Introduction: The availability, national scope and perceived unbiased nature of administrative claims data makes it an attractive choice by health care policy makers for evaluating quality and outcomes. We calculated Ventricular tachycardia (VT) ablation complication rates from national administrative data and compared them with data from randomized trials and prospective studies. Methods: A PUBMED database search was done to identify existing studies of VT ablation. Studies were divided into clinical (randomized controlled trials (RCTs) and prospective studies). Pooled rates of vascular, cardiac, neurological complications and procedure related mortality were computed and compared to reported complication rates from administrative database studies Results: We identified two administrative database studies of VT ablation that included a total of 14,352 procedures and 18 clinical studies with a total of 1,705 procedure. Overall complication rate in administrative studies was higher than in clinical studies (9.39% vs. 7.97%). Rates of cardiac/pericardial (4.47% vs. 2.29%) and vascular access complications (6.9% vs. 3.0%) were higher in real world studies. Neurological complications (1.17% vs. 0.45%) and procedure related mortality (1.53% vs. 1.29%) were higher in clinical studies. Among clinical studies, RCTs had the lowest reported complication rate. Conclusion: Despite substantial improvement, “real-world” complication rates from administrative data remain higher than those reported in RCTs. The discrepancy may be attributable to differences in operator skills, selection bias and variation in data quality. Use of large databases provides an important analytical resource as we embark on improving national health care efficacy and safety in the current challenging environment.
Cardiac resynchronization therapy (CRT) is an important intervention in heart failure.Whether real-world complication rates mirror those reported in randomized clinical trials (RCTs) is unknown.We sought to compare rates of procedural complications between major RCTs of CRT with "real-world" complication rates reported in registries and administrative claims database studies.We conducted a PubMed search to identify all relevant publications on CRT and classified them into RCTs and registry studies.Pooled procedural complication rates were analyzed.Differences between groups were compared using the chi-squared test.We identified a total of 6 RCTs, 2 administrative claims database studies, and 4 CRT registry studies.RCTs included a total of 4,442 patients and "real-world" studies included a total of 72,554 patients.The overall rates of procedural complications with CRT were significantly higher in RCTs compared to the real world (8.1% vs. 6.9%,P = .002).Lead-related complications were higher in the real-world studies compared to RCTs (11.3% vs. 6.5%,P = .0001).This could represent a follow-up bias with patients in registries being followed up for longer durations that would compound lead complication rates.Interestingly, RCTs had a higher incidence of pocket hematomas (2.1% vs. 0.4%, P = .001).In conclusion, real-world procedural complication rates of CRT appear to be significantly lower than those reported in RCTs.
Acute and subacute stent thromboses are rare but life-threatening complications of primary coronary intervention and stenting. We present a case of a patient with COVID-19 infection who presented with pneumonia, acute respiratory failure, and non–ST elevation myocardial infarction. Reperfusion was achieved with coronary angioplasty and drug-eluting stent placement, and the patient was started on aspirin and clopidogrel. However, 72 hours later, the patient experienced an episode of subacute stent thrombosis. This raises concerns about a possible association between stent thrombosis and increased thrombogenicity and platelet aggregability triggered by COVID-19 infection.
Metabolic syndrome (MetS) represents a cluster of metabolic abnormalities that include hypertension, central obesity, insulin resistance, and atherogenic dyslipidemia, and is strongly associated with an increased risk for developing diabetes and atherosclerotic and nonatherosclerotic cardiovascular disease (CVD). The pathogenesis of MetS involves both genetic and acquired factors that contribute to the final pathway of inflammation that leads to CVD. MetS has gained significant importance recently due to the exponential increase in obesity worldwide. Early diagnosis is important in order to employ lifestyle and risk factor modification. Here, we review the epidemiology and pathogenesis of MetS, the role of inflammation in MetS, and summarize existing natural therapies for MetS.
Introduction: Heart failure (HF) is a global health problem. We sought to examine the focus of ongoing clinical trials in HF and compare ongoing trials with population prevalence of HF with preserv...
Cardiac rehabilitation (CR) represents a spectrum of interventions that influence physical, mental, and social well-being of an individual. These interventions can range from dietary counseling to intense physical activity. The role of CR in various cardiac disorders, particularly ischemic heart disease, has been well established across multiple studies. However, real-world utilization of CR still seems to lag behind. As coronary intervention modalities keep evolving with increasing number of patients receiving percutaneous coronary intervention, there is a need for reappraisal of the role of CR in this population. In this review, we discuss data behind the benefit of CR in patients with ischemic heart disease and highlight the barriers encountered in implementing CR in real-world practice.
