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Sridharan L, Wayda B, Truby LK, Latif F, Restaino S, Takeda K, Takayama H, Naka Y, Colombo PC, Maurer M, Farr MA, Topkara VK. Mechanical Circulatory Support Device Utilization and Heart Transplant Waitlist Outcomes in Patients With Restrictive and Hypertrophic Cardiomyopathy. Circ Heart Fail 2019; 11:e004665. [PMID: 29664407 DOI: 10.1161/circheartfailure.117.004665] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 02/13/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with restrictive cardiomyopathy (RCM) and hypertrophic cardiomyopathy (HCM) generally are considered poor candidates for mechanical circulatory support devices (MCSDs) and often not able to be bridged mechanically to heart transplantation. This study characterized MCSD utilization and transplant waitlist outcomes in patients with RCM/HCM under the current allocation system and discusses changes in the era of the new donor allocation system. METHODS AND RESULTS Patients waitlisted from 2006 to 2016 in the United Network for Organ Sharing registry were stratified by RCM/HCM versus other diagnoses. MCSD utilization and waitlist duration were analyzed by propensity score models. Waitlist outcomes were assessed by cumulative incidence functions with competing events. Predictors of waitlist mortality or delisting for worsening status in patients with RCM/HCM were identified by proportional hazards model. Of 30 608 patients on the waitlist, 5.1% had RCM/HCM. Patients with RCM/HCM had 31 fewer waitlist days (P<0.01) and were ≈26% less likely to receive MCSD (P<0.01). Cumulative incidence of waitlist mortality was similar between cohorts; however, patients with RCM/HCM had higher incidence of heart transplantation. Predictors of waitlist mortality or delisting for worsening status in patients with RCM/HCM without MCSD support included estimated glomerular filtration rate <60 mL/min per 1.73 m2, pulmonary capillary wedge pressure >20 mm Hg, inotrope use, and subjective frailty. CONCLUSIONS Patients with RCM/HCM are less likely to receive MCSD but have similar waitlist mortality and slightly higher incidence of transplantation compared with other patients. The United Network for Organ Sharing RCM/HCM risk model can help identify patients who are at high risk for clinical deterioration and in need of expedited heart transplantation.
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Affiliation(s)
- Lakshmi Sridharan
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Brian Wayda
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Lauren K Truby
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Farhana Latif
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Susan Restaino
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Koji Takeda
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Hiroo Takayama
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Yoshifumi Naka
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Paolo C Colombo
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Mathew Maurer
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Maryjane A Farr
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY
| | - Veli K Topkara
- From the Division of Cardiology, Department of Medicine (L.S., B.W., L.K.T., F.L., S.R., P.C.C., M.M., M.J.F., V.K.T.) and Division of Cardiac Surgery, Department of Surgery (K.T., H.T., Y.N.), Columbia University College of Physicians and Surgeons, New York, NY.
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Cahan A, Cahan S, Cimino JJ. Computer-aided assessment of the generalizability of clinical trial results. Int J Med Inform 2017; 99:60-66. [PMID: 28118923 DOI: 10.1016/j.ijmedinf.2016.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 12/14/2016] [Accepted: 12/29/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND The effects of an intervention on patients from populations other than that included in a trial may vary as a result of differences in population features, treatment administration, or general setting. Determining the generalizability of a trial to a target population is important in clinical decision making at both the individual practitioner and policy-making levels. However, awareness to the challenges associated with the assessment of generalizability of trials is low and tools to facilitate such assessment are lacking. METHODS We review the main factors affecting the generalizability of a clinical trial results beyond the trial population. We then propose a framework for a standardized evaluation of parameters relevant to determining the external validity of clinical trials to produce a "generalizability score". We then apply this framework to populations of patients with heart failure included in trials, cohorts and registries to demonstrate the use of the generalizability score and its graphic representation along three dimensions: participants' demographics, their clinical profile and intervention setting. We use the generalizability score to compare a single trial to multiple "target" clinical scenarios. Additionally, we present the generalizability score of several studies with regard to a single "target" population. RESULTS Similarity indices vary considerably between trials and target population, but inconsistent reporting of participant characteristics limit head-to-head comparisons. CONCLUSION We discuss the challenges involved in performing automatic assessment of trial generalizability at scale and propose the adoption of a standard format for reporting the characteristics of trial participants to enable better interpretation of their results.
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Affiliation(s)
- Amos Cahan
- IBM T.J. Watson Research Center, Yorktown Heights, NY, United States.
| | - Sorel Cahan
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - James J Cimino
- Informatics Institute, University of Alabama at Birmingham, Birmingham, AL, United States
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Matsushita K, Ballew SH, Coresh J. Influence of chronic kidney disease on cardiac structure and function. Curr Hypertens Rep 2015; 17:581. [PMID: 26194332 DOI: 10.1007/s11906-015-0581-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chronic kidney disease (CKD), the presence of kidney dysfunction and/or damage, is a worldwide public health issue. Although CKD is independently associated with various subtypes of cardiovascular diseases, a recent international collaborative meta-analysis demonstrates that CKD is particularly strongly associated with heart failure, suggesting its critical impact on cardiac structure and function. Although numerous studies have investigated the association of CKD and cardiac structure and function, these studies substantially vary regarding source populations and methodology (e.g., measures of CKD and/or parameters of cardiac structure and function), making it difficult to reach universal conclusions. Nevertheless, in this review, we comprehensively examine relevant studies, discuss potential mechanisms linking CKD to alteration of cardiac structure and function, and demonstrate clinical implications as well as potential future research directions. We exclusively focus on studies investigating both CKD measures, kidney function (i.e., glomerular filtration rate [GFR], creatinine clearance, or levels of filtration markers), and kidney damage represented by albuminuria, since current international clinical guidelines of CKD recommend staging CKD and assessing its clinical risk based on both GFR and albuminuria.
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Affiliation(s)
- Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-600, Baltimore, MD, USA,
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