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Scherer LD, Lin GA, Kini V. Impact of a patient-centered tool to reduce misconceptions about coronary artery disease and its treatment: The CAD roadmap. PEC INNOVATION 2024; 4:100303. [PMID: 38911020 PMCID: PMC11193033 DOI: 10.1016/j.pecinn.2024.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/25/2024]
Abstract
Objective Health misinformation is common and can lead to harmful behaviors such as medication non-adherence. We assessed the impact of a novel patient educational tool focused on overcoming misconceptions among patients with coronary artery disease (CAD). Methods We developed the CAD Roadmap, an educational tool aimed at explaining the disease trajectory and overcoming common disease misconceptions (such as that statin medications are not beneficial). We designed a pilot survey to assess patients' 1) CAD-related knowledge, 2) medication-taking behavior, and 3) acceptability of the Roadmap. Survey participants were recruited online. CAD knowledge scores were compared with repeated measures t-tests. Results Among 114 patients with CAD (mean age 67 years, 63% male), average CAD-related knowledge was 79.0% pre-test and 89.7% after review of the CAD Roadmap (p < .001). After review of the Roadmap, 24% indicated they planned to take their medications more regularly, 93% agreed it was helpful in understanding medication benefits, and 77% felt more empowered to participate in medical decisions. Conclusion The CAD Roadmap was evaluated positively, improved disease-related knowledge, and has the potential to improve adherence to treatments. Innovation Unlike many other interventions, the CAD Roadmap is specifically designed to overcome common misconceptions to improve health behaviors.
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Affiliation(s)
- Laura D. Scherer
- University of Colorado Anschutz Medical Campus, Department of Medicine, Aurora, CO, USA
| | - Grace A. Lin
- University of California San Francisco, Department of Medicine, San Francisco, CA, USA
| | - Vinay Kini
- Weill Cornell Medical College, Department of Medicine, New York, NY, USA
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Koshy AN, Stone GW, Sartori S, Dhulipala V, Giustino G, Spirito A, Farhan S, Smith KF, Feng Y, Vinayak M, Salehi N, Tanner R, Hooda A, Krishnamoorthy P, Sweeny JM, Khera S, Dangas G, Filsoufi F, Mehran R, Kini AS, Fuster V, Sharma SK. Outcomes Following Percutaneous Coronary Intervention in Patients With Multivessel Disease Who Were Recommended for But Declined Coronary Artery Bypass Graft Surgery. J Am Heart Assoc 2024; 13:e033931. [PMID: 38818962 PMCID: PMC11255644 DOI: 10.1161/jaha.123.033931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/01/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Patients may prefer percutaneous coronary intervention (PCI) over coronary artery bypass graft (CABG) surgery, despite heart team recommendations. The outcomes in such patients have not been examined. We sought to examine the results of PCI in patients who were recommended for but declined CABG. METHODS AND RESULTS Consecutive patients with stable ischemic heart disease and unprotected left main or 3-vessel disease or Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score >22 who underwent PCI after heart team review between 2013 and 2020 were included. Patients were categorized into 3 groups according to heart team recommendations on the basis of appropriate use criteria: (1) PCI-recommended; (2) CABG-eligible but refused CABG (CABG-refusal); and (3) CABG-ineligible. The primary end point was the composite of death, myocardial infarction, or stroke at 1 year. The study included 3687 patients undergoing PCI (PCI-recommended, n=1718 [46.6%]), CABG-refusal (n=1595 [43.3%]), and CABG-ineligible (n=374 [10.1%]). Clinical and procedural risk increased across the 3 groups, with the highest comorbidity burden in CABG-ineligible patients. Composite events within 1 year after PCI occurred in 55 (4.1%), 91 (7.0%), and 41 (14.8%) of patients in the PCI-recommended, CABG-refusal, and CABG-ineligible groups, respectively. After multivariable adjustment, the risk of the primary composite outcome was significantly higher in the CABG-refusal (hazard ratio [HR], 1.67 [95% CI, 1.08-3.56]; P=0.02) and CABG-ineligible patients (HR, 3.26 [95% CI, 1.28-3.65]; P=0.004) groups compared with the reference PCI-recommended group, driven by increased death and stroke. CONCLUSIONS Cardiovascular event rates after PCI were significantly higher in patients with multivessel disease who declined or were ineligible for CABG. Our findings provide real-world data to inform shared decision-making discussions.
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Affiliation(s)
- Anoop N. Koshy
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
- Department of CardiologyThe Royal Melbourne HospitalMelbourneVictoriaAustralia
- Department of Cardiology and The University of MelbourneAustin HealthMelbourneVictoriaAustralia
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Vishal Dhulipala
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Gennaro Giustino
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Alessandro Spirito
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Serdar Farhan
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Kenneth F. Smith
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Yihan Feng
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Manish Vinayak
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Negar Salehi
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Richard Tanner
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Amit Hooda
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Parasuram Krishnamoorthy
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Joseph M. Sweeny
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Sahil Khera
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Farzan Filsoufi
- Department of Cardiac SurgeryIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
- Center for Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Annapoorna S. Kini
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Valentin Fuster
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Samin K. Sharma
- The Zena and Michael A. Wiener Cardiovascular InstituteIcahn School of Medicine at Mount SinaiNew YorkNY
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King DJ, Eskander C, Ricci J, Gittess D, Patel R, Bourne M, Budweg J, Winchester DE. Systematic Review of Literature Citing the ISCHEMIA Trial. Curr Cardiol Rep 2024; 26:325-329. [PMID: 38492177 DOI: 10.1007/s11886-024-02031-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
PURPOSE OF REVIEW Optimal therapy for patients with chronic coronary artery disease (CCD) has long been a topic under investigation and a subject of debate. Seeking to clarify appropriate management, the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial compared medical management versus coronary angiography for patients with stable ischemic heart disease. Its reception in the medical community has been met with both acclaim and criticism. In light of such disparate views of this trial, a systematic review of the literature citing the ISCHEMIA trial was performed. RECENT FINDINGS All articles citing the ISCHEMIA trial on PubMed as of July 21, 2023, were compiled and underwent qualitative analysis. A total of 430 articles were evaluated; 109 (25.3%) did not offer substantial commentary on ISCHEMIA and cite it as background evidence for further study. Of the commentary articles, the majority (224, 52.1%) gave balanced, honest appraisals of the ISCHEMIA trial. A total of 46 (10.7%) strongly praised the trial while another 39 (9.1%) were strongly critical of the results. Almost three-quarters of the literature citing the ISCHEMIA trial was commentary in nature, with roughly equal distribution across the spectrum of praise and criticism. Despite being one of the largest studies on CCD and coronary revascularization ever conducted, the impact of ISCHEMIA on the cardiology community appears to be mixed.
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Affiliation(s)
- David J King
- Department of Medicine, University of Florida, Gainesville, FL, USA.
| | | | - Jacob Ricci
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - David Gittess
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Rushi Patel
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Mitchell Bourne
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Jeffery Budweg
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - David E Winchester
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
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Ostromohov G, Fibelman M, Hirsch A, Ron Y, Cohen NA, Kariv R, Deutsch L, Kornblum J, Anbar R, Maharshak N, Fliss-Isakov N. Assessment of patients' understanding of inflammatory bowel diseases: Development and validation of a questionnaire. United European Gastroenterol J 2021; 10:104-114. [PMID: 34939350 PMCID: PMC8830304 DOI: 10.1002/ueg2.12182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 11/02/2021] [Indexed: 12/15/2022] Open
Abstract
Background Educating patients regarding thier inflammatory bowel disease (IBD) is important for their empowerment and disease management. We aimed to develop a questionnaire to evaluate patient understanding and knowledge of IBD. Methods We have developed the Understanding IBD Questionnaires (U‐IBDQ), consisting of multiple‐choice questions in two versions [for Crohn's disease (CD) and ulcerative colitis (UC)]. The questionnaires were tested for content and face validity, readability, responsiveness and reliability. Convergent validity was assessed by correlating the U‐IBDQ score with physician's subjective assessment scores. Discriminant validity was assessed by comparison to healthy controls (HC), patients with chronic gastrointestinal (GI) conditions other than IBD, and to GI nurses. Multivariate analysis was performed to determine factors associated with a high level of disease understanding. Results The study population consisted of IBD patients (n = 106), HC (n = 35), chronic GI disease patients (n = 38) and GI nurses (n = 19). Mean U‐IBDQ score among IBD patients was 56.5 ± 21.9, similar for CD and UC patients (P = 0.941), but significantly higher than that of HC and chronic GI disease patients and lower than that of GI nurses (P < 0.001), supporting its discriminant validity. The U‐IBDQ score correlated with physician's subjective score (r = 0.747, P < 0.001) and was found to be reliable (intra‐class correlation coefficient = 0.867 P < 0.001). Independent factors associated with high U‐IBDQ scores included academic education (OR = 1.21, 95% CI 1.10–1.33, P < 0.001), biologic therapy experience (OR = 1.24, 95% CI 1.01–1.53, P = 0.046), and IBD diagnosis at <21 years of age (OR = 2.97, 95% CI 1.05–8.87, P = 0.050). Conclusions The U‐IBDQ is a validated, reliable and short, self‐reported questionnaire that can be used for assessing understanding of disease pathophysiology and treatment by IBD patients.
Established knowledge on this subject
Inflammatory bowel diseases (IBD) patients' beliefs and knowledge regarding their disease may affect disease management, quality of life and disease‐related psychological health. Therapy‐related disinformation is associated with low adherence to treatment. A standardized and validated tool for assessment of IBD patients' knowledge and understanding of their disease is lacking.
Significant findings of this study
We developed and meticulously validated the understanding of IBD questionnaire, a short questionnaire aimed at measuring understanding of disease pathophysiology and treatment of IBD. Inflammatory bowel diseases‐related knowledge was associated with education level and with younger age at IBD diagnosis.
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Affiliation(s)
| | - Morin Fibelman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Internal Medicine "A", Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ayal Hirsch
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yulia Ron
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nathaniel Aviv Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Revital Kariv
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Liat Deutsch
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Jasmine Kornblum
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Ronit Anbar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Nutrition and Dietetics Department, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Nitsan Maharshak
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Naomi Fliss-Isakov
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Gastroenterology and Liver Diseases, Tel Aviv Medical Center, Tel Aviv, Israel
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