Ahsan Alam

Background: Research regarding the adverse outcomes of atrial fibrillation (AF) in patients with acute pancreatitis (AP) is limited. We hypothesize that the presence of AF is associated with worse inpatient outcomes, including increased mortality and complications in patients admitted with AP. Methods: In this cohort study, de‐identified patient data from the US Collaborative Network in TriNetX was used to assess the risk of all‐cause mortality and adverse events in patients with AP having AF compared to those without AF within 30 days of the index event from January 1, 2010 to July 6, 2024. Analyses were performed before and after propensity score matching, with risks expressed as odds ratios (OR) with 95% confidence intervals (95% CI), and Kaplan–Meier curves were generated for outcomes. Results: A total of 267 429 patients with AP were identified, of whom 44 621 had a diagnosis of AF. Patients with AP having AF presented with higher comorbidity burdens compared to the non‐AF cohort before propensity score matching. After matching, patients with AF exhibited increased risks of all‐cause mortality (OR, 1.24; 95% CI, 1.18–1.3), acute kidney injury (OR, 1.17; 95% CI, 1.14–1.2), deep venous thrombosis (OR, 1.33; 95% CI, 1.27–1.39), hemorrhage (OR, 1.06; 95% CI, 1.01–1.11), severe sepsis (OR, 1.3; 95% CI, 1.25–1.35), and requiring critical care services (OR, 1.19; 95% CI, 1.16–1.23). Conclusion: Our results suggest that AF significantly increases the risk of mortality in patients with AP, even after accounting for confounding etiological, comorbid, and pharmacological factors.

Introduction: Current ESC/EACTS guidelines recommend standard‐duration dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). However, the subsequent transition to either extended DAPT or single antiplatelet therapy (SAPT) remains debated due to limited comparative outcome data. This Bayesian meta‐analysis and meta‐regression evaluate the clinical safety of DAPT versus SAPT, and the impact of potential confounders on all‐cause mortality. Methods: Following PRISMA guidelines, a systematic search of PubMed, Embase, Cochrane Library, ScienceDirect, and Scopus was conducted till April 2025 to identify randomized clinical trials (RCTs) and cohort studies. Primary outcomes were all‐cause mortality and bleeding events. Bayesian random‐effects meta‐analysis was performed using the brms package in R with Markov Chain Monte Carlo sampling and weakly informative priors. Bayesian meta‐regression of log‐transformed odds ratios (OR) assessed associations with relevant covariates. Results: Fourteen studies (9 RCTs and 5 cohort studies) comprising 56,572 patients were included. Compared with SAPT, DAPT was associated with increased all‐cause mortality (OR 1.25; 95% credible interval [CrI], 1.04–1.51; posterior probability of harm, Pr[OR > 1] = 84%). DAPT also increased the risk of net adverse clinical events [NACE] (OR, 1.29; 95% CrI, 1.08–1.53), minor bleeding (OR, 1.60; 95% CrI, 1.10–2.33), major bleeding (OR, 1.70; 95% CrI, 1.30–2.23), and BARC 2–5 bleeding (OR, 1.78; 95% CrI, 1.40–2.26) with Pr [OR > 1] >90% for all outcomes. No significant differences were observed in cardiac death, cardiovascular mortality, major adverse cardiac and cerebrovascular events (MACCE), myocardial infarction (MI), stent thrombosis, or stroke. Meta‐regression revealed that higher baseline odds of dyslipidemia (−0.89), hypertension (−1.19), prior MI (−0.94), and previous revascularization (−0.30) were associated with greater mortality benefit from DAPT. However, in the DAPT cohort, increased odds of adverse events, including cardiac death (0.41), MACCE (0.55), stroke (0.60), MI (0.29), and NACE (0.98), were significantly associated with higher all‐cause mortality. Conclusion: Extended DAPT is associated with a higher all‐cause mortality, bleeding events, and NACE. While DAPT may benefit high‐risk populations, the increased odds of adverse events are significantly associated with mortality, warranting that it be carefully considered and monitored in post‐PCI patients.

BACKGROUND: Heart failure (HF) is associated with high mortality rates and substantial health care costs. While there is growing emphasis on integrating palliative care for patients with HF, limited data exist on the locations where adults with HF spend their final days. The study aimed to analyze the location and circumstances of death among adults with HF in the United States using Centers for Disease Control and Prevention’s Wide-ranging Online Data for epidemiological Research data. METHODS: Mortality data from individuals aged ≥20 years, with HF listed as the cause of death between 1999 and 2023, were analyzed. The places of death were categorized as the emergency room, hospice/nursing home, inpatient medical facility, or home. Multinomial logistic regression was performed to examine the associations between demographic factors and death location. RESULTS: HF-related mortality rates declined from 1999 (3.60% and 143.6 age-adjusted mortality rate) to 2010 (3.47% and 123.1 age-adjusted mortality rate). However, rates gradually increased thereafter, reaching 5.18% and 168.1 age-adjusted mortality rate in 2023. Deaths at home nearly doubled, rising from 18.41% (50 648 of 275 132) in 1999 to 33.47% (132 470 of 395 826) in 2023. Hospice/nursing home deaths increased from 30.95% (85 144 of 275 132) in 1999 to 34.71% (116 634 of 336 014) in 2017, but declined to 29.54% (116 931 of 395 826) by 2023. Young adults (20–34 years) had the highest proportion of inpatient deaths. Sex, ethnicity, and urbanization were significant predictors of death location, with men, White individuals, and those in large metropolitan areas more likely to die in medical facilities. CONCLUSIONS: This study underscores the shifting trends in the locations of death among patients with HF, with a ≈2-fold increase in HF-related deaths occurring at home over the past 2 decades. The recent decline in hospice/nursing home deaths, following a period of steady growth, calls for an in-depth examination of contributing barriers. Further research is essential to understand the sociodemographic factors driving disparities in HF-related death locations.