1
|
Thiruganasambandamoorthy V, Probst MA, Poterucha TJ, Sandhu RK, Toarta C, Raj SR, Sheldon R, Rahgozar A, Grant L. Role of Artificial Intelligence in Improving Syncope Management. Can J Cardiol 2024:S0828-282X(24)00429-X. [PMID: 38838932 DOI: 10.1016/j.cjca.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024] Open
Abstract
Syncope is common in the general population and a common presenting symptom in acute care settings. Substantial costs are attributed to the care of patients with syncope. Current challenges include differentiating syncope from its mimickers, identifying serious underlying conditions that caused the syncope, and wide variations in current management. Although validated risk tools exist, especially for short-term prognosis, there is inconsistent application, and the current approach does not meet patient needs and expectations. Artificial intelligence (AI) techniques, such as machine learning methods including natural language processing, can potentially address the current challenges in syncope management. Preliminary evidence from published studies indicates that it is possible to accurately differentiate syncope from its mimickers and predict short-term prognosis and hospitalisation. More recently, AI analysis of electrocardiograms has shown promise in detection of serious structural and functional cardiac abnormalities, which has the potential to improve syncope care. Future AI studies have the potential to address current issues in syncope management. AI can automatically prognosticate risk in real time by accessing traditional and nontraditional data. However, steps to mitigate known problems such as generalisability, patient privacy, data protection, and liability will be needed. In the past AI has had limited impact due to underdeveloped analytical methods, lack of computing power, poor access to powerful computing systems, and availability of reliable high-quality data. All impediments except data have been solved. AI will live up to its promise to transform syncope care if the health care system can satisfy AI requirement of large scale, robust, accurate, and reliable data.
Collapse
Affiliation(s)
- Venkatesh Thiruganasambandamoorthy
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Marc A Probst
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Timothy J Poterucha
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Roopinder K Sandhu
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Cristian Toarta
- Department of Emergency Medicine, McGill University, Montréal, Québec, Canada; McGill University Health Centre, Montréal, Québec, Canada
| | - Satish R Raj
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Robert Sheldon
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Arya Rahgozar
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Engineering Design and Teaching Innovation, University of Ottawa, Ottawa, Ontario, Canada
| | - Lars Grant
- Department of Emergency Medicine, McGill University, Montréal, Québec, Canada; Lady Davis Research Institute, Montréal, Québec, Canada; Jewish General Hospital, Montréal, Québec, Canada
| |
Collapse
|
2
|
Francisco-Pascual J, Rivas-Gándara N, Bach-Oller M, Badia-Molins C, Maymi-Ballesteros M, Benito B, Pérez-Rodon J, Santos-Ortega A, Sambola-Ayala A, Roca-Luque I, Cantalapiedra-Romero J, Rodríguez-Silva J, Pascual-González G, Moya-Mitjans À, Ferreira-González I. Sex-Related Differences in Patients With Unexplained Syncope and Bundle Branch Block: Lower Risk of AV Block and Lesser Need for Cardiac Pacing in Women. Front Cardiovasc Med 2022; 9:838473. [PMID: 35282384 PMCID: PMC8914040 DOI: 10.3389/fcvm.2022.838473] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To analyze if there are sex-related differences in patients with unexplained syncope and bundle branch block (BBB). Background Despite increasing awareness that sex is a major determinant of the incidence, etiology, and the outcomes of different arrhythmias, no studies have examined differences in presentation and outcomes between men and women with syncope and BBB. Methods Cohort study of consecutive patients with unexplained syncope and BBB was included from January 2010 to January 2021 with a median follow-up time of 3.4 years [interquartile range (IQR) 1.7–6.0 years]. They were evaluated by a stepwise workup protocol based on electrophysiological study (EPS) and long-term follow-up with an implantable cardiac monitor (ICM). Results Of the 443 patients included in the study, 165 (37.2%) were women. Compared with men, women had less diabetes (25.5 vs. 39.9%, p = 0.002) and less history of ischemic heart disease (IHD; 13.3 vs. 25.9%, p = 0.002). Left bundle branch block (LBBB) was more frequent in women (55.2 vs. 27.7%, p < 0.001) while right bundle branch block (RBBB) was more frequent in men (41.5 vs. 67.7%, p < 0.001). His to ventricle (HV) interval in the EPS was shorter in women (58 ms [IQR 52–71] vs. 60 ms [IQR 52–73], p = 0.035) and less women had an HV interval longer than 70 ms (28.5 vs. 38.1%, p = 0.039), however, EPS and ICM offered a similar diagnostic yield in both sexes (40.6 vs. 48.9% and 48.4% vs. 51.1%, respectively). Women had a lower risk of developing atrioventricular block (AVB) (adjusted odds ratio [OR] 0.44–95% CI 0.26–0.74, p = 0.002) and of requiring permanent pacemaker implantation (adjusted hazard ratio [HR] 0.72–95% CI: 0.52–0.99, p = 0.046). The mortality rate was lower in women (4.5 per 100 person-years [95% CI 3.1–6.4 per 100 person-years] vs. 7.3 per 100 person-years [95% CI 5.9–9.1 per 100 person-years]). Conclusions Compared to men, women with unexplained syncope and BBB have a lower risk of AVB and of requiring cardiac pacing. A stepwise diagnostic approach has a similar diagnostic yield in both sexes, and it seems appropriate to guide the treatment and avoid unnecessary pacemaker implantation, especially in women.
Collapse
Affiliation(s)
- Jaume Francisco-Pascual
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Nuria Rivas-Gándara
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Bach-Oller
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Clara Badia-Molins
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Manel Maymi-Ballesteros
- Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Begoña Benito
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Alba Santos-Ortega
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonia Sambola-Ayala
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ivo Roca-Luque
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.,Arrhythmia Section, Institut Clinic Cardiovascular, Hospital Clínic, Barcelona, Spain
| | - Javier Cantalapiedra-Romero
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Rodríguez-Silva
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Gabriel Pascual-González
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Àngel Moya-Mitjans
- Arrhythmia Unit, Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Cardiology Department, Hospital Universitari Dexeus, Barcelona, Spain
| | - Ignacio Ferreira-González
- Department of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Cardiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
4
|
Williams ND, Huser V, Rhame F, Mayer CS, Fung KW. The changing patterns of comorbidities associated with human immunodeficiency virus infection, a longitudinal retrospective cohort study of Medicare patients. Medicine (Baltimore) 2021; 100:e25428. [PMID: 33879673 PMCID: PMC8078399 DOI: 10.1097/md.0000000000025428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/15/2021] [Indexed: 01/04/2023] Open
Abstract
The objective of this paper is to determine the temporal trend of the association of 66 comorbidities with human immunodeficiency virus (HIV) infection status among Medicare beneficiaries from 2000 through 2016.We harvested patient level encounter claims from a 17-year long 100% sample of Medicare records. We used the chronic conditions warehouse comorbidity flags to determine HIV infection status and presence of comorbidities. We prepared 1 data set per year for analysis. Our 17 study data sets are retrospective annualized patient level case histories where the comorbidity status reflects if the patient has ever met the comorbidity case definition from the start of the study to the analysis year.We implemented one logistic binary regression model per study year to discover the maximum likelihood estimate (MLE) of a comorbidity belonging to our binary classes of HIV+ or HIV- study populations. We report MLE and odds ratios by comorbidity and year.Of the 66 assessed comorbidities, 35 remained associated with HIV- across all model years, 19 remained associated with HIV+ across all model years. Three comorbidities changed association from HIV+ to HIV- and 9 comorbidities changed association from HIV- to HIV+.The prevalence of comorbidities associated with HIV infection changed over time due to clinical, social, and epidemiological reasons. Comorbidity surveillance can provide important insights into the understanding and management of HIV infection and its consequences.
Collapse
Affiliation(s)
- Nick D. Williams
- The Lister Hill National Center for Biomedical Communications at the National Library of Medicine, National Institutes of Health in the United States, Bethesda, Maryland
| | - Vojtech Huser
- The Lister Hill National Center for Biomedical Communications at the National Library of Medicine, National Institutes of Health in the United States, Bethesda, Maryland
| | - Frank Rhame
- Division of Infectious Diseases and International Medicine at the University of Minnesota School of Medicine, Minnesota
| | - Craig S. Mayer
- The Lister Hill National Center for Biomedical Communications at the National Library of Medicine, National Institutes of Health in the United States, Bethesda, Maryland
| | - Kin Wah Fung
- The Lister Hill National Center for Biomedical Communications at the National Library of Medicine, National Institutes of Health in the United States, Bethesda, Maryland
| |
Collapse
|
5
|
Tran DT, Sheldon RS, Kaul P, Sandhu RK. The Current and Future Hospitalization Cost Burden of Syncope in Canada. CJC Open 2020; 2:222-228. [PMID: 32695972 PMCID: PMC7365814 DOI: 10.1016/j.cjco.2020.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/28/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Single-center studies have shown the high costs associated with the hospital evaluation of syncope. National cost estimates for syncope-related hospitalizations are sparse, and none exist in Canada. METHODS The Canadian Institute for Health Information Discharge Abstract Database was used to identify acute care hospitalizations with a primary diagnosis of syncope between fiscal years (FY) 2004 and 2015 in all provinces and territories (except Quebec). We used multiple linear regression to calculate the trends in prevalence of hospital admissions and generalized linear regression to estimate the costs of a hospitalization. The syncope hospitalization rate and the cost per hospitalization in Quebec were assumed to be the average of the rest of the country. The future hospitalization cost burden of syncope was projected to 2030. RESULTS There were 128,263 hospitalizations for a primary diagnosis of syncope over the 10-year study period, resulting in a total cost of $619.9 million (Canadian). An estimate of 41,044 syncope hospitalizations occurred in Quebec, costing $198.7 million. The total hospitalization cost of syncope in Canada was estimated at $818.5 million. The annual costs of syncope hospitalizations increased from $66.6 to $68.5 million between FY2004 and FY2015, respectively, and are projected to increase to $87.1 million in 2030. CONCLUSION Hospitalization costs for syncope in Canada are high and rising. Research is needed to identify opportunities to deliver more efficient and cost-effective care.
Collapse
Affiliation(s)
- Dat T. Tran
- Institute of Health Economics, Edmonton, Alberta, Canada
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Robert S. Sheldon
- Division of Cardiology, University of Calgary, Calgary, Alberta, Canada
| | - Padma Kaul
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Roopinder K. Sandhu
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
- Division of Cardiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
6
|
Raj SR, Ahmed SB, Sheldon RS. Understanding vasovagal syncope: a role for sex and gender. Clin Auton Res 2020; 30:369-370. [PMID: 32300948 DOI: 10.1007/s10286-020-00689-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/11/2023]
Affiliation(s)
- Satish R Raj
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, GAC70 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada. .,Division of Clinical Pharmacology, Department of Medicine, Autonomic Dysfunction Center, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Sofia B Ahmed
- Department of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Robert S Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, GAC70 HRIC Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.,Department of Medicine, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| |
Collapse
|