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Fadi Matta - One of the best experts on this subject based on the ideXlab platform.
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vena cava filters in unstable elderly patients with acute pulmonary embolism
The American Journal of Medicine, 2014Co-Authors: Paul D Stein, Fadi MattaAbstract:Abstract Background Inferior vena cava filters are associated with a reduced in-hospital all-cause case Fatality rate of unstable patients with acute pulmonary embolism. Whether vena cava filters are associated with a reduced case Fatality rate in adults of all ages with unstable pulmonary embolism, particularly the elderly, has not been determined. Methods Unstable patients with pulmonary embolism (in shock or ventilator dependent) 1999-2008 were identified from the Nationwide Inpatient Sample. Results Among 21,095 unstable patients with pulmonary embolism who received thrombolytic therapy, in-hospital all-cause case Fatality rate was lower in every age group who received a vena cava filter in addition to thrombolytic therapy ( P = .0012 to P Conclusion Vena cava filters are associated with a reduced in-hospital all-cause case Fatality rate in unstable adults with pulmonary embolism, irrespective of age.
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case Fatality rate in pulmonary embolism according to age and stability
Clinical and Applied Thrombosis-Hemostasis, 2013Co-Authors: Paul D Stein, Fadi Matta, Ahmed AlrifaiAbstract:Data from the Nationwide Inpatient Sample, 1999 to 2008, were used to assess the effects of advancing age on in-hospital case Fatality rate of patients with acute pulmonary embolism (PE) stratified according to stability. Among adults, all-cause case Fatality was affected more by advancing age (1.8 deaths/10 years of age) than death attributable to PE (0.7 deaths/10 years of age). All-cause case Fatality rate was affected more by advancing age in unstable adults than in stable adults (5.3 deaths/10 years of age vs 1.7 deaths/10 years of age). Case Fatality rate attributable to PE was also affected more by advancing age in unstable adults than in stable adults (4.1 deaths/10 years of age vs 0.6 deaths/10 years of age). Limited data suggest that the case Fatality rate of children was comparable to that of the elderly individuals. These results may influence the prognostic value of risk assessment tools for patients with PE.
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trends in case Fatality rate in pulmonary embolism according to stability and treatment
Thrombosis Research, 2012Co-Authors: Ahmed Alrifai, Paul D Stein, Fadi Matta, Akhil RahmanAbstract:Abstract Purpose To determine categories of patients with pulmonary embolism in whom therapy has been reducing or failing to reduce case Fatality rate. Methods Patients with acute pulmonary embolism were assessed from the Nationwide Inpatient Sample, 1999–2008. Trends of case Fatality rates were assessed according to whether patients were stable or unstable and according to treatment within these groups. Results In-hospital all-cause case Fatality rate among all patients with pulmonary embolism decreased from 16,150 of 136,740 (11.8%) in 1999 to 23,040 of 311,620 (7.4%) in 2008. All-cause case Fatality rate decreased 45.0% in stable patients from 14,780 of 133,230 (11.1%) in 1999 to 18,170 of 297,770 (6.1%) in 2008. In unstable patients it decreased only 9.7% from 1,370 of 3,510 (39.0%) in 1999 to 4,870 of 13,850 (35.2%) in 2008. Only 72,230 of 2,110,320 (3.4%) patients with acute pulmonary embolism were unstable. Among unstable patients who received thrombolytic therapy, all-cause mortality did not change from 1999–2008. Among unstable patients treated only with anticoagulants and/or a vena cava filter, all-cause case Fatality rate decreased 23.6% from 1,110 of 2,080 (53.4%) in 1999 to 4,290 of 10,530 (40.7%) in 2008, but remained higher than in those treated with thrombolytic agents. Case Fatality rates attributable to pulmonary embolism were lower than all-cause case Fatality rate, but showed similar trends. Conclusions The decreasing all-cause case Fatality rate and case Fatality rate attributable to pulmonary embolism from 1999–2008 resulted primarily from a decreasing case Fatality rate in stable patients. There was no reduction of case Fatality rate in unstable patients who received thrombolytic therapy, although case Fatality rate was relatively low with thrombolytic therapy plus a vena cava filter. Most unstable patients, however, failed to receive this combination of therapy.
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thrombolytic therapy in unstable patients with acute pulmonary embolism saves lives but underused
The American Journal of Medicine, 2012Co-Authors: Paul D Stein, Fadi MattaAbstract:Abstract Background Data are sparse and inconsistent regarding whether thrombolytic therapy reduces case Fatality rate in unstable patients with acute pulmonary embolism. We tested the hypothesis that thrombolytic therapy reduces case Fatality rate in such patients. Methods In-hospital all-cause case Fatality rate according to treatment was determined in unstable patients with pulmonary embolism who were discharged from short-stay hospitals throughout the United States from 1999 to 2008 by using data from the Nationwide Inpatient Sample. Unstable patients were in shock or ventilator dependent. Results Among unstable patients with pulmonary embolism, 21,390 of 72,230 (30%) received thrombolytic therapy. In-hospital all-cause case Fatality rate in unstable patients with thrombolytic therapy was 3105 of 21,390 (15%) versus 23,820 of 50,840 (47%) without thrombolytic therapy ( P 0001). All-cause case Fatality rate in unstable patients with thrombolytic therapy plus a vena cava filter was 505 of 6630 (7.6%) versus 4260 of 12,850 (33%) with a filter alone ( P 0001). Case Fatality rate attributable to pulmonary embolism in unstable patients was 820 of 9810 (8.4%) with thrombolytic therapy versus 1080 of 2600 (42%) with no thrombolytic therapy ( P 0001). Case Fatality rate attributable to pulmonary embolism in unstable patients with thrombolytic therapy plus vena cava filter was 70 of 2590 (2.7%) versus 160 of 600 (27%) with a filter alone ( P 0001). Conclusion In-hospital all-cause case Fatality rate and case Fatality rate attributable to pulmonary embolism in unstable patients was lower in those who received thrombolytic therapy. Thrombolytic therapy resulted in a lower case Fatality rate than using vena cava filters alone, and the combination resulted in an even lower case Fatality rate. Thrombolytic therapy in combination with a vena cava filter in unstable patients with acute pulmonary embolism seems indicated.
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case Fatality rate with pulmonary embolectomy for acute pulmonary embolism
The American Journal of Medicine, 2012Co-Authors: Paul D Stein, Fadi MattaAbstract:Abstract Background There are insufficient data to assess the potential role of pulmonary embolectomy in patients with acute pulmonary embolism. Methods In-hospital all-cause case Fatality rate with pulmonary embolectomy was assessed from the Nationwide Inpatient Sample from 1999 through 2008. Results Among unstable patients (in shock or ventilator-dependent), case Fatality rate with embolectomy was 380 of 950 (40%). Among stable patients, case Fatality rate was lower: 690 of 2820 (24%) ( P P =.01). Case Fatality rates were lower in patients with a primary diagnosis of pulmonary embolism and even lower in patients with a primary diagnosis who had none of the comorbid conditions listed in the Charlson Index. Within each stratified group, patients with vena cava filters had a lower case Fatality rate. Conclusions Case Fatality rate in unstable patients who underwent pulmonary embolectomy remained at 39%-40% from 1999-2003 to 2004-2008, and in stable patients it decreased only from 27% to 23%. Case Fatality rates were lower in those with fewer comorbid conditions and in those who received a vena cava filter. Our data reflect average outcome in the US. It may be that experienced surgeons and an aggressive multidisciplinary team could obtain a lower case Fatality rate.
Paul D Stein - One of the best experts on this subject based on the ideXlab platform.
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vena cava filters in unstable elderly patients with acute pulmonary embolism
The American Journal of Medicine, 2014Co-Authors: Paul D Stein, Fadi MattaAbstract:Abstract Background Inferior vena cava filters are associated with a reduced in-hospital all-cause case Fatality rate of unstable patients with acute pulmonary embolism. Whether vena cava filters are associated with a reduced case Fatality rate in adults of all ages with unstable pulmonary embolism, particularly the elderly, has not been determined. Methods Unstable patients with pulmonary embolism (in shock or ventilator dependent) 1999-2008 were identified from the Nationwide Inpatient Sample. Results Among 21,095 unstable patients with pulmonary embolism who received thrombolytic therapy, in-hospital all-cause case Fatality rate was lower in every age group who received a vena cava filter in addition to thrombolytic therapy ( P = .0012 to P Conclusion Vena cava filters are associated with a reduced in-hospital all-cause case Fatality rate in unstable adults with pulmonary embolism, irrespective of age.
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case Fatality rate in pulmonary embolism according to age and stability
Clinical and Applied Thrombosis-Hemostasis, 2013Co-Authors: Paul D Stein, Fadi Matta, Ahmed AlrifaiAbstract:Data from the Nationwide Inpatient Sample, 1999 to 2008, were used to assess the effects of advancing age on in-hospital case Fatality rate of patients with acute pulmonary embolism (PE) stratified according to stability. Among adults, all-cause case Fatality was affected more by advancing age (1.8 deaths/10 years of age) than death attributable to PE (0.7 deaths/10 years of age). All-cause case Fatality rate was affected more by advancing age in unstable adults than in stable adults (5.3 deaths/10 years of age vs 1.7 deaths/10 years of age). Case Fatality rate attributable to PE was also affected more by advancing age in unstable adults than in stable adults (4.1 deaths/10 years of age vs 0.6 deaths/10 years of age). Limited data suggest that the case Fatality rate of children was comparable to that of the elderly individuals. These results may influence the prognostic value of risk assessment tools for patients with PE.
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trends in case Fatality rate in pulmonary embolism according to stability and treatment
Thrombosis Research, 2012Co-Authors: Ahmed Alrifai, Paul D Stein, Fadi Matta, Akhil RahmanAbstract:Abstract Purpose To determine categories of patients with pulmonary embolism in whom therapy has been reducing or failing to reduce case Fatality rate. Methods Patients with acute pulmonary embolism were assessed from the Nationwide Inpatient Sample, 1999–2008. Trends of case Fatality rates were assessed according to whether patients were stable or unstable and according to treatment within these groups. Results In-hospital all-cause case Fatality rate among all patients with pulmonary embolism decreased from 16,150 of 136,740 (11.8%) in 1999 to 23,040 of 311,620 (7.4%) in 2008. All-cause case Fatality rate decreased 45.0% in stable patients from 14,780 of 133,230 (11.1%) in 1999 to 18,170 of 297,770 (6.1%) in 2008. In unstable patients it decreased only 9.7% from 1,370 of 3,510 (39.0%) in 1999 to 4,870 of 13,850 (35.2%) in 2008. Only 72,230 of 2,110,320 (3.4%) patients with acute pulmonary embolism were unstable. Among unstable patients who received thrombolytic therapy, all-cause mortality did not change from 1999–2008. Among unstable patients treated only with anticoagulants and/or a vena cava filter, all-cause case Fatality rate decreased 23.6% from 1,110 of 2,080 (53.4%) in 1999 to 4,290 of 10,530 (40.7%) in 2008, but remained higher than in those treated with thrombolytic agents. Case Fatality rates attributable to pulmonary embolism were lower than all-cause case Fatality rate, but showed similar trends. Conclusions The decreasing all-cause case Fatality rate and case Fatality rate attributable to pulmonary embolism from 1999–2008 resulted primarily from a decreasing case Fatality rate in stable patients. There was no reduction of case Fatality rate in unstable patients who received thrombolytic therapy, although case Fatality rate was relatively low with thrombolytic therapy plus a vena cava filter. Most unstable patients, however, failed to receive this combination of therapy.
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thrombolytic therapy in unstable patients with acute pulmonary embolism saves lives but underused
The American Journal of Medicine, 2012Co-Authors: Paul D Stein, Fadi MattaAbstract:Abstract Background Data are sparse and inconsistent regarding whether thrombolytic therapy reduces case Fatality rate in unstable patients with acute pulmonary embolism. We tested the hypothesis that thrombolytic therapy reduces case Fatality rate in such patients. Methods In-hospital all-cause case Fatality rate according to treatment was determined in unstable patients with pulmonary embolism who were discharged from short-stay hospitals throughout the United States from 1999 to 2008 by using data from the Nationwide Inpatient Sample. Unstable patients were in shock or ventilator dependent. Results Among unstable patients with pulmonary embolism, 21,390 of 72,230 (30%) received thrombolytic therapy. In-hospital all-cause case Fatality rate in unstable patients with thrombolytic therapy was 3105 of 21,390 (15%) versus 23,820 of 50,840 (47%) without thrombolytic therapy ( P 0001). All-cause case Fatality rate in unstable patients with thrombolytic therapy plus a vena cava filter was 505 of 6630 (7.6%) versus 4260 of 12,850 (33%) with a filter alone ( P 0001). Case Fatality rate attributable to pulmonary embolism in unstable patients was 820 of 9810 (8.4%) with thrombolytic therapy versus 1080 of 2600 (42%) with no thrombolytic therapy ( P 0001). Case Fatality rate attributable to pulmonary embolism in unstable patients with thrombolytic therapy plus vena cava filter was 70 of 2590 (2.7%) versus 160 of 600 (27%) with a filter alone ( P 0001). Conclusion In-hospital all-cause case Fatality rate and case Fatality rate attributable to pulmonary embolism in unstable patients was lower in those who received thrombolytic therapy. Thrombolytic therapy resulted in a lower case Fatality rate than using vena cava filters alone, and the combination resulted in an even lower case Fatality rate. Thrombolytic therapy in combination with a vena cava filter in unstable patients with acute pulmonary embolism seems indicated.
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case Fatality rate with pulmonary embolectomy for acute pulmonary embolism
The American Journal of Medicine, 2012Co-Authors: Paul D Stein, Fadi MattaAbstract:Abstract Background There are insufficient data to assess the potential role of pulmonary embolectomy in patients with acute pulmonary embolism. Methods In-hospital all-cause case Fatality rate with pulmonary embolectomy was assessed from the Nationwide Inpatient Sample from 1999 through 2008. Results Among unstable patients (in shock or ventilator-dependent), case Fatality rate with embolectomy was 380 of 950 (40%). Among stable patients, case Fatality rate was lower: 690 of 2820 (24%) ( P P =.01). Case Fatality rates were lower in patients with a primary diagnosis of pulmonary embolism and even lower in patients with a primary diagnosis who had none of the comorbid conditions listed in the Charlson Index. Within each stratified group, patients with vena cava filters had a lower case Fatality rate. Conclusions Case Fatality rate in unstable patients who underwent pulmonary embolectomy remained at 39%-40% from 1999-2003 to 2004-2008, and in stable patients it decreased only from 27% to 23%. Case Fatality rates were lower in those with fewer comorbid conditions and in those who received a vena cava filter. Our data reflect average outcome in the US. It may be that experienced surgeons and an aggressive multidisciplinary team could obtain a lower case Fatality rate.
Marc A. Rodger - One of the best experts on this subject based on the ideXlab platform.
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Systematic Review: Case-Fatality Rates of Recurrent Venous Thromboembolism and Major Bleeding Events Among Patients Treated for Venous Thromboembolism
Annals of Internal Medicine, 2010Co-Authors: Marc Carrier, Philip S. Wells, Marc A. RodgerAbstract:BACKGROUND: Case-Fatality rates are important for assessing the risks and benefits of anticoagulation in patients with venous thromboembolism (VTE). PURPOSE: To summarize case-Fatality rates of recurrent VTE and major bleeding events during anticoagulation and recurrent VTE after anticoagulation. DATA SOURCES: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and all evidence-based medicine reviews in the Ovid interface through the second quarter of 2008. STUDY SELECTION: 69 articles (13 prospective cohort studies and 56 randomized, controlled trials) that reported on patients with symptomatic VTE who received anticoagulation therapy for at least 3 months and on the rate of fatal recurrent VTE and fatal major bleeding. DATA EXTRACTION: Two reviewers independently extracted data onto standardized forms. DATA SYNTHESIS: During the initial 3 months of anticoagulation, the rate of recurrent fatal VTE was 0.4% (95% CI, 0.3% to 0.6%), with a case-Fatality rate of 11.3% (CI, 8.0% to 15.2%). The rate of fatal major bleeding events was 0.2% (CI, 0.1% to 0.3%), with a case-Fatality rate of 11.3% (CI, 7.5% to 15.9%). After anticoagulation, the rate of fatal recurrent VTE was 0.3 per 100 patient-years (CI, 0.1% to 0.4%), with a case-Fatality rate of 3.6% (CI, 1.9% to 5.7%). LIMITATIONS: Estimates come from heterogeneous trial and cohort populations and are not derived from patient-level longitudinal data. Differences in case-Fatality rates during and after anticoagulation may be attributable to unmeasured patient characteristics. CONCLUSION: The case-Fatality rates of recurrent VTE and major bleeding events are similar during the initial period of VTE treatment. The case-Fatality rate of recurrent VTE decreases after completion of the initial period of anticoagulation. When combined with absolute rates of recurrent VTE and major bleeding events, case-Fatality rates provide clinicians with a surrogate measure of mortality to balance the risks and benefits of anticoagulant therapy in patients with VTE. PRIMARY FUNDING SOURCE: Canadian Institute for Health Research and Heart and Stroke Foundation of Ontario.
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Case Fatality Rates of Recurrent Venous Thromboembolism during and Following Anticoagulation Therapy
Blood, 2008Co-Authors: Marc Carrier, Philip Wells, Marc A. RodgerAbstract:Background: The optimal duration of anticoagulation treatment in patients with unprovoked VTE is unknown. In order to counsel VTE patients on the risks and benefits of discontinuing anticoagulants, clinicians need to balance the long-term risk of recurrent VTE with major bleeding on anticoagulants. For all VTE patients on oral anticoagulant, the case-Fatality rate of major bleeding was previously reported to be 13.4% (95% confidence intervals (CI): 9.4% to 17.4%). A major knowledge gap exists regarding the case-Fatality rate of recurrent pulmonary embolism (PE) during and following anticoagulation therapy for VTE. Purpose: To summarize the case Fatality rate of recurrent VTE during and following anticoagulation therapy. Data Source: A systematic literature search strategy was conducted using MEDLINE, EMBASE, the Cochrane Register of Controlled Trials and all EBM Reviews. Study Outcome: We selected 62 studies that reported the rates of fatal PE in patients with recurrent VTE. Fatal PE was defined as confirmed autopsy report; death preceding with confirmed deep vein thrombosis (DVT) or non-fatal PE; sudden death not explained by a condition other than PE. Measurements: Pooled case Fatality rates were generated. Ninety-five percent CI were calculated for each case Fatality rate using averaged, inverse variance-weighted estimates from each study. Data Synthesis: 30,885 VTE patients were included (17,650 DVT, 8801 PE and 4434 DVT or PE Limitations: Unable to determine the case Fatality rate by etiology of VTE (i.e. provoked, unprovoked). Conclusion: Case Fatality rates for recurrent VTE are elevated during and following anticoagulation treatment for VTE but appear lower than the case-Fatality rate for major bleeding with oral anticoagulants. This information must be considered by clinicians when counseling patients on whether to continue or discontinue anticoagulant therapy following VTE. Not only must absolute recurrent VTE and major bleeding rates be compared between groups that continue and discontinue anticoagulants but the relative consequences (i.e. case Fatality rates) must be also considered with more weight placed on major bleeding episodes.
Richard A. Neher - One of the best experts on this subject based on the ideXlab platform.
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2019 novel coronavirus 2019 ncov estimating the case Fatality rate a word of caution
Swiss Medical Weekly, 2020Co-Authors: Manuel Battegay, Richard Kuehl, Sarah Tschudinsutter, Hans H Hirsch, Andreas F. Widmer, Richard A. NeherAbstract:It is tempting to estimate the case Fatality rate by dividing the number of known deaths by the number of confirmed cases. The resulting number, however, does not represent the true case Fatality rate and might be off by orders of magnitude.
Merete Storgaard - One of the best experts on this subject based on the ideXlab platform.
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influence of referral pathway on ebola virus disease case Fatality rate and effect of survival selection bias
Emerging Infectious Diseases, 2017Co-Authors: Frauke Rudolf, Mads Damkjaer, Suzanne Lunding, Kenn Dornonville De La Cour, Alyssa Young, Tim Brooks, Tom Sesay, Alex P Salam, Sharmistha Mishra, Merete StorgaardAbstract:Case-Fatality rates in Ebola treatment centers (ETCs) varied widely during the Ebola virus disease (EVD) outbreak in West Africa. We assessed the influence of referral pathway on ETC case-Fatality rates with a retrospective cohort of 126 patients treated at the Mathaska ETC in Port Loko, Sierra Leone. The patients consisted of persons who had confirmed EVD when transferred to the ETC or who had been diagnosed onsite. The case-Fatality rate for transferred patients was 46% versus 67% for patients diagnosed onsite (p = 0.02). The difference was mediated by Ebola viral load at diagnosis, suggesting a survival selection bias. Comparisons of case-Fatality rates across ETCs and clinical management strategies should account for potential survival selection bias.