Publications by authors named "Ritu Thamman"

20 Publications

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The Role and Impact of Social Media in Cardio-oncology During the COVID-19 Pandemic.

Curr Oncol Rep 2021 07 14;23(8):99. Epub 2021 Jul 14.

Cardio-Oncology Program, Division of Cardiovascular Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.

Purpose Of Review: To give an overview of the role of social media (SoMe) in cardio-oncology during the COVID-19 pandemic.

Recent Findings: SoMe has been critical in fostering education, outreach, awareness, collaboration, dissemination of information, and advocacy in cardio-oncology. This has become increasingly evident during the COVID-19 pandemic, during which SoMe has helped share best practices, community, and research focused on the impact of COVID-19 in cardiology and hematology/oncology, with cardio-oncology at the interface of these two subspecialty fields. A strength of SoMe is the ability to amplify a message in real-time, globally, with minimal investment of resources. This has been particularly beneficial for the emerging field of cardio-hematology/cardio-oncology, a field focused on the interplay of cancer and cardiovascular disease. SoMe field especially during the COVID-19 pandemic. We illustrate how social media has supported innovation (including telemedicine), amplification of healthcare workers' voice, and illumination of pre-existing and continued health disparities within the field of cardio-oncology during the pandemic.
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http://dx.doi.org/10.1007/s11912-021-01081-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8278372PMC
July 2021

Are we there yet? Menopausal hormone therapy for primary cardiovascular disease prevention.

Authors:
Ritu Thamman

Heart 2021 Jul 24;107(14):1106-1108. Epub 2021 May 24.

School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

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http://dx.doi.org/10.1136/heartjnl-2020-318390DOI Listing
July 2021

Women in Cardiology Twitter Network: An Analysis of a Global Professional Virtual Community From 2016 to 2019.

J Am Heart Assoc 2021 Feb 23;10(5):e019321. Epub 2021 Feb 23.

Division of Cardiology Department of Medicine University of California Los Angeles CA.

Background Social media is an effective channel for the advancement of women physicians; however, its use by women in cardiology has not been systematically studied. Our study seeks to characterize the current Women in Cardiology Twitter network. Methods and Results Six women-specific cardiology Twitter hashtags were analyzed: #ACCWIC (American College of Cardiology Women in Cardiology), #AHAWIC (American Heart Association Women in Cardiology), #ilooklikeacardiologist, #SCAIWIN (Society for Cardiovascular Angiography and Interventions Women in Innovations), #WomeninCardiology, and #WomeninEP (Women in Electrophysiology). Twitter data from 2016 to 2019 were obtained from Symplur Signals. Quantitative and descriptive content analyses were performed. The Women in Cardiology Twitter network generated 48 236 tweets, 266 180 903 impressions, and 12 485 users. Tweets increased by 706% (from 2083 to 16 780), impressions by 207% (from 26 755 476 to 82 080 472), and users by 440% (from 796 to 4300), including a 471% user increase internationally. The network generated 6530 (13%) original tweets and 43 103 (86%) amplification tweets. Most original and amplification tweets were authored by women (81% and 62%, respectively) and women physicians (76% and 52%, respectively), with an increase in original and amplification tweets authored by academic women physicians (98% and 109%, respectively) and trainees (390% and 249%, respectively) over time. Community building, professional development, and gender advocacy were the most common tweet contents over the study period. Community building was the most common tweet category for #ACCWIC, #AHAWIC, #ilooklikeacardiologist, #SCAIWIN, and #WomeninCardiology, whereas professional development was most common for #WomeninEP. Conclusions The Women in Cardiology Twitter network has grown immensely from 2016 to 2019, with women physicians as the driving contributors. This network has become an important channel for community building, professional development, and gender advocacy discussions in an effort to advance women in cardiology.
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http://dx.doi.org/10.1161/JAHA.120.019321DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8174265PMC
February 2021

Use of Twitter during COVID-19 pandemic: An opportunity for continuing medical education in cardiology.

Medicina (B Aires) 2020 ;80 Suppl 6:122-123

University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

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January 2021

Location of death among patients presenting with cardiovascular disease to the emergency department in the United states.

Int J Clin Pract 2021 Apr 6;75(4):e13798. Epub 2021 Feb 6.

Keele Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK.

Background: In-hospital deaths are an important outcome and little is known about deaths in the emergency department (ED). Among patients who died of cardiovascular diseases (CVD), we assessed causes of death, temporal trends and the relative distribution of deaths in the ED versus hospital.

Methods: Using the United States Nationwide Emergency Department Sample, we conducted a retrospective study of patients presenting to the ED with a primary diagnosis of CVD between 2006 and 2014. We used descriptive statistics to describe causes of deaths, temporal trends and location of death.

Results: During the study period, there were 27 144 508 visits to the ED with CVD diagnoses (~2% of all ED visits,). The most common CVD diagnoses were heart failure (n = 8 571 598), acute myocardial infarction (n = 4 827 518) and atrial fibrillation/flutter (n = 4 713 241). There were a total of 2.2 million deaths caused by the CVD, with the majority (57.6%) occurring in the ED. Cardiac arrest was the most common cause of in-hospital death (n = 1 225 095, 55.3%), followed by acute myocardial infarction (n = 279 310, 12.6%), heart failure (n = 217 367, 9.8%), intracranial hemorrhage (n = 168 009, 7.6%) and ischemic stroke (n = 151 615, 6.8%). The proportion of deaths in the ED for these causes were 91.9% cardiac arrest (n = 1 173 471), 3.6% acute myocardial infarction (n = 46 909), 1.0% heart failure (n = 12 599) and 1.1% intracranial hemorrhage (n = 13 579). There was a decrease in death for most CVDs over time.

Conclusions: Inpatient CVD admissions and their associated death may not be a robust measure of the national burden of CVD since ED death-which are common for some conditions-are not captured.
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http://dx.doi.org/10.1111/ijcp.13798DOI Listing
April 2021

Cardiac rehabilitation using telemedicine: the need for tele cardiac rehabilitation.

Rev Cardiovasc Med 2020 12;21(4):497-500

Division of Cardiology, Sarver Heart Center, University of Arizona, 85721, Tucson, United States.

Cardiac Rehabilitation programs have shown to improve outcomes. The COVID-19 pandemic has posed barriers to these programs. A virtual platform might be a good solution to these challenges. Tele Cardiac Rehabilitation and remote patient monitoring provide an excellent alternative practical solution.
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http://dx.doi.org/10.31083/j.rcm.2020.04.201DOI Listing
December 2020

Mitral annular disjunction: Wolf in sheep's clothing?

Echocardiography 2020 11;37(11):1710-1712

Mediclinic Al-Jowhara/Al-Ain hospitals, Al Ain, UAE.

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http://dx.doi.org/10.1111/echo.14898DOI Listing
November 2020

Nondietary Cardiovascular Health Metrics With Patient Experience and Loss of Productivity Among US Adults Without Cardiovascular Disease: The Medical Expenditure Panel Survey 2006 to 2015.

J Am Heart Assoc 2020 10 1;9(19):e016744. Epub 2020 Oct 1.

The Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD.

Background The American Heart Association 2020 Impact Goals aimed to promote population health through emphasis on cardiovascular health (CVH). We examined the association between nondietary CVH metrics and patient-reported outcomes among a nationally representative sample of US adults without cardiovascular disease. Methods and Results We included adults aged ≥18 years who participated in the Medical Expenditure Panel Survey between 2006 and 2015. CVH metrics were scored 1 point for each of the following: not smoking, being physically active, normal body mass index, no hypertension, no diabetes mellitus, and no dyslipidemia, or 0 points if otherwise. Diet was not assessed in Medical Expenditure Panel Survey. Patient-reported outcomes were obtained by telephone survey and included questions pertaining to patient experience and health-related quality of life. Regression models were used to compare patient-reported outcomes based on CVH, adjusting for sociodemographic factors and comorbidities. There were 177 421 Medical Expenditure Panel Survey participants (mean age, 45 [17] years) representing ~187 million US adults without cardiovascular disease. About 12% (~21 million US adults) had poor CVH. Compared with individuals with optimal CVH, those with poor CVH had higher odds of reporting poor patient-provider communication (odds ratio, 1.14; 95% CI, 1.05-1.24), poor healthcare satisfaction (odds ratio, 1.15; 95% CI, 1.08-1.22), poor perception of health (odds ratio, 5.89; 95% CI, 5.35-6.49), at least 2 disability days off work (odds ratio, 1.39; 95% CI, 1.30-1.48), and lower health-related quality of life scores. Conclusions Among US adults without cardiovascular disease, meeting a lower number of ideal CVH metrics is associated with poor patient-reported healthcare experience, poor perception of health, and lower health-related quality of life. Preventive measures aimed at optimizing ideal CVH metrics may improve patient-reported outcomes among this population.
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http://dx.doi.org/10.1161/JAHA.120.016744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792398PMC
October 2020

Global Longitudinal Strain Predicts Survival and Left Ventricular Function After Mitral Valve Surgery: A Meta-analysis.

Semin Thorac Cardiovasc Surg 2021 Summer;33(2):337-342. Epub 2020 Sep 21.

National Institute of Cardiac Surgery, Montevideo, Uruguay; Centro Cardiovascular Universitario, Montevideo, Uruguay. Electronic address:

The timing for surgical treatment in patients with primary organic severe mitral valve regurgitation and preserved left ventricular ejection fraction (LVEF) systolic is a challenge since it depends upon LV end systolic dimension and LVEF which may be late markers of LV dysfunction. Echocardiography is the most important tool in the diagnosis of mechanisms, etiology, severity, and hemodynamic consequences of mitral regurgitation. The global longitudinal strain (GLS), a new and sensitive method for the detection of LV dysfunction, might be a useful method for the evaluation of preclinical systolic dysfunction. Nevertheless, its role for predicting postoperative outcomes is not well established. A meta-analysis was performed to address the role of GLS in patients with severe mitral regurgitation and preserved LVEF who underwent mitral surgery. We included studies that compared outcomes according to preoperative GLS in regard to survival and postoperative LV function. We included 2358 patients enrolled in 8 studies. Patients with reduced GLS% had worse long term survival after mitral valve surgery (hazard ratio = 1.13, 95% confidence interval [CI]: 1.02-1.26). Patients with preoperatively reduced GLS% had lower LVEF after surgery (mean difference [MD] = -5.06%, 95% CI: -8.97-1.16%) and additionally, patients who presented postoperative LVEF dysfunction had worse preoperative GLS (MD = 4.33, 95% CI: 3.89-4.76). In patients with primary mitral regurgitation, preoperative GLS is a predictor for long term survival and postoperative LVEF. It is a useful parameter to be included when considering early surgery in patients with severe mitral regurgitation and normal LVEF.
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http://dx.doi.org/10.1053/j.semtcvs.2020.09.024DOI Listing
July 2021

ASE Statement on Point-of-Care Ultrasound during the 2019 Novel Coronavirus Pandemic.

J Am Soc Echocardiogr 2020 Jun 15;33(6):670-673. Epub 2020 Apr 15.

University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

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http://dx.doi.org/10.1016/j.echo.2020.04.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7158805PMC
June 2020

The Value of Remote Monitoring for the COVID-19 Pandemic.

Telemed J E Health 2020 09 7;26(9):1110-1112. Epub 2020 May 7.

Department of Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA.

COVID-19 has created the need for population-level screening, and telemedicine is ideally positioned to enable this. As telemedicine has evolved over the last decade, remote monitoring emerged as a new and powerful modality. COVID-19 requires scaled interactions with populations in near real-time. Remote monitoring has specific operational and design features that are well suited for the COVID-19, especially the asynchronous communication. Monitoring can be used in particular to gather pandemic data and obtain real-time clinical feedback. As telemedicine continues to grow and evolve, remote monitoring is emerging as a valuable tool for payers, providers, and public health officials alike.
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http://dx.doi.org/10.1089/tmj.2020.0134DOI Listing
September 2020

Twitter-based learning for continuing medical education?

Eur Heart J 2020 12;41(46):4376-4379

Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA.

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http://dx.doi.org/10.1093/eurheartj/ehaa346DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197537PMC
December 2020

Social Media as a Strategic Opportunity.

J Am Soc Echocardiogr 2019 09;32(9):A19

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http://dx.doi.org/10.1016/j.echo.2019.07.013DOI Listing
September 2019

Readmission and processes of care across weekend and weekday hospitalisation for acute myocardial infarction, heart failure or stroke: an observational study of the National Readmission Database.

BMJ Open 2019 08 22;9(8):e029667. Epub 2019 Aug 22.

Keele Cardiovascular Research Group, Institute of Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK

Objectives: Variation in hospital resource allocations across weekdays and weekends have led to studies of the 'weekend effect' for ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), heart failure (HF) and stroke. However, few studies have explored the 'weekend effect' on unplanned readmission. We aimed to investigate 30-day unplanned readmissions and processes of care across weekend and weekday hospitalisations for STEMI, NSTEMI, HF and stroke.

Design: We grouped hospitalisations for STEMI, NSTEMI, HF or stroke into weekday or weekend admissions. Multivariable adjusted ORs for binary outcomes across weekend versus weekday (reference) groups were estimated using logistic regression.

Setting: We included all non-elective hospitalisations for STEMI, NSTEMI, HF or stroke, which were recorded in the US Nationwide Readmissions Database between 2010 and 2014.

Participants: The analysis sample included 659 906 hospitalisations for STEMI, 1 420 600 hospitalisations for NSTEMI, 3 027 699 hospitalisations for HF, and 2 574 168 hospitalisations for stroke.

Main Outcome Measures: The primary outcome was unplanned 30-day readmission. As secondary outcomes, we considered length of stay and the following processes of care: coronary angiography, primary percutaneous coronary intervention, coronary artery bypass graft, thrombolysis, brain scan/imaging, thrombectomy, echocardiography and cardiac resynchronisation therapy/implantable cardioverter-defibrillator.

Results: Unplanned 30-day readmission rates were 11.0%, 15.1%, 23.0% and 10.9% for STEMI, NSTEMI, HF and stroke, respectively. Weekend hospitalisations for HF were associated with a statistically significant but modest increase in 30-day readmissions (OR of 1.045, 95% CI 1.033 to 1.058). Weekend hospitalisation for STEMI, NSTEMI or stroke was not associated with increased risk of 30-day readmission.

Conclusion: There was no clinically meaningful evidence against the supposition that weekend and weekday hospitalisations have the same 30-day unplanned readmissions. Thirty-day readmission rates were high, especially for HF, which has implications for service provision. Strategies to reduce readmission rates should be explored, regardless of day of hospitalisation.
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http://dx.doi.org/10.1136/bmjopen-2019-029667DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707682PMC
August 2019

Mitral annular disjunction: A systematic review of the literature.

Echocardiography 2019 08 5;36(8):1549-1558. Epub 2019 Aug 5.

Royal Stoke University Hospital, Stoke-on-Trent, UK.

Background: Mitral annular disjunction (MAD) is a structural abnormality where there is a separation between the mitral valve annulus and the left atrial wall which is not well understood.

Methods: We conducted a systematic review to evaluate the prevalence of MAD, factors associated with MAD and clinical outcomes among patients with MAD.

Results: A total of 19 studies were included in this review, and the number of noncase report studies had between 23 and 1439 patients. The pooled rate of MAD in studies of myxomatous mitral valve patients was 66/130 (50.8%, 3 studies), and among patients with mitral valve prolapse was 95/291 (32.6%, 3 studies). One study suggests that 78% of patients with MAD had mitral valve prolapse, and another suggested it was strongly associated with myxomatous mitral valve disease (HR 5.04 95% CI 1.66-15.31). In terms of clinical significance, it has been reported that MAD with disjunction > 8.5 mm was associated with nonsustained ventricular tachycardia (OR 10 95% CI 1.28-78.1). There is also evidence that gadolinium enhancement in papillary muscle (OR 4.09 95% CI 1.28-13.05) and longitudinal MAD distance in posterolateral wall (OR 1.16 95% CI 1.02-1.33) was predictive of ventricular arrhythmia and late gadolinium enhancement in anterolateral papillary muscle was strongly associated with serious arrhythmic event (OR 7.35 95% CI 1.15-47.02).

Conclusions: Mitral annular disjunction appears to be common in myxomatous mitral valve disease and mitral valve prolapse which can be detected on cardiac imaging and may be important because of its association with ventricular arrhythmias and sudden cardiac death.
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http://dx.doi.org/10.1111/echo.14437DOI Listing
August 2019

Acute Myocardial Infarction in Severe Mental Illness: Prevalence, Clinical Outcomes, and Process of Care in U.S. Hospitalizations.

Can J Cardiol 2019 07 2;35(7):821-830. Epub 2019 May 2.

Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom. Electronic address:

Background: Severe mental illness (SMI) is associated with increased cardiovascular mortality. We sought to examine the prevalence, clinical outcomes, and management strategy of patients with SMI presenting with acute myocardial infarction (AMI).

Methods: All AMI hospitalizations from the National Inpatient Sample were included, stratified by mental health status into 5 groups: no SMI, schizophrenia, other non-organic psychoses (ONOP), bipolar disorder, and major depression. Regression analyses were performed to assess the association (adjusted odds ratios [ORs], P ≤ 0.001 for all outcomes) between SMI subtypes and clinical outcomes.

Results: Of 6,968,777 AMI hospitalizations between 2004 and 2014, 439,544 patients (6.5%) had an SMI diagnosis. Although patients with schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared with those without SMI, only schizophrenic patients were at increased odds of mortality (OR, 1.10; 95% confidence interval [CI], 1.04-1.16), whereas ONOP was the only group at increased odds of stroke (OR, 1.53; 95% CI, 1.42-1.65) after multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared with those without SMI (OR, 1.11; 95% CI, 1.04-1.17). All those with SMI subtypes were less likely to receive coronary angiography and percutaneous coronary intervention, with the schizophrenia group being at least odds of either procedure (OR, 0.46; 95% CI, 0.45-0.48 and OR, 0.57; 95% CI, 0.55-0.59, respectively).

Conclusion: Schizophrenia and ONOP are the only SMI subtypes associated with adverse clinical outcomes after AMI. However, all patients with SMI were less likely to receive invasive management for AMI, with female gender and schizophrenia diagnosis being the strongest predictors of conservative management. A multidisciplinary approach between psychiatrists and cardiologists could improve the outcomes of this high-risk population.
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http://dx.doi.org/10.1016/j.cjca.2019.04.021DOI Listing
July 2019

Surviving cardiac arrest from mitral annular disjunction: A case report.

Echocardiography 2019 07 9;36(7):1405-1408. Epub 2019 Jul 9.

Royal Stoke University Hospital, Stoke-on-Trent, UK.

A 38-year-old man with no previous medical history presented to hospital after having an out-of-hospital cardiac arrest. He was found to have a ventricular fibrillation and was successfully resuscitated after receiving cardiopulmonary resuscitation and three shocks. Extensive investigations were performed which included an electrocardiogram that showed no significant abnormality, coronary angiogram which showed unobstructed arteries, and a flecainide challenge test which was negative for Brugada syndrome. A resting echocardiogram showed a myxomatous mitral valve with mild bi-leaflet bowing, trivial mitral regurgitation, normal left ventricular systolic function, and no other structural abnormalities. A cardiac magnetic resonance imaging showed no significant late gadolinium enhancement to suggest infarct or myocardial scarring. He was subsequently diagnosed with idiopathic ventricular fibrillation and treated with a subcutaneous internal cardioverter-defibrillator for secondary prevention. A follow-up echocardiogram was performed which revealed the presence of mitral annular disjunction which has been recently shown to be associated with significant life-threatening arrhythmias and sudden cardiac death. This case highlights the importance of improving awareness of mitral annular disjunction which is not often considered as a cause for adverse patient outcomes.
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http://dx.doi.org/10.1111/echo.14411DOI Listing
July 2019

Nonspecific Chest Pain and 30-Day Unplanned Readmissions in the United States (From the Nationwide Readmission Database).

Am J Cardiol 2019 04 25;123(8):1343-1350. Epub 2019 Jan 25.

Keele Cardiovascular Research Group, Institute for Science & Technology in Medicine, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom.

Chest pain is a common reason for admission to hospital and little is known regarding 30-day unplanned readmissions after an admission with a primary discharge diagnosis of nonspecific chest pain. We analyzed patients with a primary diagnosis of nonspecific chest pain in the Nationwide Readmission Database who were admitted in 2010 to 2014. Rates, causes, and predictors of 30-day unplanned readmissions were determined. A total of 1,842,270 patients had a diagnosis of nonspecific chest pain. The 30-day unplanned readmission rate was 8.6%. From 2010 to 2014, there was an increase in 30-day unplanned readmissions from 8.1% to 9.5%. The majority of 30-day unplanned readmissions were for noncardiac reasons (73.4%). The 3 most prevalent noncardiac causes for readmissions were neuropsychiatric (10.9%), gastrointestinal (10.5%), and infections (9.9%), while the 3 most prevalent cardiac causes were coronary artery disease including angina (8.4%), arrhythmias (6.6%), and heart failure 5.5%. The strongest predictors of readmission were alcohol misuse ([OR] odds ratio 1.74 95% [CI] confidence interval 1.66-1.81), renal failure (OR 1.82 95%CI 1.76-1.87), cancer (OR 2.40 95%CI 2.27-2.53), discharge to a nursing home (OR 2.26 95%CI 2.18-2.34), and discharge against medical advice (OR 1.94 95%CI 1.86-2.02). The rate of 30-day unplanned readmission was 6.1% among those who received any test compared to 9.3% in those who did not receive any test. Rates of early unplanned readmissions occur following 1 in 12 admissions for nonspecific chest pain with noncardiac causes being the most common reason. Patients who receive a cardiovascular investigation appear to have fewer unplanned readmissions.
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http://dx.doi.org/10.1016/j.amjcard.2019.01.012DOI Listing
April 2019