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Yan SP, Song X, Wei L, Gong YS, Hu HY, Li YQ. Performance of heart rate adjusted heart rate variability for risk stratification of sudden cardiac death. BMC Cardiovasc Disord 2023; 23:144. [PMID: 36949420 PMCID: PMC10032001 DOI: 10.1186/s12872-023-03184-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
PURPOSE As a non-invasive tool for the assessment of cardiovascular autonomic function, the predictive value of heart rate variability (HRV) for sudden cardiac death (SCD) risk stratification remains unclear. In this study, we investigated the performance of the individualized heart rate (HR) adjusted HRV (HRVI) for SCD risk stratification in subjects with diverse risks. METHODS A total of 11 commonly used HRV metrics were analyzed in 192 subjects, including 88 healthy controls (low risk group), 82 hypertrophic cardiomyopathy (HCM) patients (medium risk group), and 22 SCD victims (high risk group). The relationship between HRV metrics and HR was examined with long-term and short-term analysis. The performance HRVI was evaluated by area under the receiver operating characteristic curve (AUC) and covariance of variation (CV). RESULTS Most of the HRV metrics were exponentially decayed with the increase of HR, while the exponential power coefficients were significantly different among groups. The HRVI metrics discriminated low, medium and high risk subjects with a median AUC of 0.72[0.11], which was considerably higher than that of the traditional long-term (0.63[0.04]) and short-term (0.58[0.05]) HRV without adjustment. The average CV of the HRVI metrics was also significantly lower than traditional short-term HRV metrics (0.09 ± 0.02 vs. 0.24 ± 0.13, p < 0.01). CONCLUSIONS Subjects with diverse risks of SCD had similar exponential decay relationship between HRV metrics and HR, but with different decaying rates. HRVI provides reliable and robust estimation for risk stratification of SCD.
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Affiliation(s)
- Su-Peng Yan
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Xin Song
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Liang Wei
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Yu-Shun Gong
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, 30 Gaotanyan Main Street, Chongqing, 400038, China
| | - Hou-Yuan Hu
- Department of Cardiology, Southwest Hospital, Army Medical University, Chongqing, 400038, China
| | - Yong-Qin Li
- Department of Biomedical Engineering and Imaging Medicine, Army Medical University, 30 Gaotanyan Main Street, Chongqing, 400038, China.
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Lin E, Gobraeil J, Johnston S, Venables MJ, Archibald D. Consensus-Based Development of an Assessment Tool: A Methodology for Patient Engagement in Primary Care and CPD Research. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:153-158. [PMID: 35916890 PMCID: PMC9398503 DOI: 10.1097/ceh.0000000000000440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
With cardiovascular disease (CVD) posing a significant disease burden in Canada and more broadly, preventative efforts which incorporate best evidence, patient preference, and physician expertise must continue to take place. Primary care providers play a pivotal role in this effort, and a greater understanding of patient perspectives is needed to guide management and inform training. We used a validated consensus method, the nominal group technique (NGT), to identify patient-reported experience measures (PREM) related to CVD prevention deemed most important by both patients and providers. The NGT was used by using structured discussions between patients and providers to bring ideas about PREM CVD outcomes to a consensus. Four patient partners and four primary care providers were selected to participate in an NGT session. Each participant wrote down items/questions they believed important in CVD preventative care. After discussions, all items underwent anonymous ranking on a 5-point scale. Items were included/excluded based on 75% agreement a priori. The panel produced 10 items from a total of 26 after 2 rounds of ranking. The top two items were as follows: "Is your treatment plan tailored to you" and "Was your physician good at giving information about your risk factors?" These results are significantly different compared with existing quality measures because they highlight aspects of patient experience and therapeutic relationship. A questionnaire consisting of prioritized PREM items is valuable in quality improvement and continuous professional development (CPD).
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Alnabelsi TS, Faulkner SP, Cook M, Freeman K, Shelton J, Paranzino M, Nerusu S, Smyth SS, Gupta VA. Passive antipyretic therapy is not as effective as invasive hypothermia for maintaining normothermia after cardiac arrest. Am J Emerg Med 2021; 50:202-206. [PMID: 34390903 DOI: 10.1016/j.ajem.2021.06.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 12/14/2022] Open
Abstract
AIM OF THE STUDY Targeted temperature management is a class I indication in comatose patients after a cardiac arrest. While the literature has primarily focused on innovative methods to achieve target temperatures, pharmacologic therapy has received little attention. We sought to examine whether pharmacologic therapy using antipyretics is effective in maintaining normothermia in post cardiac arrest patients. MATERIALS AND METHODS Patients ≥18 years who were resuscitated after an in-hospital or out-of-hospital cardiac arrest and admitted at our institution from January 2012 to September 2015 were retrospectively included. Patients were divided into groups based on the method of temperature control that was utilized. The primary outcome was temperature control <38 °C during the first 48 h after the cardiac arrest. RESULTS 671 patients were identified in Group 1 (no hypothermia), 647 in Group 2 (antipyretics), 44 in Group 3 (invasive hypothermia), and 51 in Group 4 (invasive hypothermia and antipyretics). Mean patient age was 59 (SD ±15.7) years with 40.6% being female. Using Group 1 as the control arm, 57.7% of patients maintained target temperature with antipyretics alone (p < 0.001), compared to 69.3% in the control group and 82.1% in the combined hypothermia groups 3&4 (p = 0.01). Patients receiving both invasive hypothermia and antipyretics (Group 4), had the greatest mean temperature decrease of 5.2 °C. CONCLUSIONS Among patients undergoing targeted temperature management, relying solely on as needed use of antipyretics is not sufficient to maintain temperatures <38 °C. However, antipyretics could be used as an initial strategy if given regularly and/or in conjunction with more aggressive cooling techniques.
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Affiliation(s)
- Talal S Alnabelsi
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America.
| | - Sarah P Faulkner
- College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Matthew Cook
- College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Kalen Freeman
- College of Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Julie Shelton
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Marc Paranzino
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Sethabhisha Nerusu
- Department of Biostatistics, University of Kentucky, Lexington, KY, United States of America
| | - Susan S Smyth
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Vedant A Gupta
- Gill Heart and Vascular Institute, Division of Cardiovascular Medicine, University of Kentucky, Lexington, KY, United States of America
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Halasz G, Cattaneo M, Piepoli M, Biagi A, Romano S, Biasini V, Villa M, Cassina T, Capelli B. Early Repolarization in Pediatric Athletes: A Dynamic Electrocardiographic Pattern With Benign Prognosis. J Am Heart Assoc 2021; 10:e020776. [PMID: 34387099 PMCID: PMC8475030 DOI: 10.1161/jaha.121.020776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Early repolarization pattern (ERP) is considered a common training‐related and benign ECG finding in young adult athletes. Few data exist on ERP in the pediatric athletes population. Therefore, we aimed to evaluate the ERP prevalence, characteristics, and prognosis in pediatric athletes aged ≤16 years. Methods and Results Eight‐hundred eighty‐six consecutive pediatric athletes engaged in 17 different sports (mean age, 11.7±2.5 years; 7–16 years) were enrolled and prospectively evaluated with medical history, physical examination, resting and exercise ECGs, and transthoracic echocardiography during their preparticipation screening. Known cardiovascular diseases associated with sudden cardiac death was considered exclusion criteria. Athletes were followed up yearly for 4 years. The prevalence of ERP was 117 (13.2%), equally distributed in both sexes (P=0.072), irrespectively of body mass index and classification of sports. The most common ERP localizations were inferolateral and inferior leads (53.8% and 27.3%, respectively). Notching J‐point morphology was the most prevalent (70%), and rapidly ascending ST elevation (96%) was the most common ST‐segment morphology. Athletes with ERP were older (P<0.001) had lower rest and recovery heart rates (P<0.001), increased precordial and limb R‐wave voltages (P<0.001), increased R/S Sokolow index (P<0.001), and longer PR interval (P=0.006) in comparison with the athletes without ERP. Neither major cardiovascular nor arrhythmic events, nor sudden cardiac death were recorded over a median follow‐up of 4.2 years. One hundred seventeen (80.3%) athletes with ERP exhibited a persistent ERP. ERP localization and J‐point morphology changed during follow‐up in 11 (11.7%) and 17 (18%) of athletes, respectively. Conclusions ERP is common in pediatric athletes. It was mostly located in the inferolateral leads and associated with concave ascending ST segment with other training‐related ECG changes. The lack of either sudden cardiac death or cardiomyopathies linked to sudden cardiac death over follow‐up suggests that in pediatric athletes, ERP may be considered a benign training‐related ECG phenomenon with a potential dynamic pattern.
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Affiliation(s)
- Geza Halasz
- Cardiology Department Guglielmo Da Saliceto Hospital Piacenza Italy.,Cardiology Department Cardiocentro Ticino Lugano Switzerland
| | - Mattia Cattaneo
- Cardiology Department Cardiocentro Ticino Lugano Switzerland
| | - Massimo Piepoli
- Cardiology Department Guglielmo Da Saliceto Hospital Piacenza Italy
| | - Andrea Biagi
- Cardiology Department Guglielmo Da Saliceto Hospital Piacenza Italy
| | - Silvio Romano
- Cardiology Department of Life Health & Environmental Sciences University of L'Aquila L'Aquila Italy
| | | | - Michele Villa
- Cardiovascular Intensive Care Unit Cardiocentro Ticino Lugano Switzerland
| | - Tiziano Cassina
- Cardiovascular Intensive Care Unit Cardiocentro Ticino Lugano Switzerland
| | - Bruno Capelli
- Sport and Exercise Medicine Cardiocentro Ticino Lugano Switzerland
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Svane J, Lynge TH, Hansen CJ, Risgaard B, Winkel BG, Tfelt-Hansen J. Witnessed and unwitnessed sudden cardiac death: a nationwide study of persons aged 1-35 years. Europace 2021; 23:898-906. [PMID: 33595080 DOI: 10.1093/europace/euab017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/10/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS The aim of this study is to compare clinical characteristics and causes of death among witnessed and unwitnessed sudden cardiac death (SCD) cases aged 1-35 years. METHODS AND RESULTS In this retrospective nationwide study, all deaths in persons aged 1-35 years in Denmark during 2000-09 were included (23.7 million person-years). Using the in-depth descriptive Danish death certificates and Danish nationwide registries, 860 cases of sudden, unexpected death were identified. Through review of autopsy reports and register data, we identified 635 cases of SCD of which 266 (42%) were witnessed and 326 (51%) were unwitnessed. In 43 cases (7%), witnessed status was missing. Clinical characteristics were overall similar between the two groups. We found a male predominance among unwitnessed SCD compared to witnessed SCD (71% and 62%, respectively, P-value 0.012), as well as more psychiatric comorbidity (20% and 13%, respectively, P-value 0.029). Unwitnessed SCD more often occurred during sleep whereas witnessed SCD more often occurred while the individual was awake and relaxed (P-value < 0.001). The autopsy rate among all SCD cases was 70% with no significant difference in autopsy rate between the two groups. Sudden unexplained death, which was the leading autopsy conclusion in both groups, was more frequent among unwitnessed SCD (P-value 0.001). CONCLUSION Several clinical characteristics and autopsy findings were similar between witnessed and unwitnessed SCD cases. Our data support the inclusion of both witnessed and unwitnessed cases in epidemiological studies of SCD cases aged 1-35 years, although the risk of misclassification is higher among unwitnessed and non-autopsied cases of SCD.
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Affiliation(s)
- Jesper Svane
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Carl Johann Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Bjarke Risgaard
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bo Gregers Winkel
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
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Halasz G, Cattaneo M, Piepoli M, Romano S, Biasini V, Menafoglio A, Gasperetti A, Badini M, Villa M, Dall'Ara L, Roberto M, Cassina T, Capelli B. Pediatric athletes' ECG and diagnostic performance of contemporary ECG interpretation criteria. Int J Cardiol 2021; 335:40-46. [PMID: 33857542 DOI: 10.1016/j.ijcard.2021.04.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 03/10/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Electrocardiographic (ECG) pre-participation screening(PPS) can prevent sudden cardiac death(SCD) but the Interpretation of the athlete's ECG is based on specific criteria addressed for adult athletes while few data exist about the pediatric athlete's ECG. We aimed to assess the features of pediatric athletes' ECG and compared the diagnostic performance of 2017 International ECG recommendation, 2010 European Society of Cardiology recommendation and 2013-Seattle criteria in detecting clinical conditions at risk of SCD. METHODS 886 consecutive pediatric athletes (mean age 11.7 ± 2.5 years; 7-16-years) were enrolled and prospectively evaluated with medical history, physical examination, resting and exercise ECG and transthoracic echocardiography during their PPS. RESULTS The most common physiological ECG patterns in pediatric athletes were isolated left ventricular hypertrophy criteria (26.9%), juvenile T-wave pattern (22%) and early repolarization pattern (13.2%). The most frequent borderline abnormalities were left axis deviation (1.8%) and right axis deviation (0.9%) while T-wave inversion (0.8%) especially located in inferior leads (0.7%) was the most prevalent abnormal findings. Seven athletes (0.79%) were diagnosed with a condition related to SCD. Compared to Seattle and ESC, the International improved ECG specificity (International = 98% ESC = 64% Seattle = 95%) with lower sensitivity (ESC and Seattle 86%vs International 57%). The false-positive rate decreases from 36% of ESC to 2.2% of International but the latter showed a higher false-negative rate(0.34%). CONCLUSION Pediatric athletes like the adult counterpart exhibit a high prevalence of ECG abnormalities mostly representing training-related ECG adaptation. The International criteria showed a lower false-positive rate but at the cost of loss of sensitivity.
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Affiliation(s)
- Geza Halasz
- Cardiology Department, G. Da Saliceto Hospital, Piacenza, Italy; Sport and Exercise Medicine, Cardiocentro Ticino, Lugano, Switzerland.
| | - Mattia Cattaneo
- Cardiovascular Intensive Care Unit, Cardiocentro Ticino, Lugano, Switzerland
| | - Massimo Piepoli
- Cardiology Department, G. Da Saliceto Hospital, Piacenza, Italy
| | - Silvio Romano
- Cardiology, Department of Life, Health & Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Andrea Menafoglio
- Sport and Exercise Medicine, Cardiocentro Ticino, Lugano, Switzerland; Cardiology Department, Ospedale San Giovanni Bellinzona, Bellinzona, Switzerland
| | - Alessio Gasperetti
- Department of Clinical Sciences and Community Health, Heart Rhythm Center, Centro Cardiologico Monzino, Milano, Italy
| | - Matteo Badini
- Cardiology Department, Cardiocentro Ticino, Lugano, Switzerland
| | - Michele Villa
- Cardiovascular Intensive Care Unit, Cardiocentro Ticino, Lugano, Switzerland
| | - Lorenzo Dall'Ara
- University Hospital of Modena, Anesthesiology Department, Modena, Italy
| | - Marco Roberto
- Cardiology Department, Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Cassina
- Cardiovascular Intensive Care Unit, Cardiocentro Ticino, Lugano, Switzerland
| | - Bruno Capelli
- Cardiovascular Intensive Care Unit, Cardiocentro Ticino, Lugano, Switzerland; Sport and Exercise Medicine, Cardiocentro Ticino, Lugano, Switzerland
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Antemortem and Post-Mortem Characteristics of Lethal Mitral Valve Prolapse Among All Countywide Sudden Deaths. JACC Clin Electrophysiol 2021; 7:1025-1034. [PMID: 33640349 DOI: 10.1016/j.jacep.2021.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The goal of this study was to investigate the characteristics of mitral valve prolapse (MVP) in a post-mortem study of consecutive sudden cardiac deaths (SCDs) in subjects up to 90 years of age. BACKGROUND Up to 2.3% of subjects with MVPs experience SCD, but by convention SCD is rarely confirmed by autopsy. In a post-mortem study of persons <40 years of age, 7% of SCDs were caused by MVP; bileaflet involvement, mitral annular disjunction (MAD), and replacement fibrosis were common. METHODS In the San Francisco POST SCD (Postmortem Systematic Investigation of Sudden Cardiac Death) study, autopsies have been performed on >1,000 consecutive World Health Organization-defined (presumed) cases of SCD in subjects aged 18 to 90 years since 2011; a total of 603 were adjudicated. Autopsy-defined sudden arrhythmic death (SAD) required absence of nonarrhythmic cause; MVP diagnosis required leaflet billowing. One hundred antemortem echocardiograms were revised to identify additional MVPs missed on autopsy. RESULTS Among the 603 presumed SCDs, 339 (56%) were autopsy-defined SADs, with MVP identified in 7 (1%). Six additional MVPs were identified by review of echocardiograms, for a prevalence of at least 2% among 603 presumed SCDs and 4% among 339 SADs (vs. 264 non-SADs; p = 0.02). All 6 additional MVPs had monoleaflet rather than bileaflet involvement and mild mitral regurgitation, ruling out hemodynamic cause. Less than one-half had MAD with replacement fibrosis, but all had multisite interstitial fibrosis. CONCLUSIONS In a countywide post-mortem study of all adult cases of SCD, MVP prevalence was at least 4% of SADs, but one-half were missed on autopsy. Monoleaflet MVP was often underdiagnosed post-mortem. Compared with young cases of SCD, lethal MVP in older cases of SCD did not consistently have bileaflet anatomy, replacement fibrosis, or MAD.
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8
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Hughes DL, Rice JD, Burton JR, Jin Y, Peterson RA, Ambardekar AV, Pomposelli JJ, Pomfret EA, Kriss MS. Presence of any degree of coronary artery disease among liver transplant candidates is associated with increased rate of post-transplant major adverse cardiac events. Clin Transplant 2020; 34:e14077. [PMID: 32939833 DOI: 10.1111/ctr.14077] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/24/2020] [Accepted: 08/22/2020] [Indexed: 01/14/2023]
Abstract
The impact of coronary artery disease (CAD) among liver transplant candidates (LTC) on post-LT clinical outcomes remains unclear. The aim of this study is to determine association of presence and severity of CAD on post-LT major adverse cardiac events (MACE) including cardiac-associated mortality. We conducted a retrospective cohort analysis of 231 patients who underwent diagnostic coronary angiogram (DCA) during their LT evaluation at a tertiary medical center from 2012-2017. Patients were analyzed based on degree of CAD (no CAD, non-obstructive CAD [< 50% stenosis], obstructive CAD [≥50% stenosis]) per DCA results. MACE were noted at 30 days, 1 year, 3 years, and 5 years post-LT, and Kaplan-Meier curves were used to determine post-LT MACE-free probability. LTC with any CAD, including non-obstructive CAD, had lower MACE-free probability at all post-LT time points (0.94 vs 0.65 at 30 days, P = .001; 0.87 vs 0.59 at 1 year, P = .002; 0.87 vs 0.41 at 3 years, P < .001; 0.87 vs 0.37 at 5 years, P < .001). Identification of and medical intervention for non-obstructive CAD should be considered in all LTC, though further studies are necessary to determine optimal medical interventions to mitigate MACE risk in this cohort.
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Affiliation(s)
- Dempsey L Hughes
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan D Rice
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - James R Burton
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ying Jin
- Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ryan A Peterson
- Department of Biostatistics and Informatics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Amrut V Ambardekar
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - James J Pomposelli
- Division of Transplant Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elizabeth A Pomfret
- Division of Transplant Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael S Kriss
- Division of Gastroenterology and Hepatology, University of Colorado School of Medicine, Aurora, CO, USA
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Abstract
PURPOSE OF REVIEW Persons with diabetes mellitus (DM) have increased morbidity and mortality rates compared with persons without DM. Sudden cardiac death (SCD) is a leading cause of death, and multiple studies have found an increased risk of SCD among individuals with DM. This review sought to collect the latest knowledge of the epidemiological and pathophysiological interplay between DM and SCD. RECENT FINDINGS Persons with DM have a two- to tenfold increased risk of SCD compared with persons without DM. The underlying mechanisms for the increased risk of SCD are complex and multifactorial. The main pathophysiological contributors are DM-induced cardiac autonomic neuropathy (CAN), metabolic changes, silent ischemia, and polypharmacy. Persons with DM have an increased risk of SCD. Future studies should focus on CAN and the combined risk of QT prolongation from the interplay between CAN, hypoglycemia, and polypharmacy. Genes and pathways involved in control of the autonomic nervous system and cardiac ion channels could be a future focal point.
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10
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Zamzam A, Syed MH, Rand ML, Singh K, Hussain MA, Jain S, Khan H, Verma S, Al-Omran M, Abdin R, Qadura M. Altered coagulation profile in peripheral artery disease patients. Vascular 2020; 28:368-377. [PMID: 32252612 DOI: 10.1177/1708538120915997] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Peripheral artery disease patients have been shown to be more susceptible to thrombotic events compared to non-peripheral artery disease patients. Therefore, the aim of this study was to investigate the coagulation profile in peripheral artery disease patients with chronic limb threatening ischemia, moderate peripheral artery disease patients with claudication, and non-peripheral artery disease controls. METHODS Chronic limb threatening ischemia patients were matched to peripheral artery disease patients with claudication and non-peripheral artery disease controls in a 1:1:1 ratio. Each patient had their cytokines, markers of thrombin generation, coagulation factors, natural anti-coagulants, fibrinolysis, and endothelial injury markers assessed. RESULTS Markers of thrombin activation, thrombin Fragments F1 + 2 (Frag 1 + 2), and thrombin-anti-thrombin complex were found to be significantly elevated in all peripheral artery disease and chronic limb threatening ischemia patients relative to non-peripheral artery disease controls. Similarly, relative to non-peripheral artery disease controls, inflammatory markers including C-reactive protein, soluble platelet factor 4, and neutrophil gelatinase-associated lipocalin were also found to be significantly upregulated in chronic limb threatening ischemia patients, but not in peripheral artery disease patients with claudication. Furthermore, our data demonstrated significant increases in markers of endothelial injury in chronic limb threatening ischemia patients relative to non-peripheral artery disease controls. Finally, decreases in natural anti-coagulants (protein C and protein S) and coagulation factors FIX, FXI, and FXII were also observed in chronic limb threatening ischemia patients when compared with non-peripheral artery disease controls. CONCLUSIONS Our data suggest that in relation to non-peripheral artery disease controls, chronic limb threatening ischemia patients are more hypercoagulable. However, peripheral artery disease patients with claudication appear to have similar levels of circulating procoagulant markers as non-peripheral artery disease patients. This may explain the increased risk of thrombotic events observed in chronic limb threatening ischemia patients.
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Affiliation(s)
- Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Muzammil H Syed
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Margaret L Rand
- Department of Laboratory Medicine and Pathobiology, Biochemistry and Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Haematology/Oncology & Translational Medicine, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Krishna Singh
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Mohamad A Hussain
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Shubha Jain
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hamzah Khan
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Rawand Abdin
- Division of Cardiac Surgery, St. Michael's Hospital, Toronto, Canada
| | - Mohammad Qadura
- Division of Vascular Surgery, St. Michael's Hospital, Toronto, Ontario, Canada
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11
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M Isiozor N, Kunutsor SK, Voutilainen A, Kurl S, Kauhanen J, A Laukkanen J. Association between ideal cardiovascular health and risk of sudden cardiac death and all-cause mortality among middle-aged men in Finland. Eur J Prev Cardiol 2020; 28:294-300. [PMID: 33891691 DOI: 10.1177/2047487320915338] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/05/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Strong associations have been demonstrated between the American Heart Association's cardiovascular health (CVH) metrics and various cardiovascular outcomes, but the association with sudden cardiac death (SCD) is uncertain. We examined the associations between these CVH metrics and the risks of SCD and all-cause mortality among men in Finland. METHODS AND RESULTS We used the prospective population-based Kuopio Ischaemic Heart Disease cohort study, which consists of men between 42 and 60 years of age at baseline. CVH metrics were computed for 2577 men with CVH scores at baseline ranging from 0 to 7, categorized into CVH scores of 0-2 (poor), 3-4 (intermediate) and 5-7 (ideal). Multivariate Cox regression models were used to estimate the hazards ratios (HRs) and 95% confidence intervals (CIs) of ideal CVH metrics for SCD and all-cause mortality. During a median follow-up period of 25.8 years, 280 SCDs and 1289 all-cause mortality events were recorded. The risks of SCD and all-cause mortality decreased continuously with increasing number of CVH metrics across the range 2-7 (p value for non-linearity for all <0.05). In multivariable analyses, men with an ideal CVH score had an 85% reduced risk of SCD compared with men with a poor CVH score (HR 0.15; 95% CI 0.05-0.48; p = 0.001). For all-cause mortality, there was a 67% lower risk among men with an ideal CVH score compared with those with a poor CVH score (HR 0.33; 95% CI 0.23-0.49; p <0.001). CONCLUSIONS Ideal CVH metrics were strongly and linearly associated with decreased risks of SCD and all-cause mortality among middle-aged men in Finland.
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Affiliation(s)
- Nzechukwu M Isiozor
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Setor K Kunutsor
- National Institute for Health Research, Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, UK
- Translational Health Sciences, Bristol Medical School, Musculoskeletal Research Unit, University of Bristol, UK
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Sudhir Kurl
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Jussi Kauhanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
- Faculty of Sport and Health Sciences, University of Jyvaskyla, Finland
- Central Finland Health Care District, Department of Internal Medicine, Jyvaskyla, Finland
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12
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Cosmi D, Mariottoni B, Cosmi F. Stable atypical chest pain with negative anatomical or functional diagnostic test: Diagnosis no matter what or prevention at any cost? Clin Cardiol 2019; 42:982-987. [PMID: 31432542 PMCID: PMC6788466 DOI: 10.1002/clc.23250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/13/2019] [Accepted: 08/14/2019] [Indexed: 12/19/2022] Open
Abstract
Background Approximately 1% to 2% of patients with stable atypical chest pain (SACP) experienced a major coronary event, even after a negative functional or anatomical test. Methods Over the past 15 years, 1706 patients with SACP evaluated in our clinics underwent functional stress testing or coronary computed tomographic angiography (CTA). In these patients, we also assessed the presence of three major modifiable lifestyle‐related risk factors (cigarette smoking, low intake of fruit and vegetables, and physical inactivity). Patients were stratified according to the presence of at least one risky lifestyle factor or no risky lifestyle factors. Functional or anatomical tests were positive in 170 patients (10%). We followed the remaining 1536 patients with negative tests for 1 year to evaluate the incidence of major coronary events. Results The percentage of patients reporting major coronary events was 1.2% in the group with risky lifestyles and 0.2% in the non‐risky lifestyle group (P < .01). Events were more common in smokers. Conclusions Patients with SACP, when functional or anatomical tests are negative, have a residual risk of fatal and non‐fatal cardiovascular events of 1% at 1 year of follow‐up. People with incorrect lifestyles, especially smokers, have a higher risk of events. We think that in this population, a more effective intervention on lifestyles could be the key to reduce major cardiovascular events.
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Affiliation(s)
- Deborah Cosmi
- Department of Cardiology, Gubbio and GualdoTadino Hospital, Perugia, Italy
| | | | - Franco Cosmi
- Department of Cardiology, Cortona Hospital, Arezzo, Italy
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13
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Bollmann A, Hindricks G. Anything that can be measured can be improved: the case of performance measures in heart failure and beyond. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:4-5. [PMID: 30346505 DOI: 10.1093/ehjqcco/qcy051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Andreas Bollmann
- Heart Center Leipzig at University of Leipzig, Department of Electrophysiology and Leipzig Heart Institute, Strümpellstr. 39, Leipzig, Germany
| | - Gerhard Hindricks
- Heart Center Leipzig at University of Leipzig, Department of Electrophysiology and Leipzig Heart Institute, Strümpellstr. 39, Leipzig, Germany
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14
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Luo LH, Wang JY, Chen X, Lin J, Zhang M. Mode of initiation and clinical significance of malignant rapid ventricular arrhythmias: An observational study. Medicine (Baltimore) 2018; 97:e0660. [PMID: 29718887 PMCID: PMC6392556 DOI: 10.1097/md.0000000000010660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The purpose of this study was to explore the modes of initiation and clinical significance of malignant rapid ventricular arrhythmias (MRVAs).The surface 12-lead electrocardiogram (ECG) or sustained electrocardiomonitor graph was analyzed in 79 patients. All patients had at least 1 MRVA after being admitted to the hospital.According to the length of coupling interval of the initial premature ventricular contraction of MRVA, the modes of initiation of MRVA were divided into the following types: those initiated by premature ventricular contraction with short coupling intervals in patients with normal Q-T interval, and for which short-long-short sequences before MRVA precipitation were not observed; those initiated following short-long-short sequences, which were divided into 2 types according to the length of Q-T interval: a normal Q-T interval and a long Q-T interval. On the basis of the different modes of onset, treatments of MRVA were different.MRVAs have different modes of onset depending on the patients' underlying condition. Prompt recognition of the mode of onset is necessary to facilitate appropriate management. These findings could have important pathophysiologic and clinical implications.
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Affiliation(s)
- Li-Hong Luo
- Department of Cardiology, Xixi Hospital of Hangzhou, Hangzhou
| | | | - Xin Chen
- Department of ICU, Hangzhou Cancer Hospital, Hangzhou
| | - Jiafeng Lin
- Department of Cardiology, Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ming Zhang
- Department of ICU, Hangzhou Cancer Hospital, Hangzhou
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15
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Family Communication About Genetic Risk of Hereditary Cardiomyopathies and Arrhythmias: an Integrative Review. J Genet Couns 2018; 27:1022-1039. [PMID: 29492742 DOI: 10.1007/s10897-018-0225-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/29/2018] [Indexed: 12/20/2022]
Abstract
Screening for hereditary cardiomyopathies and arrhythmias (HCA) may enable early detection, treatment, targeted surveillance, and result in effective prevention of debilitating complications and sudden cardiac death. Screening at-risk family members for HCA is conducted through cascade screening. Only half of at-risk family members are screened for HCA. To participate in screening, at-risk family members must be aware of their risk. This often relies on communication from diagnosed individuals to their relatives. However, family communication is not well understood and is ripe for developing interventions to improve screening rates. Until very recently, family communication of genetic risk has been mostly studied in non-cardiac disease. Using this non-cardiac literature, we developed the family communication of genetic risk (FCGR) conceptual framework. The FCGR has four main elements of the communication process: influential factors, communication strategies, communication occurrence, and reaction to communication. Using the FCGR, we conducted an integrated review of the available literature on genetic risk communication in HCA families. Descriptive analysis of 12 articles resulted in the development of categories describing details of the FCGR elements in the context of HCA. This review synthesizes what is known about influential factors, communication strategies, communication occurrence, and outcomes of communication in the context of HCA.
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16
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Abstract
Sudden death is a major problem, with significant impact on public health. Many conditions predispose to sudden cardiac death and sudden cardiac arrest (SCA), foremost among them coronary artery disease, and an effective therapy exists in the form of the implantable cardioverter defibrillator. Risk stratification for SCA remains imperfect, especially for patients with nonischemic cardiomyopathy. Ongoing trials may make it easier to identify those at high risk, and potentially those at very low risk, in the future.
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Affiliation(s)
- Daniel P Morin
- Ochsner Medical Center, Ochsner Clinical School, University of Queensland Medical School, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
| | - Munther K Homoud
- New England Cardiac Arrhythmia Center, Division of Cardiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - N A Mark Estes
- New England Cardiac Arrhythmia Center, Division of Cardiology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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17
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Tereshchenko LG, Soliman EZ, Davis BR, Oparil S. Risk stratification of sudden cardiac death in hypertension. J Electrocardiol 2017; 50:798-801. [PMID: 28916176 DOI: 10.1016/j.jelectrocard.2017.08.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Indexed: 12/28/2022]
Abstract
In the United States, up to 450,000 people per year die suddenly; an average of 1 sudden death every 70s. Strategies for preventing sudden cardiac death are urgently needed. Systemic arterial hypertension is a major risk factor for sudden cardiac death and the increasing burden of hypertension is a worldwide problem. The lifetime risk of sudden cardiac death at 30years of age is higher by 30% in individuals with hypertension. Each 20/10mmHg increase in systolic/diastolic blood pressure, is associated with a 20% additional increase in sudden cardiac death risk. Theoretically, antihypertensive treatment should be an effective strategy for sudden cardiac death prevention. However, a recent meta-analysis of 15 randomized controlled trials showed that antihypertensive treatment does not reduce the incidence of sudden cardiac death. This manuscript reviews ECG predictors of sudden cardiac death and the importance of risk stratification for appropriate management of hypertension.
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Affiliation(s)
- Larisa G Tereshchenko
- The Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, United States.
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Division of Public Health Sciences, Department of Medicine, Cardiology Section, Wake Forest School of Medicine, Winston Salem, NC, United States
| | - Barry R Davis
- University of Texas School of Public Health, Houston, TX, United States
| | - Suzanne Oparil
- University of Alabama at Birmingham, Department of Medicine, School of Medicine, Birmingham, AL, United States
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18
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Leonard CE, Hennessy S, Han X, Siscovick DS, Flory JH, Deo R. Pro- and Antiarrhythmic Actions of Sulfonylureas: Mechanistic and Clinical Evidence. Trends Endocrinol Metab 2017; 28:561-586. [PMID: 28545784 PMCID: PMC5522643 DOI: 10.1016/j.tem.2017.04.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 12/19/2022]
Abstract
Sulfonylureas are the most commonly used second-line drug class for treating type 2 diabetes mellitus (T2DM). While the cardiovascular safety of sulfonylureas has been examined in several trials and nonrandomized studies, little is known of their specific effects on sudden cardiac arrest (SCA) and related serious arrhythmic outcomes. This knowledge gap is striking, because persons with DM are at increased risk of SCA. In this review, we explore the influence of sulfonylureas on the risk of serious arrhythmias, with specific foci on ischemic preconditioning, cardiac excitability, and serious hypoglycemia as putative mechanisms. Elucidating the relationship between individual sulfonylureas and serious arrhythmias is critical, especially as the diabetes epidemic intensifies and SCA incidence increases in persons with diabetes.
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Affiliation(s)
- Charles E Leonard
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Sean Hennessy
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Xu Han
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David S Siscovick
- The New York Academy of Medicine, New York, NY 10029, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195, USA
| | - James H Flory
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Healthcare Policy and Research, Division of Comparative Effectiveness, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA; Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA
| | - Rajat Deo
- Center for Pharmacoepidemiology Research and Training, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
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