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Papers by mahek shah

Journal of the American College of Cardiology

Circulation, 2014

Background: The day of the week has been inconsistently linked to the length of hospital stay (LO... more Background: The day of the week has been inconsistently linked to the length of hospital stay (LOS) and even mortality in patients with heart failure (HF). With Medicare expenditure for HF hospitalizations exceeding 17 billion USD a year, there has been an increased focus on measures that could decrease HF readmissions. While reduced physician staffing, poor quality of care and lesser supervision may be seen on weekends, its role in predicting a worse outcome is unclear. Methods: All patients with HF as the admitting diagnosis between 1/1/2003 and 12/31/2013 were included. The admissions were stratified based on the day of admission and an association with outcomes as LOS, new acute myocardial infarction (AMI) or readmission for HF was analyzed. Results: From the 22,287 admissions included, 4,874 (22%) were on the weekend. The average age (69+/-15 years in both groups, p=0.98) and risk factors as hypertension, diabetes, hyperlipidemia, chronic kidney disease and coronary artery dise...

American Journal of Case Reports, 2020

This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jef... more This Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of Thomas Jefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarly publications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers and interested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion in Division of Internal Medicine Faculty Papers & Presentations by an authorized administrator of the Jefferson Digital Commons.

Baylor University Medical Center Proceedings, 2020

Depression and anxiety in patients with heart disease and/or cancer have been shown to affect qua... more Depression and anxiety in patients with heart disease and/or cancer have been shown to affect quality of life, adherence with medical management, and prognosis. We investigated the association of the diagnoses of cancer, heart disease, or both with self-reported symptoms consistent with serious mental illness (SMI). We used the K6 score to identify self-reported symptoms consistent with SMI from patients' responses to the 2017 National Health Interview Survey. Our final cohort included 24,777 individual surveys. Of those respondents, 1509 reported cancer, 2639 reported heart disease, and 534 reported both. About 96% of patients reported a K6 score <13, and 4% reported a K6 score 13, which is suggestive of SMI. Logistic regression identified significant associations between SMI and an inability to afford mental care/counseling, an inability to afford prescribed medications, and unemployed status, with odds ratios of 6.97, 2.94, and 3.49, respectively. Having both heart disease and cancer was independently associated with SMI (odds ratio ¼ 2.57; 95% confidence interval, 1.53-4.31; P < 0.001). In conclusion, in a nationally representative self-reported questionnaire, patients with a combined diagnosis of cancer and heart disease were significantly more likely to report SMI than those with either diagnosis alone.

Journal of Cardiac Failure, 2020

Heart Failure Reviews, 2020

The original version of this article unfortunately contained a mistake. Unfortunately, the name o... more The original version of this article unfortunately contained a mistake. Unfortunately, the name of one of the authors (Dr. Pradhum Ram) has been misspelled as (Prathaum Ram) instead. The original article has been corrected.

AORTA, 2019

Severe obstructive lesions in the aortic arch are rare. Crossing such lesions poses additional ch... more Severe obstructive lesions in the aortic arch are rare. Crossing such lesions poses additional challenges in patients who require cardiac catheterizations. Oftentimes, specialized catheters are required to negotiate the lesion. Herein, we are reporting a series of case images that illustrate a severe lesion in the aortic arch during coronary angiography.

Chest, 2019

BACKGROUND: Patients with sepsis are particularly vulnerable to readmissions. We describe the ass... more BACKGROUND: Patients with sepsis are particularly vulnerable to readmissions. We describe the associated etiology and risk factors for readmission in patients with sepsis using a large administrative database inclusive of patients of all ages and insurance status. METHODS: Our study cohort was derived from the Healthcare Cost and Utilization Project's National Readmission Data from 2013 to 2014 by identifying patients admitted with sepsis. The primary outcome was 30-day readmission with etiology identified by using International Classification of Diseases, Ninth Revision, Clinical Modification, codes. RESULTS: From a total 1,030,335 index admissions; mean age, 66.8 AE 17.4 years (60% age $65 years), 898,257 patients (87.2%) survived to discharge. A total of 157,235 (17.5%) patients had a 30-day readmission; median time to readmission was 11 days (interquartile range, 5-19). Infectious etiology (42.16%; including sepsis, 22.86%) was the most commonly associated cause for 30-day readmission followed by gastrointestinal (9.6%), cardiovascular (8.73%), pulmonary (7.82%), and renal causes (4.99%). Significant predictors associated with increased 30-day readmission included diabetes (OR,

The American Journal of Cardiology, 2019

Journal of cardiovascular electrophysiology, Jan 17, 2018

The utilization of cardiac resynchronization therapy defibrillator (CRT-D) has increased signific... more The utilization of cardiac resynchronization therapy defibrillator (CRT-D) has increased significantly, since its initial approval for use in selected patients with heart failure. Limited data exist as for current trends in implant-related in-hospital complications and cost utilization. The aim of our study was to examine in-hospital complication rates associated with CRT-D and their trends over the last decade. Using the Nationwide Inpatient Sample, we estimated 378 248 CRT-D procedures from 2003 to 2012. We investigated common complications, including mechanical, cardiovascular, pericardial complications (hemopericardium, cardiac tamponade, or pericardiocentesis), pneumothorax, stroke, vascular complications (consisting of hemorrhage/hematoma, incidents requiring surgical repair, and accidental arterial puncture), and in-hospital deaths described with CRT-D, defining them by the validated International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis cod...

Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2018

The clinical benefit of patent foramen ovale (PFO) closure after cryptogenic stroke has been a to... more The clinical benefit of patent foramen ovale (PFO) closure after cryptogenic stroke has been a topic of debate for decades. Recently, 3 randomized controlled trials of PFO closure in patients with cryptogenic stroke demonstrated a significantly reduced risk of recurrent stroke compared with standard medical therapy alone. This meta-analysis was performed to clarify the efficacy of PFO closure for future stroke prevention in this population. A systematic literature search was undertaken. Published pooled data from 5 large randomized clinical trials (CLOSE, RESPECT, Gore REDUCE, CLOSURE I, and PC) were combined and then subsequently analyzed. Enrolled patients with cryptogenic stroke were assigned to receive standard medical care or to undergo endovascular PFO closure, with a primary outcome of reduction in stroke recurrence rate. Secondary outcomes included rates of transient ischemic attack (TIA), composite outcome of stroke, TIA, and death from all causes, and rates of atrial fibri...

International journal of cardiology, Jan 10, 2018

Cardiogenic shock (CS) in absence of acute myocardial infarction (AMI) has significant morbidity ... more Cardiogenic shock (CS) in absence of acute myocardial infarction (AMI) has significant morbidity and mortality. This population of patients has been excluded from prior major randomized trials and observational studies. We included patients with CS in absence of AMI from the 2013-14 HCUP's National Readmission Database. 30-day readmissions were studied and etiology for readmission was identified by using ICD-9CM codes in primary diagnosis field. Multivariable mixed effect logistic regression models were created to identify predictors of 30-day readmission and in-hospital mortality, respectively. We studied 38,198 index admissions with non-AMI CS, with an in-hospital mortality of 35.4%. Mean age, length and cost of stay were 63.6 years, 16.9 days and 69,947$, respectively among survivors of index admission. Among those discharged, 22.6% were readmitted within 30 days with >50% readmissions occurring within 11-days. Cardiovascular etiologies (42.3%), especially heart failure (2...

Case reports in cardiology, 2018

Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare co... more Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary anomaly with high mortality. It is associated with cardiovascular complications and is usually diagnosed soon after birth. Those who survive into adulthood can present with signs of myocardial infarction, heart failure, mitral regurgitation, severe pulmonary hypertension, or sudden cardiac death. We present a 53-year-old female presenting with atrial fibrillation and found to have an incidental diagnosis of ALCAPA who refused surgical correction. We also review the epidemiology, diagnosis, age-based clinical presentations, and treatment options for ALCAPA.

Clinical cardiology, Jan 3, 2018

Limited data exists on readmission among patients with takotsubo cardiomyopathy [TC], a commonly ... more Limited data exists on readmission among patients with takotsubo cardiomyopathy [TC], a commonly reversible cause of heart failure. We sought to identify etiologies and predictors for readmission among TC patients. We queried the National Readmissions Database for 2013-2014 to identify patients with primary admission for TC using ICD-9CM code 429.83. Patients who were readmitted to the hospital within 1-month post-discharge were further evaluated to identify etiologies, predictors and the resultant economic burden of readmission. Additionally, we analyzed readmission for TC at 6-months. We studied 5,997 patients admitted with TC, of whom 1.2% experienced in-hospital mortality. The median age was 67 years with 91.5% of the studied patients being female. Among survivors, 10.3% of the patients were readmitted within 1-month Twenty-five percent of the initial 1-month readmissions occurred within 4-days, 50% within 10-days and 75% within 20-days from discharge. The commonest etiologies f...

Clinical cardiology, Jan 18, 2018

Elevation in cardiac troponins is common among septic patients. We sought to explore outcomes amo... more Elevation in cardiac troponins is common among septic patients. We sought to explore outcomes among those admitted with demand ischemia(DI), acute myocardial infarction(AMI) and neither DI nor AMI in sepsis. We analyzed data from the 2011-2014 National Inpatient Sample among patients admitted for sepsis. We compared outcomes among sepsis patients with i)DI versus AMI and ii)DI versus neither DI nor AMI using separate propensity matched cohorts. The primary end-point was in-hospital mortality. We studied 666,154 patients, mean age being 63.7 years, and 50.8% participants being female. Overall, 94.7% of the included patients had neither DI nor AMI, 4.4% had AMI and 0.83% had DI. Between 2011 and 2014, we observed an increasing trend for DI but decreasing trend for AMI in sepsis. Patients with DI experienced higher rates of atrial and ventricular arrhythmias, had longer length of stay and higher cost of stay when compared to patients with neither demand ischemia nor AMI. Despite higher...

Circulation. Heart failure, 2018

Acute myocardial infarction (AMI) occurs as a result of irreversible damage to cardiac myocytes s... more Acute myocardial infarction (AMI) occurs as a result of irreversible damage to cardiac myocytes secondary to lack of blood supply. Cardiogenic shock complicating AMI has significant associated morbidity and mortality, and data on postdischarge outcomes are limited. We derived the study cohort of patients with AMI and cardiogenic shock from the 2013 to 2014 Healthcare Cost and Utilization Project National Readmission Database. Incidence, predictors, and causes of 30-day readmissions were analyzed. From 43 212 index admissions for AMI with cardiogenic shock, 26 016 (60.2%) survived to discharge and 5277 (20.2% of survivors) patients were readmitted within 30 days. More than 50% of these readmissions occurred within first 10 days. Cardiac causes accounted for 42% of 30-day readmissions (heart failure 20.6%; acute coronary syndrome 11.6%). Among noncardiac causes, respiratory (11.4%), infectious (9.4%), medical or surgical care complications (6.3%), gastrointestinal/hepatobiliary (6.5%)...

Journal of cardiovascular electrophysiology, Jan 25, 2018

Catheter ablation is widely accepted intervention for atrial fibrillation (AF) refractory to anti... more Catheter ablation is widely accepted intervention for atrial fibrillation (AF) refractory to antiarrhythmic drugs (AAD), but limited data is available regarding contemporary trends in major complications and in hospital mortality due to the procedure. This study was aimed at exploring the temporal trends of in-hospital mortality, major complications and impact of hospital volume on frequency of AF ablation related outcomes. Nationwide inpatient sample (NIS) database was utilized to identify the AF patients treated with catheter ablation. In-hospital death and common complications including vascular access complications, cardiac perforation and/or tamponade, pneumothorax, stroke and transient ischemic attack, were identified using international Classification of disease (ICD-9-CM) codes. In-hospital mortality rate of 0.15% and overall complication rate of 5.46% were noted among AF ablation recipients (n = 50,969). Significant increase in complications during study period (relative in...

International journal of cardiology, Jan 15, 2017

In-hospital care may be constrained during the weekend due to lesser resources. Impact on outcome... more In-hospital care may be constrained during the weekend due to lesser resources. Impact on outcomes of weekend versus weekday care in congestive heart failure (HF) needs further study. Admissions with a primary diagnosis of HF using ICD-9CM codes were studied. 22,287 HF-admissions from Einstein Medical Center (2003-2013) and 2,248,482 HF-admissions from the 2002-2012 Nationwide Inpatient Sample (NIS) were analyzed separately. Primary outcomes were 30-day HF-readmission and in-hospital mortality. Logistic regression models were used to evaluate outcomes. Weekends experienced lower rates of admission and discharge. Mondays experienced the highest admission rate and Fridays experienced the highest discharge rate. Friday was independently associated with highest 30-day HF-readmission rates (Adjusted OR 1.12, CI 1.01-1.23; p=0.02) in addition to risk factors such as African-American race, hypertension, diabetes, hyperlipidemia, end-stage renal disease and coronary artery disease. Within t...

Journal of Thrombosis and Thrombolysis, 2017

other comorbidities. They also had significantly higher rate of in-hospital mortality (OR 1.66) a... more other comorbidities. They also had significantly higher rate of in-hospital mortality (OR 1.66) and hemorrhagic events (OR 1.47) prior to matching. Post-matching, there was no difference in hospital mortality (22.9 vs. 21.8%; p = 0.51) or hemorrhagic events (3.8 vs. 3.0%; p = 0.27) between CKD and No CKD groups. Patients with CKD had a longer length of stay, but no difference in proportion of patients receiving a blood transfusion and total hospitalization charges postmatching. Multivariate analysis showed that CKD did not predict mortality (OR 0.88, 0.75-1.02; p = 0.09) or hemorrhagic events (OR 0.89, 95% CI 0.76-1.04; 0.13). There was no increase in rate of hospital mortality or hemorrhagic events among CKD patients who underwent thrombolysis for PE.

Cleveland Clinic journal of medicine, 2017

A large mass in the right ventricle: Tumor or thrombus? A 69-year-old woman with hypertension, di... more A large mass in the right ventricle: Tumor or thrombus? A 69-year-old woman with hypertension, diabetes mellitus, and chronic kidney disease presented with a 1-month history of worsening episodic dyspnea, lower-extremity edema, and dizziness. Two months earlier, she had been diagnosed with poorly differentiated pelvic adnexal sarcoma associated with a mature teratoma of the left ovary, and she had undergone bilateral salpingo-oophorectomy, pelvic and para-aortic lymph node dissection, and omentectomy. Examination revealed tachypnea (23 breaths per minute) and bilateral pitting pedal edema. The neck veins were distended. There was no hepatomegaly. Results of laboratory testing were unremarkable.