Browsing by Author "Pandey, Ambarish"

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    Heart Failure Epidemiology and Outcomes Statistics: A Report of the Heart Failure Society of America
    (Elsevier, 2023) Bozkurt, Biykem; Ahmad, Tariq; Alexander, Kevin M.; Baker, William L.; Bosak, Kelly; Breathett, Khadijah; Fonarow, Gregg C.; Heidenreich, Paul; Ho, Jennifer E.; Hsich, Eileen; Ibrahim, Nasrien E.; Jones, Lenette M.; Khan, Sadiya S.; Khazanie, Prateeti; Koelling, Todd; Krumholz, Harlan M.; Khush, Kiran K.; Lee, Christopher; Morris, Alanna A.; Page, Robert L., II; Pandey, Ambarish; Piano, Mariann R.; Stehlik, Josef; Stevenson, Lynne Warner; Teerlink, John R.; Vaduganathan, Muthiah; Ziaeian, Boback; Writing Committee Members; Medicine, School of Medicine
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    Sex Associated Differences in the Clinical Outcomes of Left Ventricular Assist Device Recipients: Insights from INTERMACS
    (American Heart Association, 2023) Shetty, Naman S.; Parcha, Vibhu; Abdelmessih, Peter; Patel, Nirav; Hasnie, Ammar A.; Kalra, Rajat; Pandey, Ambarish; Breathett, Khadijah; Morris, Alanna A.; Arora, Garima; Arora, Pankaj; Medicine, School of Medicine
    Background: Sex-associated differences in clinical outcomes among left ventricular assist device recipients in the United States have been recognized. However, an investigation of the social and clinical determinants of sex-associated differences is lacking. Methods: Left ventricular assist device receiving patients enrolled in Interagency Registry for Mechanically Assisted Circulatory Support between 2005 and 2017 were included. The primary outcome was all-cause mortality. Secondary outcomes included heart transplantation and postimplantation adverse event rates. The cohort was stratified by the social subgroup of race and ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic Asian, and Hispanic), and clinical subgroups of device strategy (destination therapy, bridge to transplant, and bridge to candidacy), and implantation center volume (low [≤20 implants/y], medium [21-30 implants/y], and high [>30 implants/y]). A multivariable-adjusted Cox proportional hazard model was used to assess the risk of death and heart transplantation with prespecified interaction testing. Poisson regression was used to estimate adverse events by sex across the various subgroups. Results: Among 18 525 patients, there were 3968 (21.4%) females. Compared with their male counterparts, Hispanic (adjusted hazard ratio [HRadj], 1.75 [1.23-2.47]) females had the highest risk of death followed by non-Hispanic White females (HRadj, 1.15 [1.07-1.25]; Pinteraction=0.02). Hispanic (HRadj, 0.60 [0.40-0.89]) females had the lowest cumulative incidence of heart transplantation followed by non-Hispanic Black females (HRadj, 0.76 [0.67-0.86]), and non-Hispanic White females (HRadj, 0.88 [0.80-0.96]) compared with their male counterparts (Pinteraction<0.001). Compared with their male counterparts, females on the bridge to candidacy strategy (HRadj, 1.32 [1.18-1.48]) had the highest risk of death (Pinteraction=0.01). The risk of death (Pinteraction=0.44) and cumulative incidence of heart transplantation (Pinteraction=0.40) did not vary by sex in the center volume subgroup. A higher incidence rate of adverse events after left ventricular assist device implantation was also seen in females compared with the males, overall, and across all subgroups. Conclusions: Among left ventricular assist device recipients, the risk of death, the cumulative incidence of heart transplantation, and adverse events differ by sex across the social and clinical subgroups.
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    Variation in Hospital-use and Outcomes Associated with Pulmonary Artery Catheterization in Heart Failure in the United States
    (American Heart Association, 2016-11) Khera, Rohan; Pandey, Ambarish; Kumar, Nilay; Singh, Rajeev; Bano, Shah; Golwala, Harsh; Kumbhani, Dharam J.; Girotra, Saket; Fonarow, Gregg C.; Medicine, School of Medicine
    Background There has been an increase in the use of pulmonary artery (PA) catheters in heart failure (HF) in the United States in recent years. However, patterns of hospital-use and trends in patient outcomes are not known. Methods and Results In the National Inpatient Sample 2001–2012, using ICD-9 codes we identified 11,888,525 adult (≥18 years) HF hospitalizations nationally, of which an estimated 75,209 (SE 0.6%) received a PA catheter. In 2001, the number of hospitals with ≥1 PA catheterization was 1753, decreasing to 1183 in 2011. The mean PA catheter use per hospital trended from 4.9/year in 2001 (limits 1–133) to 3.8/year in 2007 (limits 1–46), but increased to 5.5/year in 2011 (limits 1–70). During 2001–2006, PA catheterization declined across hospitals; however, in 2007–2012 there has been a disproportionate increase at hospitals with large bedsize, teaching programs, and advanced HF capabilities. The overall in-hospital mortality with PA catheter use was higher than without PA catheter use (13.1% vs. 3.4%, P<0.0001), however, in propensity-matched analysis, differences in mortality between these groups have attenuated over time – risk-adjusted odds ratio for mortality for PA-catheterization, 1.66 (95% CI 1.60–1.74) in 2001–2003 down to 1.04 (95% CI 0.97– 1.12) in 2010–2012. Conclusions There is substantial hospital-level variability in PA catheterization in HF along with increasing volume at fewer hospitals overrepresented by large, academic hospitals with advanced HF capabilities. This is accompanied by a decline in excess mortality associated with PA catheterization.