Salik Nazir - Academia.edu (original) (raw)
Papers by Salik Nazir
Journal of Nephrology, Feb 9, 2022
Background This pilot study describes the overall design and results of the Program for the Evalu... more Background This pilot study describes the overall design and results of the Program for the Evaluation and Management of the Cardiac Events registry for the Middle East and North Africa (MENA) Region. Methods This prospective, multi-center, multi-country study included patients hospitalized with acute myocardial infarction (AMI) and/or acute heart failure (AHF). We evaluated the clinical characteristics, socioeconomic and educational levels, management, in-hospital outcomes, and 30-day mortality rate of patients that were admitted to one tertiary-care center in each of 14 Arab countries in the MENA region. Results Between 22 April and 28 August 2018, 543 AMI and 381AHF patients were enrolled from 14 Arab countries (mean age, 57±12 years, 82.5% men). Over half of the patients in both study groups had low incomes with limited health care coverage, and limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia.
American Journal of Cardiology, Feb 1, 2022
Mayo Clinic Proceedings, Apr 1, 2022
Circulation, Nov 16, 2021
Circulation, Nov 16, 2021
Mitral regurgitation (MR) is the second most common valvular heart disease in the United States w... more Mitral regurgitation (MR) is the second most common valvular heart disease in the United States with recent improvements in the management of MR including percutaneous therapies. However, MR-related mortality may vary across sex and race groups in the elderly population. Methods: We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. MR related deaths, age ≥75 years were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC) overall and stratified by sex and race groups. Results: AAMR related to MR decreased from 29.0 in 1999 to 15.4 in 2012 and then increased to 16.4 in 2019 (2012-2019 APC 1.2 [95% CI, 0.5 to 2.0]). AAMR was higher in women (19.6) compared with men (18.6). Among the race groups, AAMR was highest in non-Hispanic whites (NHWs) (20.8) followed by non-Hispanics Others (NH Others) (includes American Indian or Alaska Natives and Asian or Pacific Islanders) (12.7), non-Hispanic blacks (NHBs) (10.5) and lastly Hispanics (10.1). AAMR was highest in NHW females (21.1). After an initial decline, APC in AAMR increased in both men (1.4) and women (1.0) since 2012 and NHWs (0.9) since 2011. AAMR decreased in NHBs (APC -5.0) till 2009 and Hispanics (APC -4.6) until 2013 and remained stable thereafter. APC in AAMR decreased in NH-Others (-1.9) during the entire study period. Conclusion: After initial decline, MR related mortality has been increasing recently. Significant disparities exist across various sex and race subgroups. Further studies are needed to understand these trends and address the underlying causes of the disparities and increasing mortality in this patient population.
European Heart Journal, Oct 1, 2021
Journal of the American College of Cardiology, May 1, 2021
Current Problems in Cardiology, Mar 1, 2023
INTRODUCTION Transcatheter mitral valve repair (TMVr) has shown to reduce heart failure (HF) reho... more INTRODUCTION Transcatheter mitral valve repair (TMVr) has shown to reduce heart failure (HF) rehospitalization and all cause mortality. However, the 30-day all-cause readmission remains high (∼15%) after TMVr. Therefore, we sought to develop and validate a 30-day readmission risk calculator for TMVr. METHODS Nationwide Readmission Database from January 2014 to December 2017 was utilized. A linear calculator was developed to determine the probability for 30-day readmission. Internal calibration with bootstrapped calculations were conducted to assess model accuracy. The root mean square error and mean absolute error were calculated to determine model performance. RESULTS Of 8,339 patients who underwent TMVr, 1,246 (14.2%) were readmitted within 30 days. The final 30-day readmission risk prediction tool included the following variables: Heart failure, Atrial Fibrillation, Anemia, length of stay ≥4 days, Acute kidney injury (AKI), and Non-Home discharge, Non-Elective admission and Bleeding/Transfusion. The c-statistic of the prediction model was 0.63. The validation c-statistic for readmission risk tool was 0.628. On internal calibration, our tool was extremely accurate in predicting readmissions up to 20%. CONCLUSION A simple and easy to use risk prediction tool identifies TMVr patients at increased risk of 30-day readmissions. The tool can guide in optimal discharge planning and reduce resource utilization.
The American Journal of Medicine, Jul 1, 2021
The ideal management of spontaneous coronary artery dissection (SCAD) has yet to be clearly defin... more The ideal management of spontaneous coronary artery dissection (SCAD) has yet to be clearly defined. We conducted a comprehensive search of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception from 1966 through September 2020 for all original studies (randomized controlled trials and observational studies) that evaluated patients with SCAD. Study groups were defined by allocation to medical therapy (medical therapy) vs invasive therapy (invasive therapy) (i.e., percutaneous coronary intervention or coronary artery bypass grafting). The risk of death (RR= 0.753, 95% CI: 0.21 to 2.73; I2= 21.1%, p=0.61), recurrence of SCAD (RR=1.09; 95% CI: 0.61 to 1.93; I2=0.0%, p=0.74), and repeat revascularization (RR=0.64; 95% CI: 0.21 to 1.94; I2= 57.6%; p=0.38) were not statistically different between medical therapy and invasive therapy for a follow up ranging from 4 months to 3 years. In conclusion, in this meta-analysis of observational studies, the long-term risk of death, recurrent SCAD, and repeat revascularization did not significantly differ among SCAD patient treated with medical therapy compared to those treated with invasive therapy. These findings support the current expert consensus that patients should be treated with medical therapy when clinically stable and no high-risk features present. Further large-scale studies including RCTs are needed to confirm these findings.
Journal of Cardiac Failure, Jul 1, 2023
Cardiology, 2023
Background: Outcomes of patients with hypertrophic cardiomyopathy (HCM) following transcatheter a... more Background: Outcomes of patients with hypertrophic cardiomyopathy (HCM) following transcatheter aortic valve replacement (TAVR) remain largely unknown. Objectives: This study sought to assess the clinical characteristics and outcomes of HCM patients following TAVR. Methods: We queried the National Inpatient Sample from 2014 to 2018 for TAVR hospitalizations with and without HCM, creating a propensity-matched cohort to compare outcomes. Results: 207,880 patients that underwent TAVR during the study period, 810 (0.38%) had coexisting HCM. In the unmatched population, TAVR patients with HCM compared to those without HCM, were more likely to be female, had a higher prevalence of heart failure, obesity, cancer, and history of pacemaker/implantable cardioverter defibrillation, and were more likely to have nonelective and weekend admissions (p for all <0.05). TAVR patients without HCM had higher prevalence of coronary artery disease, prior percutaneous coronary intervention, prior coronary artery bypass grafting, and peripheral arterial disease compared to their counterparts (p for all <0.05). In the propensity-matched cohort, TAVR patients with HCM had significantly higher incidence of in-hospital mortality, acute kidney injury/hemodialysis, bleeding complications, vascular complications, permanent pacemaker requirement, aortic dissection, cardiogenic shock, and mechanical ventilation requirement. Conclusion: Endovascular TAVR in HCM patients is associated with an increased incidence of in-hospital mortality and procedural complications.
Circulation, Nov 16, 2021
Cardiology, 2021
Introduction: Although transcatheter mitral valve repair (TMVr) is a contrast-free procedure, pri... more Introduction: Although transcatheter mitral valve repair (TMVr) is a contrast-free procedure, prior single-center studies have demonstrated a high incidence of acute kidney injury (AKI) following TMVr. The main objective of this study was to examine risk factors for AKI, and its association with outcomes in patients undergoing TMVr. Methods: We queried the National Readmission Database to identify TMVr procedures performed between January 2014 and December 2017. Complex samples multivariable logistic and linear regression models were used to identify risk factors associated with AKI, as well as to determine the association between AKI and clinical outcomes (in-hospital mortality, index length of stay (LOS), 30-day all-cause readmissions, and 30-day heart failure [HF] readmissions). Results: Of 14,623 patients who underwent TMVr during the study period, 2,001 (13.6%) had a diagnosis of AKI. HF, chronic kidney disease, chronic liver disease, fluid/electrolyte disorder, weight loss, nonelective admission, cardiogenic shock, and bleeding/transfusion were independently associated with an increased risk of AKI. In patients undergoing TMVr, AKI was associated with an increased risk of in-hospital mortality (adjusted odds ratio [aOR], 4.94; 95% confidence interval [CI], 2.92–8.34), 30-day all-cause readmissions (aOR, 1.91; 95% CI, 1.49–2.46), 30-day HF readmissions (aOR, 2.30; 95% CI, 1.38–3.84), and longer index LOS (adjusted parameter estimate, 5.78; 95% CI, 5.26–6.41). Conclusion: AKI in the setting of TMVr is common and is associated with worse clinical outcomes. Further studies are needed to determine if optimizing renal function prior to TMVr may improve outcomes, as well as to understand the impact of TMVr itself on renal function.
Journal of the American College of Cardiology, Oct 1, 2020
American Journal of Cardiology, Aug 1, 2021
American Journal of Cardiology, Nov 1, 2020
International Journal of Cardiology, Sep 1, 2021
BACKGROUND Sex-based differences in clinical outcomes have been previously well described in type... more BACKGROUND Sex-based differences in clinical outcomes have been previously well described in type 1 myocardial infarction (T1MI). However, type 2 myocardial infarction (T2MI) is more common in contemporary practice, with scarce data regarding sex-based differences of outcomes. METHODS The Nationwide Readmission Database 2018 was queried for hospitalizations with T2MI as a primary or secondary diagnosis. Complex samples multivariable logistic and linear regression models were used to determine the association between T2MI and outcomes (in-hospital mortality, index length of stay [LOS], hospital costs, discharge to nursing facility, and 30-day all-cause readmissions) in females compared to males with T2MI. RESULTS A total of 252,641 hospitalizations [119,783 (47.4%) females and 132,858 (52.6%) males] were included in this analysis. Females with T2MI was associated with lower in-hospital mortality (adjusted odds ratio [aOR] 0.92; 95% confidence interval [CI] 0.88-0.96; P < 0.001), shorter LOS (adjusted parameter estimate [aPE] -0.28; 95% CI -0.38-0.17; P < 0.001), less hospital costs (aPE -1510.70; 95% CI -1916.04-1105.37; P < 0.001), and increased nursing home discharges (aOR 1.08; 95% CI 1.05-1.12; P < 0.001) compared to males with T2MI. Females and males with T2MI had similar rates of 30-day all-cause readmission (aOR 1.00; 95% CI 0.97-1.04; P = 0.841). CONCLUSION Among T2MI hospitalizations, females have lower in-hospital mortality, hospitalization costs, shorter LOS, and increased rates of nursing home discharge compared to males. Although statistically significant, the clinical significance of these small differences are unknown and require future studies.
Journal of Nephrology, Feb 9, 2022
Background This pilot study describes the overall design and results of the Program for the Evalu... more Background This pilot study describes the overall design and results of the Program for the Evaluation and Management of the Cardiac Events registry for the Middle East and North Africa (MENA) Region. Methods This prospective, multi-center, multi-country study included patients hospitalized with acute myocardial infarction (AMI) and/or acute heart failure (AHF). We evaluated the clinical characteristics, socioeconomic and educational levels, management, in-hospital outcomes, and 30-day mortality rate of patients that were admitted to one tertiary-care center in each of 14 Arab countries in the MENA region. Results Between 22 April and 28 August 2018, 543 AMI and 381AHF patients were enrolled from 14 Arab countries (mean age, 57±12 years, 82.5% men). Over half of the patients in both study groups had low incomes with limited health care coverage, and limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia.
American Journal of Cardiology, Feb 1, 2022
Mayo Clinic Proceedings, Apr 1, 2022
Circulation, Nov 16, 2021
Circulation, Nov 16, 2021
Mitral regurgitation (MR) is the second most common valvular heart disease in the United States w... more Mitral regurgitation (MR) is the second most common valvular heart disease in the United States with recent improvements in the management of MR including percutaneous therapies. However, MR-related mortality may vary across sex and race groups in the elderly population. Methods: We used CDC Wide-ranging Online Data for Epidemiologic Research (CDC WONDER) to access National Vital Statistics System data from 1999 to 2019. MR related deaths, age ≥75 years were identified from multiple causes of death and were represented as age-adjusted mortality rates (AAMR) per 100,000 population. Joinpoint regression was used to examine changes in trend and annual percentage change (APC) overall and stratified by sex and race groups. Results: AAMR related to MR decreased from 29.0 in 1999 to 15.4 in 2012 and then increased to 16.4 in 2019 (2012-2019 APC 1.2 [95% CI, 0.5 to 2.0]). AAMR was higher in women (19.6) compared with men (18.6). Among the race groups, AAMR was highest in non-Hispanic whites (NHWs) (20.8) followed by non-Hispanics Others (NH Others) (includes American Indian or Alaska Natives and Asian or Pacific Islanders) (12.7), non-Hispanic blacks (NHBs) (10.5) and lastly Hispanics (10.1). AAMR was highest in NHW females (21.1). After an initial decline, APC in AAMR increased in both men (1.4) and women (1.0) since 2012 and NHWs (0.9) since 2011. AAMR decreased in NHBs (APC -5.0) till 2009 and Hispanics (APC -4.6) until 2013 and remained stable thereafter. APC in AAMR decreased in NH-Others (-1.9) during the entire study period. Conclusion: After initial decline, MR related mortality has been increasing recently. Significant disparities exist across various sex and race subgroups. Further studies are needed to understand these trends and address the underlying causes of the disparities and increasing mortality in this patient population.
European Heart Journal, Oct 1, 2021
Journal of the American College of Cardiology, May 1, 2021
Current Problems in Cardiology, Mar 1, 2023
INTRODUCTION Transcatheter mitral valve repair (TMVr) has shown to reduce heart failure (HF) reho... more INTRODUCTION Transcatheter mitral valve repair (TMVr) has shown to reduce heart failure (HF) rehospitalization and all cause mortality. However, the 30-day all-cause readmission remains high (∼15%) after TMVr. Therefore, we sought to develop and validate a 30-day readmission risk calculator for TMVr. METHODS Nationwide Readmission Database from January 2014 to December 2017 was utilized. A linear calculator was developed to determine the probability for 30-day readmission. Internal calibration with bootstrapped calculations were conducted to assess model accuracy. The root mean square error and mean absolute error were calculated to determine model performance. RESULTS Of 8,339 patients who underwent TMVr, 1,246 (14.2%) were readmitted within 30 days. The final 30-day readmission risk prediction tool included the following variables: Heart failure, Atrial Fibrillation, Anemia, length of stay ≥4 days, Acute kidney injury (AKI), and Non-Home discharge, Non-Elective admission and Bleeding/Transfusion. The c-statistic of the prediction model was 0.63. The validation c-statistic for readmission risk tool was 0.628. On internal calibration, our tool was extremely accurate in predicting readmissions up to 20%. CONCLUSION A simple and easy to use risk prediction tool identifies TMVr patients at increased risk of 30-day readmissions. The tool can guide in optimal discharge planning and reduce resource utilization.
The American Journal of Medicine, Jul 1, 2021
The ideal management of spontaneous coronary artery dissection (SCAD) has yet to be clearly defin... more The ideal management of spontaneous coronary artery dissection (SCAD) has yet to be clearly defined. We conducted a comprehensive search of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception from 1966 through September 2020 for all original studies (randomized controlled trials and observational studies) that evaluated patients with SCAD. Study groups were defined by allocation to medical therapy (medical therapy) vs invasive therapy (invasive therapy) (i.e., percutaneous coronary intervention or coronary artery bypass grafting). The risk of death (RR= 0.753, 95% CI: 0.21 to 2.73; I2= 21.1%, p=0.61), recurrence of SCAD (RR=1.09; 95% CI: 0.61 to 1.93; I2=0.0%, p=0.74), and repeat revascularization (RR=0.64; 95% CI: 0.21 to 1.94; I2= 57.6%; p=0.38) were not statistically different between medical therapy and invasive therapy for a follow up ranging from 4 months to 3 years. In conclusion, in this meta-analysis of observational studies, the long-term risk of death, recurrent SCAD, and repeat revascularization did not significantly differ among SCAD patient treated with medical therapy compared to those treated with invasive therapy. These findings support the current expert consensus that patients should be treated with medical therapy when clinically stable and no high-risk features present. Further large-scale studies including RCTs are needed to confirm these findings.
Journal of Cardiac Failure, Jul 1, 2023
Cardiology, 2023
Background: Outcomes of patients with hypertrophic cardiomyopathy (HCM) following transcatheter a... more Background: Outcomes of patients with hypertrophic cardiomyopathy (HCM) following transcatheter aortic valve replacement (TAVR) remain largely unknown. Objectives: This study sought to assess the clinical characteristics and outcomes of HCM patients following TAVR. Methods: We queried the National Inpatient Sample from 2014 to 2018 for TAVR hospitalizations with and without HCM, creating a propensity-matched cohort to compare outcomes. Results: 207,880 patients that underwent TAVR during the study period, 810 (0.38%) had coexisting HCM. In the unmatched population, TAVR patients with HCM compared to those without HCM, were more likely to be female, had a higher prevalence of heart failure, obesity, cancer, and history of pacemaker/implantable cardioverter defibrillation, and were more likely to have nonelective and weekend admissions (p for all <0.05). TAVR patients without HCM had higher prevalence of coronary artery disease, prior percutaneous coronary intervention, prior coronary artery bypass grafting, and peripheral arterial disease compared to their counterparts (p for all <0.05). In the propensity-matched cohort, TAVR patients with HCM had significantly higher incidence of in-hospital mortality, acute kidney injury/hemodialysis, bleeding complications, vascular complications, permanent pacemaker requirement, aortic dissection, cardiogenic shock, and mechanical ventilation requirement. Conclusion: Endovascular TAVR in HCM patients is associated with an increased incidence of in-hospital mortality and procedural complications.
Circulation, Nov 16, 2021
Cardiology, 2021
Introduction: Although transcatheter mitral valve repair (TMVr) is a contrast-free procedure, pri... more Introduction: Although transcatheter mitral valve repair (TMVr) is a contrast-free procedure, prior single-center studies have demonstrated a high incidence of acute kidney injury (AKI) following TMVr. The main objective of this study was to examine risk factors for AKI, and its association with outcomes in patients undergoing TMVr. Methods: We queried the National Readmission Database to identify TMVr procedures performed between January 2014 and December 2017. Complex samples multivariable logistic and linear regression models were used to identify risk factors associated with AKI, as well as to determine the association between AKI and clinical outcomes (in-hospital mortality, index length of stay (LOS), 30-day all-cause readmissions, and 30-day heart failure [HF] readmissions). Results: Of 14,623 patients who underwent TMVr during the study period, 2,001 (13.6%) had a diagnosis of AKI. HF, chronic kidney disease, chronic liver disease, fluid/electrolyte disorder, weight loss, nonelective admission, cardiogenic shock, and bleeding/transfusion were independently associated with an increased risk of AKI. In patients undergoing TMVr, AKI was associated with an increased risk of in-hospital mortality (adjusted odds ratio [aOR], 4.94; 95% confidence interval [CI], 2.92–8.34), 30-day all-cause readmissions (aOR, 1.91; 95% CI, 1.49–2.46), 30-day HF readmissions (aOR, 2.30; 95% CI, 1.38–3.84), and longer index LOS (adjusted parameter estimate, 5.78; 95% CI, 5.26–6.41). Conclusion: AKI in the setting of TMVr is common and is associated with worse clinical outcomes. Further studies are needed to determine if optimizing renal function prior to TMVr may improve outcomes, as well as to understand the impact of TMVr itself on renal function.
Journal of the American College of Cardiology, Oct 1, 2020
American Journal of Cardiology, Aug 1, 2021
American Journal of Cardiology, Nov 1, 2020
International Journal of Cardiology, Sep 1, 2021
BACKGROUND Sex-based differences in clinical outcomes have been previously well described in type... more BACKGROUND Sex-based differences in clinical outcomes have been previously well described in type 1 myocardial infarction (T1MI). However, type 2 myocardial infarction (T2MI) is more common in contemporary practice, with scarce data regarding sex-based differences of outcomes. METHODS The Nationwide Readmission Database 2018 was queried for hospitalizations with T2MI as a primary or secondary diagnosis. Complex samples multivariable logistic and linear regression models were used to determine the association between T2MI and outcomes (in-hospital mortality, index length of stay [LOS], hospital costs, discharge to nursing facility, and 30-day all-cause readmissions) in females compared to males with T2MI. RESULTS A total of 252,641 hospitalizations [119,783 (47.4%) females and 132,858 (52.6%) males] were included in this analysis. Females with T2MI was associated with lower in-hospital mortality (adjusted odds ratio [aOR] 0.92; 95% confidence interval [CI] 0.88-0.96; P < 0.001), shorter LOS (adjusted parameter estimate [aPE] -0.28; 95% CI -0.38-0.17; P < 0.001), less hospital costs (aPE -1510.70; 95% CI -1916.04-1105.37; P < 0.001), and increased nursing home discharges (aOR 1.08; 95% CI 1.05-1.12; P < 0.001) compared to males with T2MI. Females and males with T2MI had similar rates of 30-day all-cause readmission (aOR 1.00; 95% CI 0.97-1.04; P = 0.841). CONCLUSION Among T2MI hospitalizations, females have lower in-hospital mortality, hospitalization costs, shorter LOS, and increased rates of nursing home discharge compared to males. Although statistically significant, the clinical significance of these small differences are unknown and require future studies.