek, Dave Katzianer, Md

Phase 1

Introduction. Heart failure readmissions are costly and lead to poor health outcomes. The efficacy of discharge instructions or other outpatient interventions may be affected by patient’s primary language status. The aim of this study is to look at the impact of primary language status on the frequency of heart failure admissions.

Methods. This study was a retrospective chart review of EMRs, on Epic software, at Jefferson academic medical center and community affiliate in Philadelphia, PA between March 2017 and October 2018. Patients were included if they had a principal diagnosis of HF or a diagnosis associated with “acute” heart failure …

Evaluation Of Ventricular Repolarization In Patients Undergoing Cardiac Resynchronization Therapy (Crt) Using Two Modalities: Conventional Biventricular Pacing Vs. His-Bundle Pacing, Anshul Gupta, Behzad B. Pavri, Md, Fhrs

Phase 1

Introduction:

Permanent His-bundle pacing (HBP) is being used as an alternative to biventricular pacing (BiVP) for CRT. HBP preserves the physiologic pattern of ventricular activation and markedly reduces ventricular dyssynchrony. While ventricular depolarization with HBP vs. BiVP has been studied, the effects of the 2 modalities on repolarization have not been compared. The purpose of this study was to compare ventricular repolarization in patients with HBP and BiVP. We hypothesize that HBP provides more physiologic repolarization as compared to BiVP.

Methods: ECG repolarization parameters were analyzed in patients who underwent HBP and BiVP using the first available ECG post implant. …

Association Of Cyp2c19*17 Allele And Choice Of P2y12 Inhibitor On Cardiovascular Outcomes Following Percutaneous Coronary Intervention, Yash Varma, Bs, Craig R. Lee, Phd, Pharmd, Joseph S. Rossi, Md, George A. Stouffer, Md

Phase 1

Introduction: The CYP2C19*17 allele variant is a gain-of-function polymorphism which increases levels of the active metabolite of clopidogrel.

Objective: *17 is associated with increased bleeding risk during clopidogrel therapy, but it is unclear whether alternative P2Y12 inhibitors, prasugrel and ticagrelor, produce better clinical outcomes in patients undergoing percutaneous coronary intervention (PCI).

Methods: A single-center observational study was conducted in 928 PCI patients who received CYP2C19 testing and dual anti-platelet therapy (DAPT). Risk of major adverse cardiovascular or cerebrovascular events (MACCE) and clinically significant bleeding over 12 months were compared across genotype and DAPT groups by proportional hazards regression.

Results: 584 …

Does Concomitant Cabg Influence The Outcomes Of Post-Myocardial Infarction Ventricular Septal Defect Repair?, Dylan P. Horan, Jae Hwan Choi, Matthew P. Weber, Elizabeth Maynes, Sinal Patel, Jothika Challapalli, Jessica G.Y. Luc, John W. Entwistle, H. Todd Massey, Rohinton J. Morris, Vakhtang Tchantchaleishvili

Phase 1

Introduction: Ventricular septal defect (VSD) following myocardial infarction (MI) is a relatively infrequent complication with high mortality. Over time, understanding of the pathology and its management has resulted in improved outcomes; however, controversies remain.

Objective: We sought to investigate the effect of concomitant coronary artery bypass graft (CABG) on outcomes following post-MI VSD repair.

Methods: Electronic search was performed to identify all relevant studies published from 2000 to 2018. After assessment for inclusion and exclusion criteria, 66 studies were selected for the analysis. Data were extracted and pooled for systematic review and meta-analysis.

Results: Average age was 68.7 years …