Searched for: person:gdr227
in-biosketch:true
The Reply [Letter]
Smilowitz, Nathaniel R; Rubinfeld, Gregory D
PMID: 37230599
ISSN: 1555-7162
CID: 5508602
Acute Myocardial Infarction Following Hospitalization for Gastrointestinal Bleeding: Incidence, Predictors, Management, and Outcomes: Acute Myocardial Infarction After Gastrointestinal Bleeding
Rubinfeld, Gregory D; Berger, Jeffrey S; Smilowitz, Nathaniel R
BACKGROUND:Clinical characteristics of patients with acute myocardial infarction after gastrointestinal bleeding are poorly characterized. We sought to evaluate the incidence, management and outcomes of myocardial infarction following hospitalization for gastrointestinal bleeding. METHODS:Patients admitted with a diagnosis of gastrointestinal bleeding with and without subsequent hospital readmissions for acute myocardial infarction within 90 days were identified in the 2014 United States Nationwide Readmission Database. Patients with myocardial infarction with and without a recent prior gastrointestinal bleed were compared to determine differences in management and in-hospital outcomes. Logistic regression models were used to estimate odds of invasive management and all-cause in-hospital mortality after covariate adjustment. RESULTS:A total of 644,622 patients with gastrointestinal bleeding were identified, of which 7,523 (1.2%) were readmitted for myocardial infarction within 90 days. Compared to myocardial infarction patients without recent gastrointestinal bleeding, patients with myocardial infarction within 90 days after gastrointestinal bleeding were older, more likely to be women, have kidney disease, present with non-ST segment elevation MI, and were less likely to undergo invasive management of AMI (28% vs 63%, P<0.01). Prior gastrointestinal bleeding was associated with higher all-cause in-hospital myocardial infarction mortality (22% vs 9%, P<0.01). CONCLUSION/CONCLUSIONS:In the first 3 months after hospitalization for gastrointestinal bleeding, 1 of every 83 patients was readmitted with acute myocardial infarction. Patients with myocardial infarction after gastrointestinal bleeding were less likely to undergo invasive management and coronary revascularization and had higher mortality than those without recent bleeding.
PMID: 35469734
ISSN: 1555-7162
CID: 5205532
Factors associated with participation in a short-term dietary intervention study among patients with established coronary artery disease: insights from the EVADE CAD trial
Rubinfeld, Gregory; Driggin, Elissa; Woolf, Kathleen; Slater, James; Newman, Jonathan D; Heffron, Sean; Shah, Binita
PMID: 32639244
ISSN: 1473-5830
CID: 4552562
Association of Thrombocytopenia, Revascularization, and In-Hospital Outcomes in Patients with Acute Myocardial Infarction
Rubinfeld, Gregory D; Smilowitz, Nathaniel R; Berger, Jeffrey S; Newman, Jonathan D
BACKGROUND:The impact of thrombocytopenia on revascularization and outcomes in patients presenting with acute myocardial infarction remains poorly understood. We sought to evaluate associations between thrombocytopenia, in-hospital management, bleeding, and cardiovascular outcomes in patients hospitalized for acute myocardial infarction in the United States. METHODS:Patients hospitalized from 2004 to 2014 with a primary diagnosis of acute myocardial infarction were identified from the National Inpatient Sample. Management of acute myocardial infarction was compared between patients with and without thrombocytopenia. Multivariable logistic regression models were used to estimate odds of in-hospital adverse events stratified by thrombocytopenia and adjusted for demographics, cardiovascular risk factors, comorbidities, and treatment. RESULTS:A total of 6,717,769 patients were hospitalized with a primary diagnosis of acute myocardial infarction and thrombocytopenia was reported in 219,351 (3.3%). Patients with thrombocytopenia were older, more likely to have other medical comorbidities, were more likely to undergo coronary artery bypass grafting (28.8% vs. 8.2%, p<0.001), and were less likely to receive a drug eluting stent (15.5% vs. 29.5%, p<0.001). After multivariable adjustment, thrombocytopenia was independently associated with nearly two-fold increased odds of in-hospital mortality (aOR 1.91, 95% CI 1.86-1.97). Thrombocytopenia was also independently associated with ischemic stroke, cardiogenic shock, cardiac arrest and bleeding complications. CONCLUSIONS:Patients with thrombocytopenia in the setting of acute myocardial infarction had increased odds of bleeding, cardiovascular outcomes, and mortality compared with patients without thrombocytopenia. Future investigations to mitigate the poor prognosis of patients with acute myocardial infarction and thrombocytopenia are warranted.
PMID: 31034804
ISSN: 1555-7162
CID: 3854442
The prognostic accuracy of the "surprise question" in geriatric patients at a large new york city hospital [Meeting Abstract]
Rubinfeld, G; Boodram, P; Ho, Cho M; Zweig, Y; Perskin, M
Background: The surprise question (SQ) is an assessment tool used to iden-tify hospitalized patients with poor prognoses by asking providers the following question: "Would you be surprised if this patient died within the next 6 months?" We sought to describe the prognostic utility of the SQ as well as the impact of age and gender on the accuracy of the SQ in elderly patients.
Method(s): We identified patients hospitalized between March and April of 2018 seen by the geriatric consultation service at our hospital. Responses to the SQ on admission and patient demographic data were recorded. We queried the New York State death registry and the hospi-tal's internal medical record 6 months after each SQ response was filed. This data was then used to assess the accuracy of providers' responses. The accuracy of the SQ was compared across gender and age groups using chi-square tests with statistical significance defined as p<0.05.
Result(s): A total of 163 cases were studied. The mean age of the patients analyzed was 85.7 years. 55.8% of the patients were female. The overall accuracy of the SQ was 54.6% (95% CI 46.6%-62.4%). The sensi-tivity and specificity of the SQ for death within 6 months were 66.7% (95% CI 44.7%-84.4%) and 53% (95% CI 43.9%-61.1%), respec-tively. The positive predictive value and negative predictive value of the SQ for death within 6 months were 19.5% (95% CI 14.8%-25.3%) and 90.1% (95% CI 83.5%-94.3%), respectively. There was no significant difference in the accuracy of the SQ between male and female patients (56.3% vs. 53.3%, p = 0.70). The SQ was more accurate in patients under 90 years of age compared to patients 90 years of age and older (60.6% vs. 44.1%, p = 0.04)
Conclusion(s): In this single institution study, we found the SQ to be neither sensitive nor specific for predicting death within 6 months of hospi-tal admission. The SQ is more accurate in patients under 90 years of age compared to older patients. Future investigation into both patient and provider characteristics that contribute to the limited accuracy of this simple assessment tool may further illustrate potential biases that impact successful prognostication
EMBASE:627352930
ISSN: 1532-5415
CID: 3831782
Impact of thrombocytopenia on in-hospital management and outcomes in patients presenting with acute myocardial infarction [Meeting Abstract]
Rubinfeld, G D; Smilowitz, N R; Berger, J S; Newman, J D
Introduction: Thrombocytopenia is a common laboratory abnormality among patients presenting with acute myocardial infarction (AMI). We sought to evaluate associations between thrombocytopenia, in-hospital management and cardiovascular outcomes in patients hospitalized for AMI in the United States.
Method(s): Patients hospitalized from 2004 to 2014 with a primary diagnosis of AMI were identified from the National Inpatient Sample (NIS). Thrombocytopenia was identified based on ICD-9 codes. Multivariable logistic regression models were used to estimate odds of in-hospital adverse events stratified by thrombocytopenia and adjusted for demographics, cardiovascular risk factors, comorbidities, and treatment.
Result(s): A total of 6,717,769 patients were hospitalized with a primary diagnosis of AMI and thrombocytopenia was reported in 219,351 (3.3%). Patients with thrombocytopenia were older, more likely to have medical comorbidities, were more likely to undergo coronary artery bypass grafting [CABG] (28.8% vs. 8.2%, p<0.001), and were less likely to receive a drug eluting stent [DES] (15.5% vs. 29.5%, p<0.001). After multivariable adjustment, thrombocytopenia remained an independent predictor of in-hospital mortality, ischemic stroke, cardiogenic shock, cardiac arrest and bleeding complications (Table).
Conclusion(s): This is the largest analysis of AMI outcomes for patients with and without thrombocytopenia. AMI patients with thrombocytopenia have a significantly greater risk of adverse outcomes, are more likely to undergo CABG and less likely receive a DES during hospitalization compared to other AMI patients. Thrombocytopenia may identify AMI patients at high risk for in-hospital morbidity and mortality. Future investigations to mitigate the poor prognosis of patients with AMI and thrombocytopenia are warranted
EMBASE:626979643
ISSN: 1524-4539
CID: 3788622
Too Cold to Clot? Does Intraoperative Hypothermia Contribute to Bleeding After Aortic Surgery?
Stein, Louis H; Rubinfeld, Gregory; Balsam, Leora B; Ursomanno, Patricia; DeAnda, Abe
Background/UNASSIGNED:We determined the impact of intraoperative hypothermia on postoperative bleeding after thoracic aortic surgery. Methods/UNASSIGNED:We retrospectively analyzed 98 consecutive patients who underwent aortic surgery with deep hypothermic circulatory arrest between 2010 and 2014. We evaluated lowest temperature, absolute decrease in temperature, and rewarming rate. Univariate and multivariate regression were used to determine relationships between temperature, clinical characteristics, and measures of postoperative bleeding. Results/UNASSIGNED:The mean age of patients was 60.5 ± 15.1 years, with 64.3% male and 60% Caucasian. The lowest temperatures recorded were 13.5 ± 4.6°C at the bypass circuit. Change in hematocrit was associated with ethnicity, preoperative hematocrit, and rewarming rate. Chest tube output was associated with body mass index, preoperative platelet count, prior cardiac surgery, cardiopulmonary bypass (CPB) duration, intraoperative blood product transfusion, lowest surface temperature, and change in surface temperature. Postoperative packed red blood cell transfusion was associated with ejection fraction, chronic obstructive pulmonary disease (COPD), platelet count, partial thromboplastin time, CPB duration, and lowest blood temperature. Fresh frozen plasma transfusion correlated with COPD, CPB duration, and final blood temperature. Platelet transfusion correlated with body mass index and preoperative platelet count. Unplanned reoperation for bleeding was associated with final temperature and change in temperature. Conclusion/UNASSIGNED:We found no consistent associations between intraoperative temperature and indicators of bleeding. Intraoperative cooling strategies should be based on optimal end-organ protection rather than fear of postoperative bleeding; rewarming strategies may ameliorate the risk of coagulopathy.
PMCID:5890758
PMID: 29657946
ISSN: 2325-4637
CID: 3042652
Manifestations and Treatments of Inflammatory Bowel Disease Across Different Races and Ethnicities in an Urban Public Hospital Setting [Meeting Abstract]
Rubinfeld, Gregory; Crowe, Brooks; Radin, Arielle; Chen, Lea Ann
ISI:000393902100098
ISSN: 1536-4844
CID: 2482192
Management of Rapidly Ascending Driveline Tunnel Infection
Rubinfeld, Gregory; Levine, Jamie P; Reyentovich, Alex; DeAnda, Abe; Balsam, Leora B
We present a case of rapidly ascending left ventricular assist device driveline and tunnel infection in a patient with a long length of driveline buried beyond the distal velour coating. Device salvage with radical debridement, exit site relocation, and local tissue advancement is described. The findings in this case suggest that the interface between nonvelour covered driveline and subcutaneous tissue can become the nidus of a virulent ascending infection because of poor tissue ingrowth.
PMID: 26442620
ISSN: 1540-8191
CID: 1794622
THE PROGNOSTIC VALUE OF AORTIC DISTENSIBITY FOR CARDIOVASCULAR HOSPITALIZATIONS AND ALL-CAUSE MORTALITY [Meeting Abstract]
Sood, Michael; Dontineni, Nripen; Lee, Ernest; Rubinson, Michael; Vittoria, Michael; Khullar, Gaurav; Rubinfeld, Gregory; Elkomos-Botros, George; Sacchi, Terrence; Brener, Sorin; Heitner, John
ISI:000302326701201
ISSN: 0735-1097
CID: 5505222