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Maraey A, Yazdi V, Chaaban N, Aglan A, Elzanaty A, Moustafa A, Karim S, He BJ. Disparities in the implantation of secondary prevention implantable cardioverter defibrillator in the United States. Pacing Clin Electrophysiol 2024. [PMID: 38967399 DOI: 10.1111/pace.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/18/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND The annual incidence of sudden cardiac death is over 300,000 in the United States (US). Historically, inpatient implantation of secondary prevention implantable cardioverter defibrillator (ICD) has been variable and subject to healthcare disparities. OBJECTIVE To evaluate contemporary practice trends of inpatient secondary prevention ICD implants within the US on the basis of race, sex, and socioeconomic status (SES). METHODS The study is a retrospective analysis of the National Inpatient Sample from 2016 to 2020 of adult discharges with a primary diagnosis of ventricular tachycardia (VT), ventricular flutter, and fibrillation (VF). Adjusted ICD implantation rates based on race, sex, and SES and associated temporal trends were calculated using multivariate regression. RESULTS A total of 193,600 primary VT/VF discharges in the NIS were included in the cohort, of which 57,895 (29.9%) had ICD placement. There was a significant racial and ethnic disparity in ICD placement for Black, Hispanic, Asian, and Native American patients as compared to White patients; adjusted odds ratio (aOR): 0.86 [p < .01], 0.90 [p = .03], 0.81[p < .01], 0.45 [p < .01], respectively. Female patients were also less likely to receive an ICD compared to male patients (aOR: 0.75, p < .01). Disparities in ICD placement remained stable over the study period (ptrend ≥ .05 in all races, both sexes and income categories). CONCLUSION Racial, sex, and SES disparities persisted for secondary prevention ICD implants in the US. An investigation into contributing factors and subsequent approaches are needed to address the modifiable causes of disparities in ICD implantation as these trends have not improved compared to historic data.
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Affiliation(s)
- Ahmed Maraey
- Division of Cardiovascular Diseases, University of Toledo, Toledo, Ohio, USA
| | - Vahid Yazdi
- University of Toledo College of Medicine, Toledo, Ohio, USA
| | - Nourhan Chaaban
- Division of Cardiovascular Diseases, University of Toledo, Toledo, Ohio, USA
| | - Amro Aglan
- Department of Internal Medicine Department, Lahey Clinic, Burlington, Massachusetts, USA
| | - Ahmed Elzanaty
- Division of Cardiovascular Diseases, University of Toledo, Toledo, Ohio, USA
| | | | - Saima Karim
- Heart and Vascular Institute, MetroHealth Medical Center/Case Western Reserve University, Cleveland, Ohio, USA
| | - Beixin Julie He
- Division of Cardiology, University of Washington, Seattle, Washington, USA
- Hospital and Specialty Medicine, VA Puget Sound Health Care System, Seattle, Washington, USA
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Hutchens J, Frawley J, Sullivan EA. Is self-advocacy universally achievable for patients? The experiences of Australian women with cardiac disease in pregnancy and postpartum. Int J Qual Stud Health Well-being 2023; 18:2182953. [PMID: 36821349 PMCID: PMC9970247 DOI: 10.1080/17482631.2023.2182953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Patient self-advocacy is valued and promoted; however, it may not be readily accessible to all. This analysis examines the experiences of women in Australia who had cardiac disease in pregnancy or the first year postpartum through the lenses of self-advocacy and gender, specifically seeking to elaborate on the contexts, impacts, barriers, and women's responses to the barriers to self-advocacy. METHOD A qualitative study design was used. Twenty-five women participated in semi-structured in-depth interviews. Data were analysed using thematic analysis. RESULTS Analysis of findings generated the following themes: 1) Silent dream scream, 2) Easier said than done, 3) Crazy-making, and 4) Concentric circles of advocacy. Regardless of women's personal attributes, knowledge and experience, self-advocating for their health was complex and difficult and had negative cardiac and psychological outcomes. CONCLUSION While the women encountered significant barriers to self-advocating, they were resilient and ultimately developed strategies to be heard and to advocate on their own behalf and that of other women. Findings can be used to identify ways to support women to self-advocate and to provide adequately resourced and culturally safe environments to enable healthcare professionals to provide person-centred care.
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Affiliation(s)
- Jane Hutchens
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia,CONTACT Jane Hutchens School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Jane Frawley
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
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Boursalie S, MacIntyre C, Sapp JL, Gray C, Abdelwahab A, Gardner M, Lee D, Matheson K, Parkash R. Disparities in Referral and Utilization of Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death. Can J Cardiol 2023; 39:1610-1616. [PMID: 37423507 DOI: 10.1016/j.cjca.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/26/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) reduce mortality in patients with reduced left ventricular ejection fraction (LVEF). We investigated sex disparities in a contemporary Canadian population for utilization of primary prevention ICDs. METHODS This was a retrospective cohort study on patients with reduced LVEF admitted to hospitals from 2010 to 2020 in Nova Scotia (population = 971,935). RESULTS There were 4406 patients eligible for ICDs: 3108 (71%) men and 1298 (29%) women. The mean follow-up time was 3.9 ± 3.0 years. Rates of coronary disease were similar between men and women (45.8% vs 44.0%; P = 0.28), but men had lower LVEF (26.6 ± 5.9% vs 27.2 ± 5.8%; P = 0.0017). The referral rate for ICD was 11% (n = 487), with 13% of men (n = 403) and 6.5% of women (n = 84) referred (P < 0.001). The ICD implantation rate in the population was 8% (n = 358), with 9.5% of men (n = 296) and 4.8% of women (n = 62) (P < 0.001) receiving the device. Men were more likely than women to receive an ICD (odds ratio 2.08, 95% confidence interval 1.61-2.70; P < 0.0001)). There was no significant difference in mortality between men and women (P = 0.2764). There was no significant difference in device therapies between men and women (43.8% vs 31.1%; P = 0.0685). CONCLUSIONS A significant disparity exists in the utilization of primary prevention ICDs between men and women in a contemporary Canadian population.
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Affiliation(s)
- Suzanne Boursalie
- Division of Cardiology, Department of Medicine, Dalhousie, University, Halifax, Nova Scotia, Canada
| | - Ciorsti MacIntyre
- Division of Cardiology, Department of Medicine, Dalhousie, University, Halifax, Nova Scotia, Canada
| | - John L Sapp
- Division of Cardiology, Department of Medicine, Dalhousie, University, Halifax, Nova Scotia, Canada
| | - Chris Gray
- Division of Cardiology, Department of Medicine, Dalhousie, University, Halifax, Nova Scotia, Canada
| | - Amir Abdelwahab
- Division of Cardiology, Department of Medicine, Dalhousie, University, Halifax, Nova Scotia, Canada
| | - Martin Gardner
- Division of Cardiology, Department of Medicine, Dalhousie, University, Halifax, Nova Scotia, Canada
| | - David Lee
- Division of Cardiology, Department of Medicine, Dalhousie, University, Halifax, Nova Scotia, Canada
| | - Kara Matheson
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Ratika Parkash
- Division of Cardiology, Department of Medicine, Dalhousie, University, Halifax, Nova Scotia, Canada.
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Ingelaere S, Hoffmann R, Guler I, Vijgen J, Mairesse GH, Blankoff I, Vandekerckhove Y, le Polain de Waroux JB, Vandenberk B, Willems R. Inequality between women and men in ICD implantation. IJC HEART & VASCULATURE 2022; 41:101075. [PMID: 35782706 PMCID: PMC9240366 DOI: 10.1016/j.ijcha.2022.101075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022]
Abstract
Background The impact of sex on ICD implantation practice and survival remain a topic of controversy. To assess sex-specific differences in ICD implantation practice we compared clinical characteristics and survival in women and men. Methods From a nationwide registry, all new ICD implantations performed between 01/02/2010 and 31/01/2019 in Belgian patients were analyzed retrospectively. Baseline characteristics and survival rates were compared between sexes. To identify predictors of mortality, multivariable Cox regression was performed. Results Only 3096 (20.9%) of 14,787 ICD implantations were performed in women. Within each type of underlying cardiomyopathy, the proportion women were lower than men. The main indication in men was ischemic vs dilated cardiomyopathy in women. Women were overall younger (59.1 ± 15.1 vs 62.6 ± 13.1 years; p < 0.001) and had less comorbidities except for oncological disease. More women functioned in NYHA-class III (33.6% vs 27.9%; p < 0.001) and had a QRS > 150 ms (29.4% vs 24.3%; p < 0.001), consistent with a higher use of CRT-D devices (31.7% vs 25.1%; p < 0.001). Women had more complications, reflected by the need to more re-interventions within 1 year (4.3% vs 2.7%, p < 0.001). After correction for covariates, sex-category was not a significant predictor of mortality (p = 0.055). Conclusion There is a significant sex-disparity in ICD implantation rates, not fully explained by epidemiological differences in the prevalence of cardiomyopathies, which could imply an undertreatment of women. Women differ from men in baseline characteristics at implantation suggesting a selection bias. Further research is necessary to evaluate if women receive equal sudden cardiac death prevention.
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Abstract
Racism and racial bias influence the lives and cardiovascular health of minority individuals. The fact that minority groups tend to have a higher burden of cardiovascular disease risk factors is often a result of racist policies that restrict opportunities to live in healthy neighbourhoods and have access to high-quality education and healthcare. The fact that minorities tend to have the worst outcomes when cardiovascular disease develops is often a result of institutional or individual racial bias encountered when they interact with the healthcare system. In this review, we discuss bias, discrimination, and structural racism from the viewpoints of cardiologists in Canada, the United Kingdom, and the US, and how racial bias impacts cardiovascular care. Finally, we discuss proposals to mitigate the impact of racism in our specialty.
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Gender Differences in Implantable Cardioverter-Defibrillator Utilization for Primary Prevention of Sudden Cardiac Death. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00954-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Johnson AE, Bell YK, Hamm ME, Saba SF, Myaskovsky L. A Qualitative Analysis of Patient-Related Factors Associated With Implantable Cardioverter Defibrillator Acceptance. Cardiol Ther 2020; 9:421-432. [PMID: 32476091 PMCID: PMC7584700 DOI: 10.1007/s40119-020-00180-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Patient-related factors determining implantable cardioverter-defibrillator (ICD) use for primary prevention of sudden cardiac death in patients with cardiomyopathy have not been well explored. To assess race and sex differences regarding ICD preferences in this patient population, we sought to analyze a diverse cohort of patients with heart failure (HF) with reduced ejection fraction. METHODS We conducted qualitative interviews of 28 adults with severe HF and either (1) an ICD or (2) no ICD. Interviews were recorded, transcribed, and coded using an inductively developed codebook by independent investigators. Coding was fully adjudicated and transcripts were reviewed to identify themes. RESULTS We recruited patients between 12/2015 and 06/2017, primarily from the outpatient cardiology clinic (24/28 = 86%). Half were women (50%) and 13/28 (46%) were black. Eight did not have an ICD. Neither race nor sex was associated with ICD. Four themes emerged: (1) HF requiring an ICD is profoundly disruptive to patients' lives; (2) patients had positive, yet unrealistic opinions of ICDs; or (3) Patients had negative/ambivalent opinions of ICDs; (4) medical decision-making included aspects of shared decision-making and informed consent. CONCLUSIONS Patients without ICDs perceived less benefit from ICDs and had less decision support. Participants viewed conversations with providers as insufficient. Needed interventions include the development and validation of processes for informed decisions about ICDs.
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Affiliation(s)
- Amber E Johnson
- Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Yamira K Bell
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Megan E Hamm
- Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samir F Saba
- Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Larissa Myaskovsky
- Internal Medicine and Psychiatry, University of Pittsburgh, and Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
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Isath A, Correa A, Siroky GP, Perimbeti S, Mohammed S, Chahal CAA, Padmanabhan D, Mehta D. Trends, burden, and impact of arrhythmia on cardiac amyloid patients: A 16-year nationwide study from 1999 to 2014. J Arrhythm 2020; 36:727-734. [PMID: 32782646 PMCID: PMC7411211 DOI: 10.1002/joa3.12376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patients with cardiac amyloidosis (CA) have increased mortality, which can be explained in part by an increased risk of arrhythmias. The burden of arrhythmias in CA, their predictors, and impact on in-hospital outcomes remains unclear. The role of implantable cardioverter-defibrillators (ICD) in this population is also uncertain. METHODS We queried the National Inpatient Sample (NIS) using ICD-9-CM codes 277.39 and 425.7 to identify CA. Twelve common arrhythmias were extracted using appropriate, validated ICD-9-CM codes. ICD implantation was identified using procedure ICD-9 codes 37.94 to 37.98, 00.51 and 00.54. RESULTS There were a total of 145,920 CA hospitalizations between 1999 and 2014 in the United States and 56,199 (38.5%) of them were associated with arrhythmias. The prevalence of arrhythmias remained relatively constant from 41.5% in 1999 to 40.2% in 2014. The most common arrhythmia was atrial fibrillation (25.4%). In-patient mortality was significantly higher in CA patients with arrhythmias (10.4% vs 6.5%, P < .001). ICD implantation was performed in 1,381 (0.94%) patients with CA and analysis revealed an incremental trend in implantation over the study period (0.48% in 1999 to 0.65% in 2014). In-hospital mortality was significantly lower in patients who underwent ICD implantation (3.7% vs 8%; P = .0078). CA patients with arrhythmias also had an increased cost of hospitalization and length of stay ($65,046 ± 1,079 vs $53,322 ± 687 and 8.3 ± 0.1 vs 7.4 ± 0.1 days, respectively; P < .0001). CONCLUSION Cardiac arrhythmias are common in patients with CA and are associated with worse in-hospital outcomes, increased length of stay, and cost of hospitalization.
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Affiliation(s)
- Ameesh Isath
- Department of MedicineMount Sinai St. Luke's and Mount Sinai WestNew YorkNYUSA
| | - Ashish Correa
- Department of CardiologyMount Sinai St. Luke'sNew YorkNYUSA
| | | | - Stuthi Perimbeti
- Department of MedicineMount Sinai St. Luke's and Mount Sinai WestNew YorkNYUSA
| | - Selma Mohammed
- Department of Cardiovascular MedicineMedStar Washington Hospital CenterWashingtonDCUSA
| | - C. Anwar A. Chahal
- Department of Cardiovascular MedicineMayo ClinicJacksonvilleFLUSA
- University of PennsylvaniaPhiladelphiaPAUSA
| | - Deepak Padmanabhan
- Department of Cardiovascular MedicineMayo ClinicJacksonvilleFLUSA
- Sri Jayadeva Institute of Cardiovascular Sciences and Research, CardiologyBengaluruKarnatakaIndia
| | - Davendra Mehta
- Department of CardiologyMount Sinai St. Luke'sNew YorkNYUSA
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Affiliation(s)
- Amitava Banerjee
- Institute of Health Informatics, University College London, London NW1 2DA, UK
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10
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Ali-Ahmed F, Matlock D, Zeitler EP, Thomas KL, Haines DE, Al-Khatib SM. Physicians' perceptions of shared decision-making for implantable cardioverter-defibrillators: Results of a physician survey. J Cardiovasc Electrophysiol 2019; 30:2420-2426. [PMID: 31515880 DOI: 10.1111/jce.14178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/26/2019] [Accepted: 08/31/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Centers for Medicare and Medicaid Services has mandated the use of shared decision-making (SDM) for implantable cardioverter-defibrillator (ICD) implantation. SDM tools help facilitate quality SDM by presenting patients with balanced evidence-based facts related to risk and benefits. Perceptions of ICD implantation may differ based on patients' sex and race. OBJECTIVE To determine if and how physicians are incorporating SDM in counseling patients about ICD and if they are aware of sex- and race-based differences in patients' perception of ICDs. METHODS This was a pilot study involving an online survey targeting attending physicians who implant ICDs. Physicians were randomly selected by a computer-based program; 350 surveys were sent. RESULTS Of the 124 (35%) respondents to the survey, 102 (84%) met the inclusion criteria, and of those, 99 (97%) were adult electrophysiologists. Most physicians (90, 88%) stated they engaged in SDM during the general consent process. Sixty-three (62%) physicians discuss end of life issues while obtaining general consent. Forty-four (43%) physicians said they use an existing SDM tool with the Colorado SDM tool being the most common (39, 89%). The majority of physicians were unaware of sex- and race-based differences in perceptions related to ICD implantation (sex 64, 63% and race 63, 62%). CONCLUSION A vast majority of physicians are engaging in SDM; however less than half are using a formal SDM tool, and a minority of physicians were aware of sex- and race-based differences in patients' perception of ICD implantation. Sex- and race-based tools might help address this gap.
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Affiliation(s)
- Fatima Ali-Ahmed
- Duke Clinical Research Institute, Durham, North Carolina.,Division of Cardiology, Beaumont Health, Michigan
| | - Daniel Matlock
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Emily P Zeitler
- Division of Cardiology, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine, Dartmouth, Lebanon, New Hampshire
| | - Kevin L Thomas
- Duke Clinical Research Institute, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | | | - Sana M Al-Khatib
- Duke Clinical Research Institute, Durham, North Carolina.,Division of Cardiology, Duke University Medical Center, Durham, North Carolina
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Roh SY, Choi JI, Kim MS, Cho EY, Kim YG, Lee KN, Baek YS, Shim J, Kim JS, Park SW, Chugh SS, Kim YH. Trends in the use of implantable cardioverter-defibrillators for prevention of sudden cardiac arrest: A South Korean nationwide population-based study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1086-1094. [PMID: 31197835 DOI: 10.1111/pace.13741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/18/2019] [Accepted: 06/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The benefits of implantable cardioverter-defibrillators (ICDs) for the prevention of sudden cardiac arrest (SCA) are well established. However, a significant knowledge gap remains regarding current indications and utilization of ICDs in real-world settings in Asia. METHODS Patients who underwent ICD implantation in South Korea from 2007 to 2015 were identified using the Health Insurance Review and Assessment Service database. We investigated trends in use of ICD for the prevention of SCA. RESULTS A total of 4649 ICDs were implanted during 9 years. ICDs were implanted in 1448 (31.2%) patients for primary prevention and in 3201 (68.8%) for secondary prevention. The proportion of ICDs for primary prevention increased from 6.1% in 2007 to 41.9% in 2015. Primary prevention was more frequent in older (≥40 years) recipients (34.4% vs. 14.6%, P < .0001). The rates of ICD implantation for primary prevention were highest for nonischemic dilated cardiomyopathy (55.1%) and lowest (9.7%) for inherited primary arrhythmia syndrome (IPAS). CONCLUSION Our data showed a trend of progressively increasing rates of ICD implantation in Asia, especially for primary prevention of SCA. Primary prevention as an indication for ICD in patients with IPAS remained low.
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Affiliation(s)
- Seung-Young Roh
- Division of Cardiology, Korea University College of Medicine, Korea University Medicine, Guro hospital, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Min Sun Kim
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Cho
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yun Gi Kim
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kwang-No Lee
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yong-Soo Baek
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jin Seok Kim
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sang-Weon Park
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Sumeet S Chugh
- The Smidt Heart Institute, Cedars-Sinai, Los Angeles, California
| | - Young-Hoon Kim
- Division of Cardiology, Korea University College of Medicine, Korea University Medical Center, Korea University Anam Hospital, Seoul, Republic of Korea
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