Black patients have a higher prevalence of peripheral artery disease (PAD) than white patients, and also tend to have a greater extent and severity of disease, and poorer outcomes. The association of race with quality of health (QOH) after peripheral vascular intervention (PVI), however, is less well-known. In our study, we hypothesized that after PVI, black patients experience worse QOH than white patients. We retrospectively assessed racial differences in health status using responses to the Peripheral Arterial Questionnaire (PAQ) at baseline (pre-PVI) and up to 6 months following PVI among 387 patients. We used the PAQ summary score (which includes physical limitation, symptoms, social function and quality of life) as a measure of QOH. We compared QOH scores at baseline and at follow-up after PVI between black ( n=132, 34.1%) and white ( n=255, 65.9%) patients. We then computed the change in score from baseline to follow-up for each patient (the delta) and compared the median delta between the two groups. Multivariable regression was used to model the delta QOH after controlling for factors associated with race or with the delta QOH. There was no significant difference in mean QOH by race either at baseline ( p=0.09) or at follow-up ( p=0.45). There was no significant difference in the unadjusted median delta by race (white 25.3 vs black 21.5, p=0.28) and QOH scores improved significantly at follow-up in both groups, albeit the improvement was marginally lower in black compared with white patients after adjustment for baseline confounders ( b = -6.6, p=0.05, 95% CI -13.2, -0.11).
Inferior vena cava filters are indicated in patients with venous thromboembolic disease in whom anticoagulation is a contraindication. This case highlights the importance of inferior vena cava filter placement in patients with extensive proximal deep vein thromboses in order to prevent massive pulmonary emboli, possibly associated with sudden cardiac death.
Introduction: Depression is highly prevalent among heart failure (HF) patients. It is well-known that it has several adverse effects among these patients through a variety of means; including medication non-compliance and impairment of self-care. However, the direct impact of depression as a predictor of 30-day readmission rate in patients with HF admitted for acute heart failure syndrome (AHFS) has not been well clarified. Objective: To assess the prevalence of depression and its ability to predict 30-day readmission rate and length of stay (LOS) among patients with AHFS. Methods: A retrospective analysis of 2,017 patients admitted to a tertiary hospital for AHFS from January, 2005 to December, 2015 defined by ICD-9 codes for congestive HF and depressive disorder. Results: The prevalence of depression among HF patients admitted for AHFS was 3.9% (78 patients out of 2,017), of which, 70% were females versus 30% males, and 82.3% had HFrEF versus 17.7% had HFpEF. Among patients admitted for AHFS, 30-day readmission rate was 25.3% in patients with depression versus 16.6% in patients without depression (OR:1.7, 95% CI: 1.1–2.9, P = .04). LOS was higher in patients with depression compared to those without depression (6.1 days versus 5.8 days, respectively; P = .6). Among patients admitted for AHFS with HFrEF, 30-day readmission rate was 39.4% in patients with depression versus 22.6% in those without depression (P = .004) (Table 1). The LOS among patients with HFrEF who had depression was 6.5 versus 5.7 in those without depression (P = .4). Furthermore, female patients with HFrEF who had depression and were admitted for AHFS were found to have a significant higher 30-day readmission rate of 40.9% compared to 13.8% in female group who didn't have depression (P = .001), and LOS was 6.8 versus 6.2 days respectively (P = .7). Among patients admitted for AHFS with HFpEF, 30-day readmission rate was 15.6% in patients with depression versus 16.5% in those without depression (P = .9). LOS was 6.1 days in both groups (P = .9). (Table 2). Conclusion: Having depression upon admission among patients with AHFS can be a significant factor predicting their 30-day readmission rate. These findings were more pronounced among patients with HFrEF, especially female ones. LOS was generally higher among HF patients with depression, but it didn't achieve statistical significance. Depression counseling is recommended and might aid in decreasing 30-day readmission rate and LOS among HF patients.Table 1Table 2Table 2
Two million Americans use cocaine on a regular basis. Sixty-nine percent of cocaine in the United States is adulterated with levamisole, a veterinary antihelminthic drug. In 2008, the first cases of levamisole-induced agranulocytosis and vasculopathy associated with adulterated cocaine were reported in the southwestern United States. Since then, reports of levamisole-associated toxicity have become increasingly common. The authors present the case of a 47-year-old woman from Michigan with purpuric lesions likely secondary to levamisole-induced leukocytoclastic vasculitis.
Introduction: Blacks and patients (pts) with Infrapopliteal PAD have more comorbidities than whites and those with suprapoliteal PAD. However, the long-term outcomes of black versus white pts with ...
