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Crousillat DR, Amponsah DK, Camacho A, Kandanelly RR, Bapat D, Chen C, Selberg A, Shaqdan A, Tanguturi VK, Picard MH, Hung JW, Elmariah S. Racial and Ethnic Differences in the Clinical Diagnosis of Aortic Stenosis. J Am Heart Assoc 2022; 11:e025692. [PMID: 36533618 PMCID: PMC9798798 DOI: 10.1161/jaha.122.025692] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Racial and ethnic minority groups are underrepresented among patients undergoing aortic valve replacement in the United States. We evaluated the impact of race and ethnicity on the diagnosis of aortic stenosis (AS). Methods and Results In patients with transthoracic echocardiography (TTE)-confirmed AS, we assessed rates of AS diagnosis as defined by assignment of an International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) code for AS within a large multicenter electronic health record. Multivariable Cox proportional hazard and competing risk regression models were used to evaluate the 1-year rate of AS diagnosis by race and ethnicity. Among 14 800 patients with AS, the 1-year diagnosis rate for AS following TTE was 37.4%. Increasing AS severity was associated with an increased likelihood of receiving an AS diagnosis (moderate: hazard ratio [HR], 3.05 [95% CI, 2.86-3.25]; P<0.0001; severe: HR, 4.82 [95% CI, 4.41-5.28]; P<0.0001). Compared with non-Hispanic White, non-Hispanic Black (HR, 0.65 [95% CI, 0.54-0.77]; P<0.0001) and non-Hispanic Asian individuals (HR, 0.72 [95% CI, 0.57-0.90], P=0.004) were less likely to receive a diagnosis of AS. Additional factors associated with a decreased likelihood of receiving an AS diagnosis included a noncardiology TTE ordering provider (HR, 0.92 [95% CI, 0.86-0.97]; P=0.005) and TTE performed in the inpatient setting (HR, 0.72 [95% CI, 0.66-0.78]; P<0.0001). Conclusions Rates of receiving an ICD diagnostic code for AS following a diagnostic TTE are low and vary significantly by race and ethnicity and disease severity. Further studies are needed to determine if efforts to maximize the clinical recognition of TTE-confirmed AS may help to mitigate disparities in treatment.
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Affiliation(s)
- Daniela R. Crousillat
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA,Division of Cardiovascular SciencesUniversity of South FloridaTampaFL
| | - Daniel K. Amponsah
- Department of Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Alexander Camacho
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Ritvik R. Kandanelly
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Devavrat Bapat
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Chen Chen
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Alexandra Selberg
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Ayman Shaqdan
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Varsha K. Tanguturi
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Michael H. Picard
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Judy W. Hung
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Sammy Elmariah
- Cardiology Division, Massachusetts General HospitalHarvard Medical SchoolBostonMA,Cardiology DivisionUniversity of California San FranciscoSan FranciscoCA
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Khaloo P, Uzomah UA, Shaqdan A, Ledesma PA, Galvin J, Ptaszek LM, Ruskin JN. Outcomes of Patients Hospitalized With Cardiovascular Implantable Electronic Device-Related Infective Endocarditis, Prosthetic Valve Endocarditis, and Native Valve Endocarditis: A Nationwide Study, 2003 to 2017. J Am Heart Assoc 2022; 11:e025600. [PMID: 36000421 PMCID: PMC9496407 DOI: 10.1161/jaha.122.025600] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Most published reports describing outcomes of patients with cardiovascular implantable electronic device–related infective endocarditis (CIED‐IE) are single‐center studies with small patient sample sizes. The goal of this study was to utilize population‐based data to assess trends in CIED‐IE hospitalization and to compare outcomes between patients hospitalized with CIED‐IE, prosthetic valve endocarditis (PVE), and native valve endocarditis (NVE). Methods and Results A query of the National (Nationwide) Inpatient Sample (NIS) database between 2003 and 2017 identified 646 325 patients hospitalized with infective endocarditis in the United States of whom 585 974 (90%) had NVE, 27 257 (4.2%) had CIED‐IE, and 26 111 (4%) had PVE. There was a 509% increase in CIED‐IE hospitalizations in the United States from 2003 to 2017 (P trend<0.001). In‐hospital mortality and length of stay associated with CIED‐IE decreased during the study period from 15% and 20 days in 2003 to 9.7% and 19 days in 2017 (P trend=0.032 and 0.018, respectively). The in‐hospital mortality rate was lower in patients hospitalized with CIED‐IE (9.2%) than in patients with PVE (12%) and NVE (12%). Length of stay was longest in the CIED‐IE group (17 compared with 14 days for both NVE and PVE). Hospital costs were highest for the CIED‐IE group ($56 000 compared with $37 000 in NVE and $45 000 in PVE). Conclusions Despite the fact that the number of comorbidities per patient with CIED‐IE increased during the study period, mortality rate and hospital length of stay decreased. The mortality rate was significantly lower for patients with CIED‐IE than for patients with NVE and PVE. Patients with CIED‐IE had the longest lengths of stay and highest hospital costs.
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Affiliation(s)
- Pegah Khaloo
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | | | - Ayman Shaqdan
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Pablo A Ledesma
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Jennifer Galvin
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Leon M Ptaszek
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service MGH Heart Center, Massachusetts General Hospital Boston MA
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Khaloo P, Shaqdan A, Ledesma PA, Uzomah UA, Jennifer Galvin, Ptaszek LM, Ruskin JN. Distinct etiologies of high-sensitivity troponin T elevation predict different mortality risks for patients hospitalized with COVID-19. Int J Cardiol 2021; 351:118-125. [PMID: 34952038 PMCID: PMC8690225 DOI: 10.1016/j.ijcard.2021.12.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 11/24/2021] [Accepted: 12/17/2021] [Indexed: 12/15/2022]
Abstract
Background Cardiovascular events in the context of COVID-19 infection increase the risk of negative patient outcomes, but large cohort studies describing this association are limited. The purpose of the current study was to investigate the potential associations between cardiovascular events and mortality in patients hospitalized due to COVID-19. Methods A retrospective chart review was performed in 2450 patients hospitalized for confirmed COVID-19 infection within a single hospital network between March 15 and June 15, 2020. Logistic regression analysis was used to identify predictors of mortality. Results In the study population, 57% of patients had elevated high sensitivity troponin (hs-TnT) levels. Acute heart failure occurred in 23% of patients and arrhythmias were observed in 8% of patients. Of the 1401 patients with elevated hs-TnT levels, a primary cardiac etiology (e.g., myocardial infarction) was identified in 653 (47%) patients. In the remaining 748 (53%) patients, there was evidence of a primary non-cardiac etiology for hs-TnT elevation such as renal failure (n = 304) and critical illness (n = 286). Elevated hs-TnT was associated with increased risk of mortality. A significantly higher mortality rate was observed for hs-TnT elevation associated with a primary cardiac etiology (OR 4.6, 95% CI: 2.7–7.6; P < 0.001) than a primary non-cardiac etiology (OR 2.7, 95% CI: 1.6–4.5; P < 0.001). Conclusions Elevated hs-TnT in the context of COVID-19 infection is associated with a significantly increased mortality risk. Hs-TnT elevation in the context of a primary cardiac etiology confers a nearly 2-fold higher mortality risk than hs-TnT elevation due to a primary non-cardiac etiology.
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Affiliation(s)
- Pegah Khaloo
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Ayman Shaqdan
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Pablo A Ledesma
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Uwajachukwumma A Uzomah
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Jennifer Galvin
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Leon M Ptaszek
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America
| | - Jeremy N Ruskin
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States of America.
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Uzomah UA, Rozen G, Mohammadreza Hosseini S, Shaqdan A, Ledesma PA, Yu X, Khaloo P, Galvin J, Ptaszek LM, Ruskin JN. Incidence of carditis and predictors of pacemaker implantation in patients hospitalized with Lyme disease. PLoS One 2021; 16:e0259123. [PMID: 34731187 PMCID: PMC8565769 DOI: 10.1371/journal.pone.0259123] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lyme carditis, defined as direct infection of cardiac tissue by Borrelia bacteria, affects up to 10% of patients with Lyme disease. The most frequently reported clinical manifestation of Lyme carditis is cardiac conduction system disease. The goal of this study was to identify the incidence and predictors of permanent pacemaker implantation in patients hospitalized with Lyme disease. METHODS A retrospective cohort analysis of the Nationwide Inpatient sample was performed to identify patients hospitalized with Lyme disease in the US between 2003 and 2014. Patients with Lyme carditis were defined as those hospitalized with Lyme disease who also had cardiac conduction disease, acute myocarditis, or acute pericarditis. Patients who already had pacemaker implants at the time of hospitalization (N = 310) were excluded from the Lyme carditis subgroup. The primary study outcome was permanent pacemaker implantation. Secondary outcomes included temporary cardiac pacing, permanent pacemaker implant, and in-hospital mortality. RESULTS Of the 96,140 patients hospitalized with Lyme disease during the study period, 10,465 (11%) presented with Lyme carditis. Cardiac conduction system disease was present in 9,729 (93%) of patients with Lyme carditis. Permanent pacemaker implantation was performed in 1,033 patients (1% of all Lyme hospitalizations and 11% of patients with Lyme carditis-associated conduction system disease). Predictors of permanent pacemaker implantation included older age (OR: 1.06 per 1 year; 95% CI:1.05-1.07; P<0.001), complete heart block (OR: 21.5; 95% CI: 12.9-35.7; P<0.001), and sinoatrial node dysfunction (OR: 16.8; 95% CI: 8.7-32.6; P<0.001). In-hospital mortality rate was higher in patients with Lyme carditis (1.5%) than in patients without Lyme carditis (0.5%). CONCLUSIONS Approximately 11% of patients hospitalized with Lyme disease present with carditis, primarily in the form of cardiac conduction system disease. In this 12-year study, 1% of all hospitalized patients and 11% of those with Lyme-associated cardiac conduction system disease underwent permanent pacemaker implantation.
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Affiliation(s)
- Uwajachukwumma A. Uzomah
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Guy Rozen
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Seyed Mohammadreza Hosseini
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Ayman Shaqdan
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Pablo A. Ledesma
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Xuejing Yu
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Pegah Khaloo
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jennifer Galvin
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Leon M. Ptaszek
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, Boston, MA, United States of America
| | - Jeremy N. Ruskin
- Cardiac Arrhythmia Service, MGH Heart Center, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail:
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Erickson P, Camacho A, HE WEI, Shaqdan A, Hung J, Elmariah S. DIFFERENTIAL PATTERNS OF MEAN AORTIC VALVE GRADIENT RISE IN PATIENTS WITH BIOPROSTHETIC VALVE DEGENERATION AFTER SURGICAL AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wang C, Zheng W, Shaqdan A, Wang C, Qin X, Zhao X, Wang X, Yuan L, Nie S, Liu R. Efficacy and safety of switching from ticagrelor to clopidogrel during the early and late phase in acute coronary syndrome patients after percutaneous coronary intervention. Platelets 2019; 31:337-343. [PMID: 31043110 DOI: 10.1080/09537104.2019.1609668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In patients with acute coronary syndrome (ACS), treatment using ticagrelor demonstrated significant ischemic benefits over clopidogrel; however, it was associated with increased bleeding complications leading to frequent de-escalation to clopidogrel. The objective of the present study was to investigate the efficacy and safety of de-escalation in early and late phase after percutaneous coronary intervention (PCI). We performed a retrospective study of 4678 ACS patients from March 2016 to April 2017 who initially received ticagrelor then de-escalated to clopidogrel and categorized them into Group 1: early phase (1-30 days) and Group 2: late phase (>30 days-1 year) switching groups. The primary efficacy endpoints included cardiovascular death, definite/probable stent thrombosis, myocardial infarction, unplanned revascularization, and stroke. The safety endpoint was Bleeding Academic Research Consortium classification 3 or 5 bleeding events within 1 year after PCI. The incidence of switching occurred in 1019 patients; 380 (37.3%) in Group 1 (median 14 days, interquartile range 4-30 days) versus 639 (62.7%) in Group 2 (median 180 days, interquartile range 90-270 days). The ischemic endpoints occurred in 53 (13.9%) patients in Group 1 versus 35 (5.4%) in Group 2 (HR 1.93,95%CI 1.22-3.08, p < .0001). There were no significant differences of major bleeding events (HR 0.91; 95%CI, 0.58-1.43, p = .90) seen between the groups. The main cause for switching between the two groups was due to BARC 1 or 2 bleeding types. Early de-escalation from ticagrelor to clopidogrel during the initial 30 days after ACS was associated with higher risk of ischemic events when compared with switching beyond 30 days.
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Affiliation(s)
- Chenggang Wang
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Wen Zheng
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Ayman Shaqdan
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Chunmei Wang
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Xiuchuan Qin
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Xuedong Zhao
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Xu Wang
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Lin Yuan
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Shaoping Nie
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
| | - Ran Liu
- Emergency and Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Disease, Beijing, China
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Shaqdan K, Nicola R, Shaqdan A, Abujudeh HH. Traumatic Injury of the Duodenum and Pancreas. Emerg Radiol 2016. [DOI: 10.1093/med/9780190223656.003.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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