The burden of amyloidosis among hospitalized patients is increasing over time. However, amyloidosis remains an underdiagnosed cause of heart failure (HF) hospitalization among older adults. We investigated the prevalence and prognostic implications of amyloidosis among patients hospitalized with HF. All hospitalizations for primary diagnosis of HF between January 1, 2010, and August 31, 2015, identified in the Nationwide Readmissions Database were categorized into those with and without a secondary diagnosis of amyloidosis. HF hospitalizations with amyloidosis were then matched in a 3:1 fashion to HF hospitalizations without amyloidosis using the year of admission, discharge quarter, age, sex, and Charlson comorbidity index. Primary outcomes were inpatient mortality and 30-day readmission. Multivariable logistic regression was used to estimate the association between HF with amyloidosis and clinical outcomes. Of 1,593,360 HF hospitalizations that met inclusion criteria, 2,846 (0.18%) had HF with a secondary diagnosis of amyloidosis and were matched to 8,515 hospitalizations for HF without amyloidosis. Hospitalizations for HF with amyloidosis were associated with higher prevalence of kidney disease (56% vs. 45%), malignancy (20% vs. 4%), and higher inpatient mortality (6% vs. 3%) as compared with HF without amyloidosis. In adjusted analyses, HF with amyloidosis was associated with higher odds of in-hospital mortality (odds ratio: 1.46; 95% confidence interval [CI]: 1.17 to 1.82), 30-day readmission (odds ratio: 1.17; 95% CI: 1.05 to 1.31), and longer mean length of stay (least-squares mean difference: 1.46; 95% CI: 1.12 to 1.80). In patients hospitalized with decompensated HF, presence of amyloidosis was associated with higher risk of inpatient mortality and 30-day readmission.

Background: Heart failure (HF) remains a major cause of hospitalizations in the United States (US). Respiratory syncytial virus (RSV) has been associated with HF exacerbations. We compared in-hospital outcomes and healthcare utilization among US HF hospitalizations with and without RSV. Methods: Using the Nationwide Readmissions Database (2016–2022), we propensity-matched HF hospitalizations with a secondary diagnosis of RSV (HF-RSV) 1:1 to those without RSV (HF-noRSV). Multivariable logistic and Poisson regression models were used to assess associations between RSV and outcomes. The primary outcome was in-hospital mortality; secondary outcomes included adverse events, length of stay (LOS), hospitalization costs, and 30-day readmissions. Results: Among 11,158,836 HF hospitalizations, 32,419 (0.29%) had RSV. Compared with matched HF-noRSV hospitalizations, HF-RSV was associated with higher odds of in-hospital mortality (adjusted odds ratio [aOR] 1.12; 95% CI 1.04–1.20), septic shock (aOR 1.40; 95% CI 1.29–1.52), acute respiratory failure (aOR 3.43; 95% CI 3.32–3.55), and noninvasive mechanical ventilation (aOR 2.15; 95% CI 2.04–2.26). HF-RSV had lower odds of cardiogenic shock (aOR 0.82; 95% CI 0.73–0.92), ventricular tachycardia/fibrillation (aOR 0.73; 95% CI 0.68–0.78), ischemic stroke (aOR 0.31; 95% CI 0.27–0.36), transient ischemic attack (aOR 0.33; 95% CI 0.25–0.44), and 30-day readmissions (aOR 0.54; 95% CI 0.46–0.56). HF-RSV hospitalizations had higher costs (adjusted coefficient 0.02; 95% CI 0.01–0.02) and longer LOS (adjusted coefficient 0.14; 95% CI 0.13–0.14). Conclusions: Among US HF hospitalizations, RSV was associated with higher mortality and respiratory-related complications and increased healthcare resource utilization.

Background: Percutaneous left atrial appendage occlusion (LAAO), alternative to oral anticoagulation (OAC), currently faces non-standardized bleeding data and imprecise borderline ischemic signals within the direct oral anticoagulant (DOAC) era. Objective: This study applied a pragmatic framework to evaluate the comparative efficacy and safety of LAAO versus OAC in a DOAC-predominant setting. Methods: PubMed, Embase, and Cochrane Library were searched for randomized controlled trials comparing LAAO with OAC, restricted to a DOAC-predominant comparator. Risk ratios (RR) with 95% confidence intervals (CI) were calculated via a Mantel-Haenszel random-effects model. Results: Four trials comprising 5,890 patients were included (96.4% of controls assigned to DOACs). Overall stroke (RR 1.18, 95% CI 0.87–1.60; p=0.28), systemic embolism (RR 1.09, 95% CI 0.29–4.07; p=0.89), major bleeding (RR 0.98, 95% CI 0.81–1.19; p=0.84), hemorrhagic stroke (RR 0.82, 95% CI 0.45–1.51; p=0.53), and all-cause mortality (RR 1.00, 95% CI 0.85–1.17; p=0.98) did not differ significantly. Ischemic stroke presented a persistent numerical asymmetry favoring OAC that approached statistical significance (RR 1.36, 95% CI 0.99–1.89; p=0.06). Conversely, within available protocol-defined datasets, LAAO significantly reduced nonprocedural clinically relevant bleeding (RR 0.50, 95% CI 0.42–0.59; p<0.01). Conclusions: In a pragmatic analysis of the DOAC era, randomized data show statistical equivalence for individual hard clinical endpoints, alongside a persistent numerical asymmetry for ischemic stroke. The reduction in nonprocedural clinically relevant bleeding is driven by the attenuation of late non-major events. Current evidence remains non-definitive, warranting shared clinical decision-making to balance individual thromboembolic risks against long-term bleeding susceptibility.

Hospitalists have played a leading role in caring for hospitalized COVID-19 patients. Many clinical and administrative changes occurred in hospitals to meet the varied pandemic needs. We surveyed hospitalists to understand their perspective on pandemic-related changes in technology, models of care, administration and leadership, impact on personal lives, and which of these changes should be continued versus reverting to pre-pandemic practices. A 30-question survey was distributed to hospitalists working across the United States between April 6, 2022 to May 16, 2022. Baseline demographics were measured, and post-pandemic perspectives related to changes were analyzed. Perspectives were measured using a 5-point Likert scale and responses were categorized into “agree” and “did not agree” for analysis. Variation was assessed using Chi-square or Fisher exact tests. Open-ended questions were reported following qualitative content analysis organized into themes and reported as frequency. 177 respondents (39%) completed the survey. Nearly three-fourths favored hybrid meetings, and two-thirds preferred to continue new models of care. Nearly 90% desired more family and leisure time, continued wellness, and support services, and resumption of social gatherings. No major differences in perspectives were noted between hospitalists at teaching facilities and non-teaching facilities except for resuming protected time for non-clinical activities in those from teaching facilities (83.0% vs 62.5%). Respondents less than age 50 were more likely to prefer virtual meetings (59.0% vs 31.3%). Content analysis of open-ended questions resulted in different themes for each question. Respondents favored more work-life balance and less administrative and logistical work burden. Hospitalists preferred to continue the use of technology and new models of care even in the post-pandemic period and express a desire for more work-life balance and less administrative and logistical work burden.