Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the “forgotten pulmonic valve”
BackgroundCarcinoid heart disease is increasingly recognized and challenging to manage due to limited outcomes data. This is the largest known cohort study of valvular pathology, treatment (including pulmonary and tricuspid valve replacements [PVR and TVR]), dispairties, mortality, and cost in patie...
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1071138/full |
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| author | Dominique J. Monlezun Dominique J. Monlezun Andrew Badalamenti Awad Javaid Kostas Marmagkiolis Kevin Honan Jin Wan Kim Rishi Patel Bindu Akhanti Dan Halperin Arvind Dasari Efstratios Koutroumpakis Peter Kim Juan Lopez-Mattei Syed Wamique Yusuf Mehmet Cilingiroglu Mamas A. Mamas Igor Gregoric James Yao Saamir Hassan Cezar Iliescu |
| author_facet | Dominique J. Monlezun Dominique J. Monlezun Andrew Badalamenti Awad Javaid Kostas Marmagkiolis Kevin Honan Jin Wan Kim Rishi Patel Bindu Akhanti Dan Halperin Arvind Dasari Efstratios Koutroumpakis Peter Kim Juan Lopez-Mattei Syed Wamique Yusuf Mehmet Cilingiroglu Mamas A. Mamas Igor Gregoric James Yao Saamir Hassan Cezar Iliescu |
| author_sort | Dominique J. Monlezun |
| collection | DOAJ |
| description | BackgroundCarcinoid heart disease is increasingly recognized and challenging to manage due to limited outcomes data. This is the largest known cohort study of valvular pathology, treatment (including pulmonary and tricuspid valve replacements [PVR and TVR]), dispairties, mortality, and cost in patients with malignant carcinoid tumor (MCT).MethodsMachine learning-augmented propensity score-adjusted multivariable regression was conducted for clincal outcomes in the 2016–2018 U.S. National Inpatient Sample (NIS). Regression models were weighted by the complex survey design and adjusted for known confounders and the likelihood of undergoing valvular procedures.ResultsAmong 101,521,656 hospitalizations, 55,910 (0.06%) had MCT. Patients with MCT vs. those without had significantly higher inpatient mortality (2.93 vs. 2.04%, p = 0.002), longer mean length of stay (12.20 vs. 4.62, p < 0.001), and increased mean total cost of stay ($70,252.18 vs. 51,092.01, p < 0.001). There was a step-wise increased rate of TVR and PVR with each subsequent year, with significantly more TV (0.16% vs. 0.01, p < 0.001) and PV (0.03 vs. 0.00, p = 0.040) diagnosed with vs. without MCT for 2016, with comparable trends in 2017 and 2018. There were no significant procedural disparities among patients with MCT for sex, race, income, urban density, or geographic region, except in 2017, when the highest prevalence of PV procedures were performed in the Western North at 50.00% (p = 0.034). In machine learning and propensity score augmented multivariable regression, MCT did not significantly increase the likelihood of TVR or PVR. In sub-group analysis restricted to MCT, neither TVR nor PVR significantly increased mortality, though it did increase cost (respectively, $141,082.30, p = 0.015; $355,356.40, p = 0.012).ConclusionThis analysis reflects a favorable trend in recognizing the need for TVR and PVR in patients with MCT, with associated increased cost but not mortality. Our study also suggests that pulmonic valve pathology is increasingly recognized in MCT as reflected by the upward trend in PVRs. Further research and updated societal guidelines may need to focus on the “forgotten pulmonic valve” to improve outcomes and disparities in this understudied patient population. |
| first_indexed | 2024-04-10T16:39:27Z |
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| id | doaj.art-dc7e272944944ca5ba38ff4361b86b27 |
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| language | English |
| last_indexed | 2024-04-10T16:39:27Z |
| publishDate | 2023-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-dc7e272944944ca5ba38ff4361b86b272023-02-08T10:51:35ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-02-01910.3389/fcvm.2022.10711381071138Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the “forgotten pulmonic valve”Dominique J. Monlezun0Dominique J. Monlezun1Andrew Badalamenti2Awad Javaid3Kostas Marmagkiolis4Kevin Honan5Jin Wan Kim6Rishi Patel7Bindu Akhanti8Dan Halperin9Arvind Dasari10Efstratios Koutroumpakis11Peter Kim12Juan Lopez-Mattei13Syed Wamique Yusuf14Mehmet Cilingiroglu15Mamas A. Mamas16Igor Gregoric17James Yao18Saamir Hassan19Cezar Iliescu20Department of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesCenter for Artificial Intelligence and Health Equities, Global System Analytics and Structures (GSAS), New Orleans, LA, United StatesDivision of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United StatesDivision of Cardiovascular Medicine, Kirk Kerkorian School of Medicine at the University of Nevada-Las Vegas, Las Vegas, NV, United StatesDivision of Cardiovascular Disease, University of Arkansas for Medical Sciences, Little Rock, AR, United StatesDivision of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United StatesDivision of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United StatesDivision of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United StatesDivision of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United StatesDepartment of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesDepartment of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesDepartment of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesDepartment of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesDepartment of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesDepartment of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesDepartment of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesKeele Cardiovascular Research Group, Keele University, Stoke-on-Trent, United KingdomDivision of Cardiovascular Medicine, The University of Texas Health Sciences Center at Houston, Houston, TX, United StatesDepartment of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesDepartment of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesDepartment of Cardiology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, United StatesBackgroundCarcinoid heart disease is increasingly recognized and challenging to manage due to limited outcomes data. This is the largest known cohort study of valvular pathology, treatment (including pulmonary and tricuspid valve replacements [PVR and TVR]), dispairties, mortality, and cost in patients with malignant carcinoid tumor (MCT).MethodsMachine learning-augmented propensity score-adjusted multivariable regression was conducted for clincal outcomes in the 2016–2018 U.S. National Inpatient Sample (NIS). Regression models were weighted by the complex survey design and adjusted for known confounders and the likelihood of undergoing valvular procedures.ResultsAmong 101,521,656 hospitalizations, 55,910 (0.06%) had MCT. Patients with MCT vs. those without had significantly higher inpatient mortality (2.93 vs. 2.04%, p = 0.002), longer mean length of stay (12.20 vs. 4.62, p < 0.001), and increased mean total cost of stay ($70,252.18 vs. 51,092.01, p < 0.001). There was a step-wise increased rate of TVR and PVR with each subsequent year, with significantly more TV (0.16% vs. 0.01, p < 0.001) and PV (0.03 vs. 0.00, p = 0.040) diagnosed with vs. without MCT for 2016, with comparable trends in 2017 and 2018. There were no significant procedural disparities among patients with MCT for sex, race, income, urban density, or geographic region, except in 2017, when the highest prevalence of PV procedures were performed in the Western North at 50.00% (p = 0.034). In machine learning and propensity score augmented multivariable regression, MCT did not significantly increase the likelihood of TVR or PVR. In sub-group analysis restricted to MCT, neither TVR nor PVR significantly increased mortality, though it did increase cost (respectively, $141,082.30, p = 0.015; $355,356.40, p = 0.012).ConclusionThis analysis reflects a favorable trend in recognizing the need for TVR and PVR in patients with MCT, with associated increased cost but not mortality. Our study also suggests that pulmonic valve pathology is increasingly recognized in MCT as reflected by the upward trend in PVRs. Further research and updated societal guidelines may need to focus on the “forgotten pulmonic valve” to improve outcomes and disparities in this understudied patient population.https://www.frontiersin.org/articles/10.3389/fcvm.2022.1071138/fullcardio-oncologycarcinoidvalvular diseaseartificial intelligencepropensity score |
| spellingShingle | Dominique J. Monlezun Dominique J. Monlezun Andrew Badalamenti Awad Javaid Kostas Marmagkiolis Kevin Honan Jin Wan Kim Rishi Patel Bindu Akhanti Dan Halperin Arvind Dasari Efstratios Koutroumpakis Peter Kim Juan Lopez-Mattei Syed Wamique Yusuf Mehmet Cilingiroglu Mamas A. Mamas Igor Gregoric James Yao Saamir Hassan Cezar Iliescu Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the “forgotten pulmonic valve” Frontiers in Cardiovascular Medicine cardio-oncology carcinoid valvular disease artificial intelligence propensity score |
| title | Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the “forgotten pulmonic valve” |
| title_full | Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the “forgotten pulmonic valve” |
| title_fullStr | Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the “forgotten pulmonic valve” |
| title_full_unstemmed | Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the “forgotten pulmonic valve” |
| title_short | Artificial intelligence-augmented analysis of contemporary procedural, mortality, and cost trends in carcinoid heart disease in a large national cohort with a focus on the “forgotten pulmonic valve” |
| title_sort | artificial intelligence augmented analysis of contemporary procedural mortality and cost trends in carcinoid heart disease in a large national cohort with a focus on the forgotten pulmonic valve |
| topic | cardio-oncology carcinoid valvular disease artificial intelligence propensity score |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.1071138/full |
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