{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T18:31:24Z","timestamp":1779301884139,"version":"3.51.4"},"reference-count":55,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2018,10,1]],"date-time":"2018-10-01T00:00:00Z","timestamp":1538352000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2018,10,25]],"date-time":"2018-10-25T00:00:00Z","timestamp":1540425600000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:p>Cardiovascular disease (CVD) is a leading cause of post\u2013liver transplant death, and variable care patterns may affect outcomes. We aimed to describe epidemiology and outcomes of inpatient CVD care across US hospitals. Using a merged data set from the 2002\u20102011 Nationwide Inpatient Sample and the American Hospital Association Annual Survey, we evaluated liver transplant patients admitted primarily with myocardial infarction (MI), stroke (cerebrovascular accident [CVA]), congestive heart failure (CHF), dysrhythmias, cardiac arrest (CA), or malignant hypertension. Patient\u2010level data include demographics, Charlson comorbidity index, and CVD diagnoses. Facility\u2010level variables included ownership status, payer\u2010mix, hospital resources, teaching status, and physician\/nursing\u2010to\u2010bed ratios. We used generalized estimating equations to evaluate patient\u2010 and hospital\u2010level factors associated with mortality. There were 4763 hospitalizations that occurred in 153 facilities (transplant hospitals, n = 80). CVD hospitalizations increased overall by 115% over the decade (<jats:italic toggle=\"yes\">P <\/jats:italic>&lt; 0.01). CVA and MI declined over time (both <jats:italic toggle=\"yes\">P <\/jats:italic>&lt; 0.05), but CHF and dysrhythmia grew significantly (both <jats:italic toggle=\"yes\">P <\/jats:italic>&lt; 0.03); a total of 19% of hospitalizations were for multiple CVD diagnoses. Transplant hospitals had lower comorbidity patients (<jats:italic toggle=\"yes\">P <\/jats:italic>&lt; 0.001) and greater resource intensity including presence of cardiac intensive care unit, interventional radiology, operating rooms, teaching status, and nursing density (all <jats:italic toggle=\"yes\">P <\/jats:italic>&lt; 0.01). Transplant and nontransplant hospitals had similar unadjusted mortality (overall, 3.9%, <jats:italic toggle=\"yes\">P = <\/jats:italic>0.55; by diagnosis, all <jats:italic toggle=\"yes\">P <\/jats:italic>&gt; 0.07). Transplant hospitals had significantly longer overall length of stay, higher total costs, and more high\u2010cost hospitalizations (all <jats:italic toggle=\"yes\">P <\/jats:italic>&lt; 0.05). After risk adjustment, transplant hospitals were associated with higher mortality and high\u2010cost hospitalizations. In conclusion, CVD after liver transplant is evolving and responsible for growing rates of inpatient care. Transplant hospitals are associated with poor outcomes, even after risk adjustment for patient and hospital characteristics, which may be attributable to selective referral of certain patient phenotypes but could also be related to differences in quality of care. Further study is warranted.<\/jats:p>","DOI":"10.1002\/lt.25055","type":"journal-article","created":{"date-parts":[[2018,3,15]],"date-time":"2018-03-15T16:46:46Z","timestamp":1521132406000},"page":"1398-1410","source":"Crossref","is-referenced-by-count":40,"title":["Hospitalizations for Cardiovascular Disease After Liver Transplantation in the United States\u2020"],"prefix":"10.1097","volume":"24","author":[{"given":"Narjeet S.","family":"Khurmi","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu\u2010Hui","family":"Chang","sequence":"additional","affiliation":[{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Eric Steidley","sequence":"additional","affiliation":[{"name":"Divisions of Cardiovascular Medicine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew L.","family":"Singer","sequence":"additional","affiliation":[{"name":"Transplant Surgery, Department of Surgery,Mayo Clinic School of Medicine, Mayo Clinic Arizona,Phoenix,AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winston R.","family":"Hewitt","sequence":"additional","affiliation":[{"name":"Transplant Surgery, Department of Surgery,Mayo Clinic School of Medicine, Mayo Clinic Arizona,Phoenix,AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunam S.","family":"Reddy","sequence":"additional","affiliation":[{"name":"Transplant Surgery, Department of Surgery,Mayo Clinic School of Medicine, Mayo Clinic Arizona,Phoenix,AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adyr A.","family":"Moss","sequence":"additional","affiliation":[{"name":"Transplant Surgery, Department of Surgery,Mayo Clinic School of Medicine, Mayo Clinic Arizona,Phoenix,AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit K.","family":"Mathur","sequence":"additional","affiliation":[{"name":"Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery"},{"name":"Transplant Surgery, Department of Surgery,Mayo Clinic School of Medicine, Mayo Clinic Arizona,Phoenix,AZ"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2018,10,25]]},"reference":[{"key":"lt25055-bib-0001-20240115","doi-asserted-by":"crossref","first-page":"901","DOI":"10.1097\/00007890-200203270-00012","article-title":"Cardiovascular morbidity and mortality after orthotopic liver transplantation","volume":"73","year":"2002","journal-title":"Transplantation"},{"key":"lt25055-bib-0002-20240115","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1002\/lt.22468","article-title":"Cumulative risk of cardiovascular events after orthotopic liver transplantation","volume":"18","year":"2012","journal-title":"Liver Transpl"},{"key":"lt25055-bib-0003-20240115","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1002\/lt.24137","article-title":"Cardiovascular disease after liver transplantation: when, what, and who is at risk","volume":"21","year":"2015","journal-title":"Liver Transpl"},{"key":"lt25055-bib-0004-20240115","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/j.cld.2016.12.009","article-title":"Predictors of cardiovascular events after liver transplantation","volume":"21","year":"2017","journal-title":"Clin Liver Dis"},{"key":"lt25055-bib-0005-20240115","doi-asserted-by":"crossref","first-page":"1645","DOI":"10.1097\/TP.0000000000001710","article-title":"Incidence of and risk assessment for adverse cardiovascular outcomes after liver transplantation: a systematic review","volume":"101","year":"2017","journal-title":"Transplantation"},{"key":"lt25055-bib-0006-20240115","doi-asserted-by":"crossref","first-page":"2089","DOI":"10.1002\/hep.29527","article-title":"Developing a prediction model for cardiovascular risk after orthotopic liver transplantation","volume":"66","year":"2017","journal-title":"Hepatology"},{"key":"lt25055-bib-0007-20240115","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1038\/nrgastro.2013.41","article-title":"Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis","volume":"10","year":"2013","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"lt25055-bib-0008-20240115","doi-asserted-by":"crossref","first-page":"9674","DOI":"10.3748\/wjg.v22.i44.9674","article-title":"Fatty liver is associated with an increased risk of diabetes and cardiovascular disease \u2010 evidence from three different disease models: NAFLD","volume":"22","year":"2016","journal-title":"HCV and HIV. 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