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Marshall V WH, Wright LK, Lampert BC, Salavitabar A, Daniels CJ, Rajpal S. Invasive Implanted Hemodynamic Monitoring in Patients with Complex Congenital Heart Disease: State-of-the-Art Review. Am J Cardiol 2024:S0002-9149(24)00368-0. [PMID: 38761965 DOI: 10.1016/j.amjcard.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/07/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024]
Abstract
As the number of patients with congenital heart disease (CHD) continues to increase, the burden of heart failure (HF) in this population requires innovative strategies to individualize management. Given the success of implanted invasive hemodynamic monitoring (IHM) with the CardioMEMSTM HF system in adults with acquired HF, this is often suggested for use in patients with CHD, though published data are limited to case reports and case series. Therefore, this review summarizes the available published reports on the use of IHM in patients with complex CHD, describes novel applications, and highlights future directions for study. In patients with CHD, IHM has been used across the lifespan, from age 3 years to adulthood, with minimal device-related complications reported. IHM uses include (1) prevention of HF hospitalizations; (2) reassessment of hemodynamics after titration of medical therapy without repeated cardiac catheterization; (3) serial monitoring of at-risk patients for pulmonary hypertension to optimize timing of heart transplant referral; (4) and hemodynamic assessment with exercise (5) or after ventricular assist device placement. IHM has the potential to reduce the number of cardiac catheterizations in anatomically complex patients and, in patients with Fontan circulation, IHM pressures may have prognostic implications. In conclusion, though further studies are needed, as patients with CHD age and HF is more prevalent, this tool may assist CHD physicians in caring for this complex patient population.
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Affiliation(s)
- William H Marshall V
- The Ohio State University, Department of Internal Medicine, Division of Cardiovascular Medicine, Columbus, OH, United States of America; Nationwide Children's Hospital, The Heart Center, Columbus, OH, United States of America.
| | - Lydia K Wright
- Nationwide Children's Hospital, The Heart Center, Columbus, OH, United States of America
| | - Brent C Lampert
- The Ohio State University, Department of Internal Medicine, Division of Cardiovascular Medicine, Columbus, OH, United States of America
| | - Arash Salavitabar
- Nationwide Children's Hospital, The Heart Center, Columbus, OH, United States of America
| | - Curt J Daniels
- The Ohio State University, Department of Internal Medicine, Division of Cardiovascular Medicine, Columbus, OH, United States of America; Nationwide Children's Hospital, The Heart Center, Columbus, OH, United States of America
| | - Saurabh Rajpal
- The Ohio State University, Department of Internal Medicine, Division of Cardiovascular Medicine, Columbus, OH, United States of America; Nationwide Children's Hospital, The Heart Center, Columbus, OH, United States of America
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Hunold KM, Schwaderer AL, Exline M, Hebert C, Lampert BC, Southerland LT, Stephens JA, Boyer EW, Gure TR, Mion LC, Hill M, Chu CMB, Lee G, Caterino JM. Functional decline in older adults with suspected pneumonia at emergency department presentation. J Am Geriatr Soc 2024; 72:1532-1535. [PMID: 38366347 PMCID: PMC11090742 DOI: 10.1111/jgs.18798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 02/18/2024]
Affiliation(s)
| | | | - Matthew Exline
- Department of Internal Medicine, The Ohio State University, Columbus OH
| | - Courtney Hebert
- Department of Biomedical Informatics, The Ohio State University, Columbus OH
- Division of Infectious Disease, The Ohio State University, Columbus OH
| | - Brent C. Lampert
- Division of Cardiovascular Medicine, The Ohio State University, Columbus OH
| | | | - Julie A. Stephens
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus OH
| | - Edward W. Boyer
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | - Tanya R. Gure
- Division of General Internal Medicine & Geriatrics, The Ohio State University, Columbus, OH
| | | | - Michael Hill
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | - Ching-Min B. Chu
- Department of Emergency Medicine, The Ohio State University, Columbus OH
| | - Gabriel Lee
- Department of Emergency Medicine, The Ohio State University, Columbus OH
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Chamberlain AM, Hade EM, Haller IV, Horne BD, Benziger CP, Lampert BC, Rasmusson KD, Boddicker K, Manemann SM, Roger VL. A large, multi-center survey assessing health, social support, literacy, and self-management resources in patients with heart failure. BMC Public Health 2024; 24:1141. [PMID: 38658888 PMCID: PMC11040866 DOI: 10.1186/s12889-024-18533-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Most patients with heart failure (HF) have multimorbidity which may cause difficulties with self-management. Understanding the resources patients draw upon to effectively manage their health is fundamental to designing new practice models to improve outcomes in HF. We describe the rationale, conceptual framework, and implementation of a multi-center survey of HF patients, characterize differences between responders and non-responders, and summarize patient characteristics and responses to the survey constructs among responders. METHODS This was a multi-center cross-sectional survey study with linked electronic health record (EHR) data. Our survey was guided by the Chronic Care Model to understand the distribution of patient-centric factors, including health literacy, social support, self-management, and functional and mental status in patients with HF. Most questions were from existing validated questionnaires. The survey was administered to HF patients aged ≥ 30 years from 4 health systems in PCORnet® (the National Patient-Centered Clinical Research Network): Essentia Health, Intermountain Health, Mayo Clinic, and The Ohio State University. Each health system mapped their EHR data to a standardized PCORnet Common Data Model, which was used to extract demographic and clinical data on survey responders and non-responders. RESULTS Across the 4 sites, 10,662 patients with HF were invited to participate, and 3330 completed the survey (response rate: 31%). Responders were older (74 vs. 71 years; standardized difference (95% CI): 0.18 (0.13, 0.22)), less racially diverse (3% vs. 12% non-White; standardized difference (95% CI): -0.32 (-0.36, -0.28)), and had higher prevalence of many chronic conditions than non-responders, and thus may not be representative of all HF patients. The internal reliability of the validated questionnaires in our survey was good (range of Cronbach's alpha: 0.50-0.96). Responders reported their health was generally good or fair, they frequently had cardiovascular comorbidities, > 50% had difficulty climbing stairs, and > 10% reported difficulties with bathing, preparing meals, and using transportation. Nearly 80% of patients had family or friends sit with them during a doctor visit, and 54% managed their health by themselves. Patients reported generally low perceived support for self-management related to exercise and diet. CONCLUSIONS More than half of patients with HF managed their health by themselves. Increased understanding of self-management resources may guide the development of interventions to improve HF outcomes.
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Affiliation(s)
- Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA.
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Erinn M Hade
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Irina V Haller
- Essentia Institute of Rural Health, Essentia Health, Duluth, MN, USA
| | - Benjamin D Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, UT, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
| | | | - Brent C Lampert
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Sheila M Manemann
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Véronique L Roger
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Manemann SM, Hade EM, Haller IV, Horne BD, Benziger CP, Lampert BC, Rasmusson KD, Roger VL, Weston SA, Killian JM, Chamberlain AM. The impact of multimorbidity and functional limitation on quality of life in patients with heart failure: A multi-site study. J Am Geriatr Soc 2024. [PMID: 38634747 DOI: 10.1111/jgs.18924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/14/2024] [Accepted: 03/24/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Multimorbidity and functional limitation are associated with poor outcomes in heart failure (HF). However, the individual and combined effect of these on health-related quality of life in patients with HF is not well understood. METHODS Patients aged ≥30 years with two or more HF diagnostic codes and one or more HF-related prescription drugs from four U.S. institutions were mailed a survey to measure patient-centric factors including functional status (activities of daily living [ADLs]) and health-related quality of life (PROMIS-29 Health Profile). Patients with HF from January 1, 2013 to February 1, 2018 were included. Multimorbidity was defined as ≥2 non-cardiovascular comorbidities; functional limitation as any limitation in at least one of eight ADLs. Patients were categorized into four groups by multimorbidity (Yes/No) and functional limitation (Yes/No). We dichotomized the PROMIS-29 sub-scale scores at the median and calculated odd ratios for the four multimorbidity/functional limitation groups. RESULTS A total of 3330 patients with HF returned the survey (response rate 31%); 3020 completed the questions of interest and were retained. Among these patients (45% female; mean age 73 [standard deviation: 12] years), 29% had neither multimorbidity nor functional limitation, 24% had multimorbidity only, 22% had functional limitation only, and 25% had both. After adjustment, having functional limitation only was associated with higher anxiety (odds ratio [OR]: 3.44, 95% confidence interval [CI]: 2.66-4.45), depression (OR: 3.11, 95% CI: 2.39-4.06), and fatigue (OR: 4.19, 95% CI: 3.25-5.40); worse sleep (OR: 2.14, 95% CI: 1.69-2.72) and pain (OR: 6.73, 95% CI: 5.15-8.78); and greater difficulty with social activities (OR: 9.40, 95% CI: 7.19-12.28) compared with having neither. Results were similar for having both multimorbidity and functional limitation. CONCLUSION Patients with only functional limitation have similar poor health-related quality of life scores as those with both multimorbidity and functional limitation, underscoring the important role that physical functioning plays in the well-being of patients with HF.
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Affiliation(s)
- Sheila M Manemann
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Erinn M Hade
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Irina V Haller
- Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota, USA
| | - Benjamin D Horne
- Intermountain Medical Center Heart Institute, Salt Lake City, Utah, USA
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Brent C Lampert
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Veronique L Roger
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan A Weston
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Jill M Killian
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Zakko J, Premkumar A, Logan AJ, Sneddon JM, Brock GN, Pawlik TM, Mokadam NA, Whitson BA, Lampert BC, Washburn WK, Osho AA, Ganapathi AM, Schenk AD. Textbook outcome: A novel metric in heart transplantation outcomes. J Thorac Cardiovasc Surg 2024; 167:1077-1087.e13. [PMID: 36990918 DOI: 10.1016/j.jtcvs.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Assessing heart transplant program quality using short-term survival is insufficient. We define and validate the composite metric textbook outcome and examine its association with overall survival. METHODS We identified all primary, isolated adult heart transplants in the United Network for Organ Sharing/Organ Procurement and Transplantation Network Standard Transplant Analysis and Research files from May 1, 2005, to December 31, 2017. Textbook outcome was defined as length of stay 30 days or less; ejection fraction greater than 50% during 1-year follow-up; functional status 80% to 100% at 1 year; freedom from acute rejection, dialysis, and stroke during the index hospitalization; and freedom from graft failure, dialysis, rejection, retransplantation, and mortality during the first year post-transplant. Univariate and multivariate analyses were performed. Factors independently associated with textbook outcome were used to create a predictive nomogram. Conditional survival at 1 year was measured. RESULTS A total of 24,620 patients were identified with 11,169 (45.4%, 95% confidence interval, 44.7-46.0) experiencing textbook outcome. Patients with textbook outcome were more likely free from preoperative mechanical support (odds ratio, 3.504, 95% confidence interval, 2.766 to 4.439, P < .001), free from preoperative dialysis (odds ratio, 2.295, 95% confidence interval, 1.868-2.819, P < .001), to be not hospitalized (odds ratio, 1.264, 95% confidence interval, 1.183-1.349, P < .001), to be nondiabetic (odds ratio, 1.187, 95% confidence interval, 1.113-1.266, P < .001), and to be nonsmokers (odds ratio, 1.160, 95% confidence interval,1.097-1.228, P < .001). Patients with textbook outcome have improved long-term survival relative to patients without textbook outcome who survive at least 1 year (hazard ratio for death, 0.547, 95% confidence interval, 0.504-0.593, P < .001). CONCLUSIONS Textbook outcome is an alternative means of examining heart transplant outcomes and is associated with long-term survival. The use of textbook outcome as an adjunctive metric provides a holistic view of patient and center outcomes.
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Affiliation(s)
- Jason Zakko
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - April J Logan
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey M Sneddon
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Guy N Brock
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Timothy M Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nahush A Mokadam
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bryan A Whitson
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Brent C Lampert
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - William K Washburn
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Asishana A Osho
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Asvin M Ganapathi
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Austin D Schenk
- Division of Transplant Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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Hunold KM, Schwaderer AL, Exline M, Hebert C, Lampert BC, Southerland LT, Stephens JA, Boyer EW, Gure TR, Mion LC, Hill M, Chu CMB, Ernie E, Caterino JM. Emergency department patient and physician survey accuracy compared to chart abstraction in patients with acute respiratory illness. Acad Emerg Med 2023; 30:1246-1252. [PMID: 37767732 PMCID: PMC11034752 DOI: 10.1111/acem.14810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/07/2023] [Accepted: 09/23/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND High-quality research studies in older adults are needed. Unfortunately, the accuracy of chart review data in older adult patients has been called into question by previous studies. Little is known on this topic in patients with suspected pneumonia, a disease with 500,000 annual older adult U.S. emergency department (ED) visits that presents a diagnostic challenge to ED physicians. The study objective was to compare direct interview and chart abstraction as data sources. METHODS We present a preplanned secondary analysis of a prospective, observational cohort of ED patients ≥65 years of age with suspected pneumonia in two Midwest EDs. We describe the agreement between chart review and a criterion standard of prospective direct patient survey (symptoms) or direct physician survey (examination findings). Data were collected by chart review and from the patient and treating physician by survey. RESULTS The larger study enrolled 135 older adults; 134 with complete symptom data and 129 with complete examination data were included in this analysis. Pneumonia symptoms (confusion, malaise, rapid breathing, any cough, new/worse cough, any sputum production, change to sputum) had agreement between patient/legally authorized representative survey and chart review ranging from 47.8% (malaise) to 80.6% (confusion). All examination findings (rales, rhonchi, wheeze) had percent agreement between physician survey and chart review of ≥80%. However, all kappas except wheezing were less than 0.60, indicating weak agreement. CONCLUSIONS Both patient symptoms and examination findings demonstrated discrepancies between chart review and direct survey with larger discrepancies in symptoms reported. Researchers should consider these potential discrepancies during study design and data interpretation.
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Affiliation(s)
- Katherine M. Hunold
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Matthew Exline
- Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Courtney Hebert
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
- Division of Infectious Disease, The Ohio State University, Columbus, Ohio, USA
| | - Brent C. Lampert
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Julie A. Stephens
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Edward W. Boyer
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Tanya R. Gure
- Division of General Internal Medicine & Geriatrics, The Ohio State University, Columbus, Ohio, USA
| | - Lorraine C. Mion
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Michael Hill
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Ching-Min B. Chu
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Edriane Ernie
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jeffrey M. Caterino
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
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Ganapathi AM, Heh V, Rosenheck JP, Keller BC, Mokadam NA, Lampert BC, Whitson BA, Henn MC. Thoracic retransplantation: Does time to retransplantation matter? J Thorac Cardiovasc Surg 2023; 166:1529-1541.e4. [PMID: 36049964 DOI: 10.1016/j.jtcvs.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/18/2022] [Accepted: 05/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE For some individuals, chronic allograft failure is best treated with retransplantation. We sought to determine if time to retransplantation impacts short- and long-term outcomes for heart or lung retransplant recipients with a time to retransplantation more than 1 year. METHODS The United Network for Organ Sharing/Organ Procurement and Transplantation Network STAR file was queried for all adult, first-time heart (June 1, 2006, to September 30, 2020) and lung (May 1, 2005, to September 30, 2020) retransplantations with a time to retransplantation of at least 1 year. Patients were grouped according to the tertile of time to retransplantation (tertile 1: 1-7.7 years, tertile 2: 7.7-14.7 years, tertile 3: 14.7+ years; lung: tertile 1: 1-2.8 years, tertile 2: 2.8-5.6 years, tertile 3: 5.6+ years). The primary outcome was survival after retransplantation. Comparative statistics identified differences in groups, and Kaplan-Meier methods and a Cox proportional hazard model were used for survival analysis. RESULTS After selection, 908 heart and 871 lung retransplants were identified. Among heart retransplant recipients, tertile 1 was associated with male sex, smoking history, higher listing status, and increased mechanical support pretransplant. Tertile 3 had the highest rate of concomitant kidney transplant; however, the incidence of morbidity and in-hospital mortality was similar among the groups. Unadjusted and adjusted analyses revealed no survival difference among all groups. Regarding lung retransplant recipients, tertile 1 was associated with increased lung allocation score, pretransplant hospitalization, and mechanical support. Unadjusted and adjusted survival analyses revealed decreased survival in tertile 1. CONCLUSIONS Time to retransplant does not appear to affect heart recipients with a time to retransplantation of more than 1 year; however, shorter time to retransplantation for prior lung recipients is associated with decreased survival. Potential lung retransplant candidates with a time to retransplantation of less than 2.8 years should be carefully evaluated before retransplantation.
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Affiliation(s)
- Asvin M Ganapathi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Victor Heh
- Biostatistics, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Justin P Rosenheck
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Brian C Keller
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nahush A Mokadam
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Brent C Lampert
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Matthew C Henn
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Stevens E, Lampert BC, Whitson BA, Rush LJ, Mokadam NA, Barrett TA. Total artificial heart implantation: supportive care preparedness planning framework. BMJ Support Palliat Care 2023:spcare-2023-004210. [PMID: 36990682 DOI: 10.1136/spcare-2023-004210] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/08/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND The total artificial heart (TAH) is an implanted device approved as a modality to stabilize patients with severe biventricular heart failure or persistent ventricular arrhythmias for evaluation and bridge to transplantation. According to the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS), about 450 patients received a TAH between 2006 and 2018. Patients being evaluated for a TAH are often critically ill and a TAH offers the best chance at survival. Given the prognostic uncertainty of these patients, there is a crucial need for preparedness planning to help patients and their caregivers plan for living and supporting a loved one with a TAH. AIM To describe an approach to preparedness planning and highlight the importance of palliative care. METHODS We reviewed the current needs and approaches to preparedness planning for a TAH. We categorized our findings and suggest a guide to maximize conversations with patients and their decision makers. RESULTS We identified four critical areas to address: the decision maker, minimal acceptable outcome/maximal acceptable burden, living with the device, and dying with the device. We suggest using a framework of mental and physical outcomes and locations of care as a way to identify minimal acceptable outcome and maximal acceptable burden. CONCLUSION Decision making for a TAH is complex. There is an urgency and patients do not always have capacity. Identifying legal decision makers and social support is critical. The surrogate decision makers should be included in preparedness planning including discussions about end-of-life care and treatment discontinuation. Having palliative care as members of the interdisciplinary mechanical circulatory support team can assist in these preparedness conversations.
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Affiliation(s)
- Erin Stevens
- Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Brent C Lampert
- Internal Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Laura J Rush
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
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9
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Barrett TA, Di Tosto G, Shiu-Yee K, Melnyk HL, Rush LJ, Sova LN, Lampert BC, Ganapathi AM, Whitson BA, Waterman BL, McAlearney AS. Prevalence of Violence against Providers in Heart and Lung Transplant Programs. Int J Environ Res Public Health 2023; 20:4805. [PMID: 36981714 PMCID: PMC10049342 DOI: 10.3390/ijerph20064805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/05/2023] [Accepted: 03/06/2023] [Indexed: 06/18/2023]
Abstract
Workplace violence in healthcare institutions is becoming more frequent. The objective of this study was to better understand the nature of threat and physical acts of violence from heart and lung transplant patients and families toward healthcare providers and suggest programmatic mitigation strategies. We administered a brief survey to attendees at the 2022 International Society of Heart and Lung Transplantation Conference in Boston, Massachusetts. A total of 108 participants responded. Threats of physical violence were reported by forty-five participants (42%), were more frequently reported by nurses and advanced practice providers than physicians (67% and 75% vs. 34%; p < 0.001) and were more prevalent in the United States than abroad (49% vs. 21%; p = 0.026). Acts of physical violence were reported by one out of every eight providers. Violence against providers in transplant programs warrants closer review by health systems in order to ensure the safety of team members.
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Affiliation(s)
- Todd A. Barrett
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Heart and Vascular Center, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Gennaro Di Tosto
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Karen Shiu-Yee
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Halia L. Melnyk
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Laura J. Rush
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Lindsey N. Sova
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Brent C. Lampert
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Asvin M. Ganapathi
- Heart and Vascular Center, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Bryan A. Whitson
- Heart and Vascular Center, Richard M. Ross Heart Hospital, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Brittany L. Waterman
- Division of Palliative Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH 43210, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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10
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Ganapathi AM, Lampert BC, Mokadam NA, Emani S, Hasan AK, Tamer R, Whitson BA. Allocation changes in heart transplantation: What has really changed? J Thorac Cardiovasc Surg 2023; 165:724-733.e7. [PMID: 33875259 DOI: 10.1016/j.jtcvs.2021.03.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 02/27/2021] [Accepted: 03/04/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE In 2018, the heart allocation system changed status classifications and broadened geographic distribution. We examined this change at a national level based on the immediate pre- and postchange periods. METHODS Using the Scientific Registry of Transplant Recipients database, we identified all adult primary, isolated heart transplants from October 18, 2017, to October 17, 2019. Two time periods were compared: (1) October 18, 2017, to October 17, 2018 (pre); and (2) October 18, 2018, to October 17, 2019 (post). Comparisons were made between groups, and a multivariable logistic regression model was created to identify factors associated with pretransplant temporary mechanical circulatory support. Volume analysis at the regional, state, and center level was also conducted as the primary focus. RESULTS A total of 5381 independent heart transplants were identified within the time frame. On unadjusted analysis, there was a significant increase in temporary mechanical circulatory support (pre, 11.1%; post, 36.2%, P < .01) and decrease in waitlist days (pre, 93 days; post, 41 days; P < .01). Distance traveled (nautical miles) (pre, 83; post, 225; P < .01) and ischemic time (hours) (pre, 3.0; post, 3.4; P < .01) were significantly increased. On multivariable analysis, the postallocation time period was independently associated with temporary MCS (odds ratio, 4.463; 95% confidence interval, 3.844-5.183; P < .001). Transplant volumes did not significantly change after the allocation change at a regional, state, and center level. CONCLUSIONS Since the planned alteration to the allocation system, there have been changes in the use of temporary mechanical circulatory support as well as distance and ischemic time associated with transplant, but no significant volume changes were observed. Continued observation of outcomes and volume under the new allocation system will be necessary in the upcoming years.
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Affiliation(s)
- Asvin M Ganapathi
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Brent C Lampert
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nahush A Mokadam
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Sitaramesh Emani
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ayesha K Hasan
- Division of Cardiology, Department of Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Robert Tamer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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11
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Liu E, Lampert BC. Heart Failure in Older Adults: Medical Management and Advanced Therapies. Geriatrics (Basel) 2022; 7:geriatrics7020036. [PMID: 35447839 PMCID: PMC9029870 DOI: 10.3390/geriatrics7020036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 12/04/2022] Open
Abstract
As the population ages and the prevalence of heart failure increases, cardiologists and geriatricians can expect to see more elderly patients with heart failure in their everyday practice. With the advancement of medical care and technology, the options for heart failure management have expanded, though current guidelines are based on studies of younger populations, and the evidence in older populations is not as robust. Pharmacologic therapy remains the cornerstone of heart failure management and has improved long-term mortality. Prevention of sudden cardiac death with implantable devices is being more readily utilized in older patients. Advanced therapies have provided more options for end-stage heart failure, though its use is still limited in older patients. In this review, we discuss the current guidelines for medical management of heart failure in older adults, as well as the expanding literature on advanced therapies, such as heart transplantation in older patients with end-stage heart failure. We also discuss the importance of a multidisciplinary care approach including consideration of non-medical co-morbidities such as frailty and cognitive decline.
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12
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Ganapathi AM, Henn MC, Lampert BC, Nunley DR, Bumgardner G, Mokadam NA, Whitson BA. Thoracic transplantation during the COVID-19 pandemic. Clin Transplant 2021; 36:e14575. [PMID: 34964517 DOI: 10.1111/ctr.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 12/01/2022]
Abstract
The worldwide pandemic caused by COVID-19, resulting from the infection by betacoronarvirus SARS-CoV-2, has dramatically altered healthcare worldwide. Due to the highly contagious nature of SARS-CoV2, coupled with hospitals and intensive care units being overwhelmed, numerous transplant programs either slowed or shut down completely. While there have been isolated reports of COVID-19 in transplant recipients, no study to date has examined how COVID-19 affected actual transplant patterns and outcomes in the United States. Of particular importance is the impact of COVID-19 on mortality in waitlisted patients and transplant recipients. Using the Scientific Registry of Transplant Recipients (SRTR) dataset we compared waitlist and transplant characteristics from 3/2019-8/2019 to 3/2020-8/2020, as well as COVID-19 associated mortality in patients with prior heart or lung transplant or those active on the waitlist. Overall, there was an initial decrease in transplant volume in April 2020; however, volumes have normalized since then, with comparable outcomes to similar calendar months in 2019. Additionally, there were no significant changes in post-transplant outcomes or waiting list mortality. Given the ongoing COVID-19 pandemic it would be beneficial to maintain current practices for thoracic transplantation, to continue to provide this life-saving therapy to those in need. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Asvin M Ganapathi
- Divison of Cardiac Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
| | - Matthew C Henn
- Divison of Cardiac Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
| | - Brent C Lampert
- Division of Cardiology, Department of Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | - David R Nunley
- Division of Pulmonology, Department of Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | - Ginny Bumgardner
- Division of Transplant Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
| | - Nahush A Mokadam
- Divison of Cardiac Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
| | - Bryan A Whitson
- Divison of Cardiac Surgery, Department of Surgery, The Ohio State University Medical Center, Columbus, Ohio
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13
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Lampert BC, Teuteberg JJ. Implantable hemodynamic monitoring and management of left ventricular assist devices: Optimal or optional? JTCVS Open 2021; 8:18-23. [PMID: 36004193 PMCID: PMC9390756 DOI: 10.1016/j.xjon.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022]
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14
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Lampert BC, Teuteberg JJ, Cowger J, Mokadam NA, Cantor RS, Benza RL, Ganapathi AM, Myers SL, Hiesinger W, Woo J, Pagani F, Kirklin JK, Whitson BA. Impact of thoracotomy approach on right ventricular failure and length of stay in left ventricular assist device implants: an intermacs registry analysis. J Heart Lung Transplant 2021; 40:981-989. [PMID: 34229917 DOI: 10.1016/j.healun.2021.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Traditionally, implantation of Left Ventricular Assist Devices (LVADs) is performed via median sternotomy. Recently, less invasive thoracotomy approaches are growing in popularity as they involve less surgical trauma, potentially less bleeding, and may preserve right ventricular function. We hypothesized implantation of LVADs via thoracotomy has less perioperative right ventricular failure (RVF) and shorter postoperative length of stay (LOS). METHODS Continuous flow LVAD implants from Intermacs between February 6, 2014 - December 31, 2018 were identified. Patients implanted via thoracotomy were propensity matched in a 1:1 ratio with patients implanted via sternotomy. Outcomes were compared between sternotomy and thoracotomy approach and by device type (axial, centrifugal-flow with hybrid levitation (CF-HL), centrifugal-flow with full magnetic levitation devices (CF-FML)). The primary outcome was time to first moderate or severe RVF. Secondary outcomes included survival and LOS. RESULTS Overall 978 thoracotomy patients were matched with 978 sternotomy patients. Over the study period, 242 thoracotomy patients and 219 sternotomy patients developed RVF with no significant difference in time to first moderate to severe RVF by surgical approach overall (p = 0.27) or within CF-HL (p = 0.36) or CF-FML devices (p = 0.25). Survival did not differ by implant technique (150 deaths in thoracotomy group, 154 deaths in sternotomy group; p = 0.58). However, sternotomy approach was associated with a significantly shorter LOS (17 Vs 18 days, p = 0.009). CONCLUSION As compared to sternotomy, implantation of continuous flow LVADs via thoracotomy approach does not reduce moderate to severe RVF or improve survival but does reduce post-operative LOS. Device type did not influence outcomes and most centers did a small volume of thoracotomy implants.
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Affiliation(s)
- Brent C Lampert
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Jeffrey J Teuteberg
- Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, California
| | - Jennifer Cowger
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan
| | - Nahush A Mokadam
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Alabama
| | - Raymond L Benza
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Asvin M Ganapathi
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Susan L Myers
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Alabama
| | - William Hiesinger
- Division of Cardiac Surgery, Stanford University Medical Center, Palo Alto, California
| | - Joseph Woo
- Division of Cardiac Surgery, Stanford University Medical Center, Palo Alto, California
| | - Francis Pagani
- Division of Cardiac Surgery, University of Michigan Medical Center, Ann Arbor, Michigan
| | - James K Kirklin
- Kirklin Institute for Research in Surgical Outcomes, University of Alabama, Birmingham, Alabama
| | - Bryan A Whitson
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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15
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Hunold KM, Schwaderer AL, Exline M, Hebert C, Lampert BC, Southerland LT, Stephens JA, Bischof JJ, Caterino JM. Diagnosing Dyspneic Older Adult Emergency Department Patients: A Pilot Study. Acad Emerg Med 2021; 28:675-678. [PMID: 33249675 PMCID: PMC10561323 DOI: 10.1111/acem.14183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/29/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022]
Abstract
Study Objectives: Pneumonia, chronic obstructive pulmonary disease (COPD), and heart failure (HF) exacerbations can present similarly in the older adult in the Emergency Department (ED), leading to sub-optimal treatment from over- and under-diagnosis. There may be a role for antimicrobial peptides (AMPs) in improving the accurate diagnosis of pneumonia in these patients. Methods: This pilot was a prospective, observational cohort study of older adults (aged ≥65 years of age) who presented to the ED with dyspnea or elevated respiratory rate. To identify biomarkers of pneumonia, serum levels of white blood cell count, procalcitonin (PCT), and antimicrobial peptides (human beta defensin 1 and 2 [HBD-1, -2], human neutrophil peptides 1–3 [HNP1–3] and cathelididin [LL-37]) were compared between those with and without pneumonia. Criterion standard reviewers retrospectively determined the diagnoses present in the ED. Results: Three hundred ninety-one patients were screened, 140 were eligible, and 79 were enrolled. Based on criterion standard review, pneumonia was present in 10 (12.7%), COPD in 9 (11.4%) and HF in 31 (39.2%) with a co-diagnosis rate of 10.1% by criterion standard review. Comparatively, emergency medicine attending physicians diagnosed pneumonia in 16 (20.3%), COPD in 12 (15.2%), and HF in 30 (38.0%) with co-diagnosis rate of 15.2%. Emergency physicians agreed with criterion standard diagnoses in 90% of pneumonia, 75% of COPD and 65% of HF diagnoses. Differences in leukocyte count (p<0.01) and two novel AMPs (DEFA5 (p=0.08) and DEFB2 (p=0.09)) showed promise for diagnosing pneumonia. Conclusions: Emergency physicians continue to have poor diagnostic accuracy in dyspneic older adult patients. Serum AMP levels are one potential tool to improve diagnostic accuracy and outcomes for this important population and require further study.
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Affiliation(s)
| | | | - Matthew Exline
- The Ohio State University, Department of Internal Medicine
| | - Courtney Hebert
- The Ohio State University, Department of Biomedical Informatics
- The Ohio State University, Division of Infectious Disease
| | | | | | - Julie A. Stephens
- The Ohio State University, Center for Biostatistics, Department of Biomedical Informatics
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16
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Kochar A, Summers MB, Benziger CP, Marquis-Gravel G, DeWalt DA, Pepine CJ, Gupta K, Bradley SM, Dodson JA, Lampert BC, Robertson H, Polonsky TS, Jones WS, Effron MB. Clinician engagement in the ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) trial. Clin Trials 2021; 18:449-456. [PMID: 33541120 DOI: 10.1177/1740774520988838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/15/2022]
Abstract
BACKGROUND ADAPTABLE (Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness) is a pragmatic clinical trial examining high-dose versus low-dose aspirin among patients with cardiovascular disease. ADAPTABLE is leveraging novel approaches for clinical trial conduct to expedite study completion and reduce costs. One pivotal aspect of the trial conduct is maximizing clinician engagement. METHODS/RESULTS Clinician engagement can be diminished by barriers including time limitations, insufficient research infrastructure, lack of research training, inadequate compensation for research activities, and clinician beliefs. We used several key approaches to boost clinician engagement such as empowering clinician champions, including a variety of clinicians, nurses and advanced practice providers, periodic newsletters and coordinated team celebrations, and deploying novel technological solutions. Specifically, some centers generated electronic health records-based best practice advisories and research dashboards. Future large pragmatic trials will benefit from standardization of the various clinician engagement strategies especially studies leveraging electronic health records-based approaches like research dashboards. Financial or academic "credit" for clinician engagement in clinical research may boost participation rates in clinical studies. CONCLUSION Maximizing clinician engagement is important for the success of clinical trials; the strategies employed in the ADAPTABLE trial may serve as a template for future pragmatic studies.
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Affiliation(s)
- Ajar Kochar
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary B Summers
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Darren A DeWalt
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, USA
| | - Kamal Gupta
- Department of Cardiovascular Medicine, University of Kansas Medical School, Kansas City, KS, USA
| | - Steven M Bradley
- Division of Cardiology, Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - John A Dodson
- Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY, USA
| | - Brent C Lampert
- Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Holly Robertson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Tamar S Polonsky
- Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - W Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Mark B Effron
- John Ochsner Heart and Vascular Institute, The University of Queensland Ochsner Clinical School, New Orleans, LA, USA
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17
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Marquis-Gravel G, Roe MT, Robertson HR, Harrington RA, Pencina MJ, Berdan LG, Hammill BG, Faulkner M, Muñoz D, Fonarow GC, Nallamothu BK, Fintel DJ, Ford DE, Zhou L, Daugherty SE, Nauman E, Kraschnewski J, Ahmad FS, Benziger CP, Haynes K, Merritt JG, Metkus T, Kripalani S, Gupta K, Shah RC, McClay JC, Re RN, Geary C, Lampert BC, Bradley SM, Jain SK, Seifein H, Whittle J, Roger VL, Effron MB, Alvarado G, Goldberg YH, VanWormer JL, Girotra S, Farrehi P, McTigue KM, Rothman R, Hernandez AF, Jones WS. Rationale and Design of the Aspirin Dosing-A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness (ADAPTABLE) Trial. JAMA Cardiol 2021; 5:598-607. [PMID: 32186653 DOI: 10.1001/jamacardio.2020.0116] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Importance Determining the right dosage of aspirin for the secondary prevention treatment of atherosclerotic cardiovascular disease (ASCVD) remains an unanswered and critical question. Objective To report the rationale and design for a randomized clinical trial to determine the optimal dosage of aspirin to be used for secondary prevention of ASCVD, using an innovative research method. Design, Setting, and Participants This pragmatic, open-label, patient-centered, randomized clinical trial is being conducted in 15 000 patients within the National Patient-Centered Clinical Research Network (PCORnet), a distributed research network of partners including clinical research networks, health plan research networks, and patient-powered research networks across the United States. Patients with established ASCVD treated in routine clinical practice within the network are eligible. Patient recruitment began in April 2016. Enrollment was completed in June 2019. Final follow-up is expected to be completed by June 2020. Interventions Participants are randomized on a web platform in a 1:1 fashion to either 81 mg or 325 mg of aspirin daily. Main Outcomes and Measures The primary efficacy end point is the composite of all-cause mortality, hospitalization for nonfatal myocardial infarction, or hospitalization for a nonfatal stroke. The primary safety end point is hospitalization for major bleeding associated with a blood-product transfusion. End points are captured through regular queries of the health systems' common data model within the structure of PCORnet's distributed data environment. Conclusions and Relevance As a pragmatic study and the first interventional trial conducted within the PCORnet electronic data infrastructure, this trial is testing several unique and innovative operational approaches that have the potential to disrupt and transform the conduct of future patient-centered randomized clinical trials by evaluating treatments integrated in clinical practice while at the same time determining the optimal dosage of aspirin for secondary prevention of ASCVD. Trial Registration ClinicalTrials.gov Identifier: NCT02697916.
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Affiliation(s)
| | - Matthew T Roe
- Duke Clinical Research Institute, Durham, North Carolina.,Duke University Medical Center, Durham, North Carolina
| | | | | | - Michael J Pencina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Lisa G Berdan
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Madelaine Faulkner
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Daniel Muñoz
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregg C Fonarow
- Department of Medicine, University of California, Los Angeles, Los Angeles.,Associate Editor
| | - Brahmajee K Nallamothu
- Michigan Integrated Center of Health Analytics and Medical Prediction, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor
| | - Dan J Fintel
- Feinberg School of Medicine, Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Daniel E Ford
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Li Zhou
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | | | - Jennifer Kraschnewski
- Department of Medicine, Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Faraz S Ahmad
- Center for Health Information Partnerships, Feinberg School of Medicine, Institute of Public Health and Medicine, Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - J Greg Merritt
- Patient-Centered Network of Learning Health Systems (LHSNet), Ann Arbor, Michigan
| | - Thomas Metkus
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sunil Kripalani
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kamal Gupta
- Division of Cardiovascular Medicine, Department of Medicine, University of Kansas Medical Center, Kansas City
| | - Raj C Shah
- Rush Alzheimer's Disease Center, Department of Family Medicine, Rush University Medical Center, Chicago, Illinois
| | - James C McClay
- Department of Emergency Medicine, University of Nebraska Medical Center College of Medicine, Omaha
| | | | - Carol Geary
- University of Nebraska Medical Center, Omaha
| | - Brent C Lampert
- Wexner Medical Center, Division of Cardiovascular Medicine, The Ohio State University, Columbus
| | - Steven M Bradley
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis
| | - Sandeep K Jain
- UPMC Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Hani Seifein
- AdventHealth Medical Group Cardiology, Oviedo, Florida
| | - Jeff Whittle
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee
| | | | - Mark B Effron
- Ochsner Clinical School, John Ochsner Heart and Vascular Institute, University of Queensland School of Medicine, New Orleans, Louisiana
| | - Giselle Alvarado
- Herbert H. Lehman College, Department of Biological Sciences, City University of New York, Bronx
| | | | | | - Saket Girotra
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City
| | | | | | - Russell Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adrian F Hernandez
- Duke Clinical Research Institute, Durham, North Carolina.,Duke University Medical Center, Durham, North Carolina
| | - W Schuyler Jones
- Duke Clinical Research Institute, Durham, North Carolina.,Duke University Medical Center, Durham, North Carolina
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18
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Nassif ME, Qintar M, Windsor SL, Jermyn R, Shavelle DM, Tang F, Lamba S, Bhatt K, Brush J, Civitello AB, Gordon RA, Jonsson O, Lampert BC, Pelzel J, Kosiborod M. Main Results Of The Empagliflozin Evaluation By Measuring Impact On Hemodynamics In Patients With Heart Failure Trial. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.11.020] [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: 11/30/2022]
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19
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Goodwin ML, Roberts S, Lampert BC, Whitson BA. Temporary extracorporeal left ventricular support with transapical ProtekDuo cannula. JTCVS Tech 2020; 5:76-79. [PMID: 34318113 PMCID: PMC8300020 DOI: 10.1016/j.xjtc.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Matthew L. Goodwin
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio
| | - Sophia Roberts
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Brent C. Lampert
- Division of Cardiology, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Bryan A. Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio
- Address for reprints: Bryan A. Whitson, MD, PhD, The Ohio State University Wexner Medical Center, Doan Hall N816, 410 W 10th Ave, Columbus, OH 43210.
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20
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Tsay J, Pinkhas D, Lee BC, Guo A, Ferrall J, Derbala MH, Lampert BC, Emani S, Whitson BA, Smith SA. Worsening Renal Function in Cardiac Mechanical Support. Heart Lung Circ 2020; 29:1247-1255. [DOI: 10.1016/j.hlc.2019.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 03/19/2019] [Accepted: 11/18/2019] [Indexed: 01/27/2023]
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21
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Abstract
Hypertensive heart disease represents a spectrum of illnesses from uncontrolled hypertension to heart failure. The authors discuss the natural history and pathogenesis of heart failure owing to hypertensive heart disease, reviewing the important role of left ventricular hypertrophy as the inciting process leading to diastolic dysfunction and heart failure with preserved ejection fraction. They describe the various mechanisms by which a subset of patients ultimately develops systolic heart failure. They discuss management strategies for hypertensive heart disease at all stages of the disease process. Treatment in the initial stages before onset of heart failure may result in regression of disease.
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Affiliation(s)
- Jeremy Slivnick
- Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA
| | - Brent C Lampert
- Heart Transplantation and Mechanical Circulatory Support, Ohio State University Wexner Medical Center, 473 West 12th Avenue, Suite 200, Columbus, OH 43210, USA.
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22
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Lampert BC, Lindenfeld J, Abraham WT. Too Different or Too Late?: Gender Differences in Outcomes After Mitral Valve Surgery. JACC Heart Fail 2019; 7:491-492. [PMID: 31146873 DOI: 10.1016/j.jchf.2019.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Brent C Lampert
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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McDavid A, MacBrair K, Emani S, Yu L, Lee PHU, Whitson BA, Lampert BC, Agarwal R, Kilic A. Anticoagulation management following left ventricular assist device implantation is similar across all provider strategies. Interact Cardiovasc Thorac Surg 2018; 26:60-65. [PMID: 29049614 DOI: 10.1093/icvts/ivx255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 07/02/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Thromboembolic and bleeding events are potential complications following left ventricular assist device implantation. A tight control of the international normalized ratio (INR) is believed to be crucial in the reduction of postimplant complications. There is significant variability among institutions as to whether a device implanting centre should be managing the INR. In this study, we evaluated the effect of INR management strategies in maintaining a therapeutic INR. METHODS A retrospective review was utilized to identify patients implanted with either the HeartMate II or the HeartWare HVAD between January 2011 and February 2016. Patients were stratified into 4 groups based on the post-discharge INR management strategy: outside hospital system anticoagulation clinic, outside hospital primary care provider, implanting centre anticoagulation clinic or implanting centre ventricular assist device office. The INR data were collected and analysed for both the early (discharge, 7, 14, 21 and 30 days) and late (3, 6, 9 and 12 months) postoperative periods. RESULTS There were 163 patients identified during the study period who met the study inclusion criteria: 49 (30%) patients were managed by an outside hospital system anticoagulation clinic, 59 (36.2%) patients by an outside hospital physician/primary care provider, 22 (13.5%) patients by the implanting centre anticoagulation clinic and 33 (20.2%) patients by the implanting centre ventricular assist device office. There were no statistically significant differences found between management strategies across all time points. CONCLUSIONS There was no statistically significant difference found between the management strategies examined. Regardless of the chosen INR management strategy, patients have similar INR values and postoperative outcomes.
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Affiliation(s)
- Asia McDavid
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kelly MacBrair
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sitaramesh Emani
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Lianbo Yu
- Department of Biomedical Informatics, Center for Biostatistics, Ohio State University, Columbus, OH, USA
| | - Peter H U Lee
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bryan A Whitson
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Brent C Lampert
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Riddhima Agarwal
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ahmet Kilic
- Division of Cardiac Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Afzal MR, Ahmed A, Prutkin JM, Saba S, Cha YM, Friedman P, Knight BP, Kanwar M, Lampert BC, Weiss R. Multicenter Experience of Concomitant Use of Left Ventricular Assist Devices and Subcutaneous Implantable Cardioverter-Defibrillators. JACC Clin Electrophysiol 2018; 4:1261-1262. [DOI: 10.1016/j.jacep.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 10/28/2022]
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Breathett K, Maffett S, Foraker RE, Sturdivant R, Moon K, Hasan A, Franco V, Smith S, Lampert BC, Emani S, Haas G, Kahwash R, Hershberger RE, Binkley PF, Helmkamp L, Colborn K, Peterson PN, Sweitzer N, Abraham WT. Pilot Randomized Controlled Trial to Reduce Readmission for Heart Failure Using Novel Tablet and Nurse Practitioner Education. Am J Med 2018; 131:974-978. [PMID: 29555457 PMCID: PMC6098971 DOI: 10.1016/j.amjmed.2018.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/19/2018] [Accepted: 02/21/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Heart failure education programs are not standardized. The best form of education is unclear. We evaluated whether addition of a novel tablet application to nurse practitioner (NP) education was superior to NP education alone in reducing 30-day readmission after heart failure hospitalization. METHODS From February 2015-March 2016, patients admitted to a quaternary academic center with primary diagnosis of heart failure were randomized to 1) treatment - NP education plus tablet application (interactive conditional logic program that flags patient questions to medical staff), or 2) control - NP education. The primary outcome was reduction in 30-day readmission rate. Secondary outcomes included satisfaction and education assessed via survey. RESULTS Randomization included 60 patients to treatment and 66 to control. A total of 13 patients withdrew prior to intervention (treatment n = 4, control n = 1) or were lost to follow-up (treatment n = 3, control n = 5). The 30-day readmission rate trended lower for treatment compared with control, but results were not statistically significant (13.2% [7/53], 26.7% [16/60], respectively, P = .08). Similarly, satisfaction trended higher with treatment than control (P = .08). Treatment patients rated explanations from their physicians higher than control (Always: 83.7%, 55.8%, respectively, P = .01). CONCLUSIONS NP education plus tablet use was not associated with significantly lower 30-day readmission rates in comparison with NP alone, but a positive trend was seen. Patient satisfaction trended higher and heart failure explanations were better with NP education plus tablet. A larger study is needed to determine if NP education plus tablet reduces readmission rates following heart failure admission.
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Affiliation(s)
- Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson.
| | - Scott Maffett
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Randi E Foraker
- Institute for Informatics, Washington University in St. Louis School of Medicine, Mo
| | - Rod Sturdivant
- Department of Mathematics and Physics, Azusa Pacific University, Calif
| | - Kristina Moon
- Division of Cardiology, University of Wisconsin, Madison
| | - Ayesha Hasan
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Veronica Franco
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Sakima Smith
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Brent C Lampert
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Sitaramesh Emani
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Garrie Haas
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Rami Kahwash
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Ray E Hershberger
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Philip F Binkley
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
| | - Laura Helmkamp
- University of Colorado Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora
| | - Kathryn Colborn
- University of Colorado Adult and Child Consortium for Health Outcomes Research and Delivery Science, Aurora
| | - Pamela N Peterson
- Division of Cardiology, University of Colorado and Denver Health Medical Center, Denver
| | - Nancy Sweitzer
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson
| | - William T Abraham
- Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus
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Cerier E, Lampert BC, Kilic A, McDavid A, Deo SV, Kilic A. To ventricular assist devices or not: When is implantation of a ventricular assist device appropriate in advanced ambulatory heart failure? World J Cardiol 2016; 8:695-702. [PMID: 28070237 PMCID: PMC5183969 DOI: 10.4330/wjc.v8.i12.695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/18/2016] [Accepted: 10/24/2016] [Indexed: 02/06/2023] Open
Abstract
Advanced heart failure has been traditionally treated via either heart transplantation, continuous inotropes, consideration for hospice and more recently via left ventricular assist devices (LVAD). Heart transplantation has been limited by organ availability and the futility of other options has thrust LVAD therapy into the mainstream of therapy for end stage heart failure. Improvements in technology and survival combined with improvements in the quality of life have made LVADs a viable option for many patients suffering from heart failure. The question of when to implant these devices in those patients with advanced, yet still ambulatory heart failure remains a controversial topic. We discuss the current state of LVAD therapy and the risk vs benefit of these devices in the treatment of heart failure.
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Abstract
Heart failure is a common condition with significant morbidity and mortality. Pharmacologic and device therapies have resulted in substantial improvements in heart failure outcomes. Despite optimal therapy, 10 % of patients progress to advanced HF, characterized by progressive symptoms, poor quality of life, and poor prognosis. The "gold-standard" treatment of advanced heart failure remains cardiac transplantation. However, the number of patients with advanced heart failure far exceeds available donor organs. Left ventricular assist devices (LVADs) were initially developed to bridge patients with hemodynamic collapse to transplantation. Their use resulted in marked improvements in survival and quality of life in select patients giving rise to increased and expanded overall implantation. Despite these improvements, patient selection and timing for LVAD therapy is still evolving. In this article, we will review a brief history of LVADs, examine patient selection, and explore the currently debated expansion of LVADs to "less sick" patients.
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Affiliation(s)
- Andrea M Elliott
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Brent C Lampert
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Heart Failure & Transplantation, 473 W. 12th Avenue, Suite 200, Columbus, OH, 43210, USA.
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Lampert BC, Abraham WT. If Exercise Is the Best Medicine, Should Medicine Be More Focused on Exercise in HFpEF? ∗. J Am Coll Cardiol 2016; 68:1835-1837. [DOI: 10.1016/j.jacc.2016.08.014] [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] [Received: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 11/26/2022]
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Abstract
Left ventricular assist devices (LVADs) have been shown to markedly improve survival and quality of life in patients with end-stage heart failure. However, despite ongoing improvements in survival and quality of life, significant challenges still exist in the management of these patients, including a high rate of recurrent heart failure and rehospitalizations. Similar challenges exist in the non-LVAD heart failure population as well, and recent efforts to utilize remote hemodynamic monitoring techniques to improve outcomes have shown promise. No data currently exist demonstrating extension of this benefit into the LVAD population, although a theoretical benefit can be extrapolated. Herein we review current remote hemodynamic methods and potential applications towards LVAD patients.
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Affiliation(s)
- Brent C Lampert
- The Ohio State University Wexner Medical Center, 473 W. 12th Ave, Suite 200 DHLRI, Columbus, OH 43210, USA
| | - Sitaramesh Emani
- The Ohio State University Wexner Medical Center, 473 W. 12th Ave, Suite 200 DHLRI, Columbus, OH 43210, USA
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Lampert BC, Higgins RS, Phillips G, Emani S, Smith S, Whitson BA, Kilic A, Hasan AK, Teuteberg JJ. Is Education the Key to Success? Association of Formal Education and Outcomes in Left Ventricular Assist Devices. J Card Fail 2015. [DOI: 10.1016/j.cardfail.2015.06.302] [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: 11/16/2022]
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Abstract
Most patients with advanced systolic dysfunction who are assessed for a left ventricular assist device (LVAD) also have some degree of right ventricular (RV) dysfunction. Hence, RV failure (RVF) remains a common complication of LVAD placement. Severe RVF after LVAD implantation is associated with increased peri-operative mortality and length of stay and can lead to coagulopathy, altered drug metabolism, worsening nutritional status, diuretic resistance, and poor quality of life. However, current medical and surgical treatment options for RVF are limited and often result in significant impairments in quality of life. There has been continuing interest in developing risk models for RVF before LVAD implantation. This report reviews the anatomy and physiology of the RV and how it changes in the setting of LVAD support. We will discuss proposed mechanisms and describe biochemical, echocardiographic, and hemodynamic predictors of RVF in LVAD patients. We will describe management strategies for reducing and managing RVF. Finally, we will discuss the increasingly recognized and difficult to manage entity of chronic RVF after LVAD placement and describe opportunities for future research.
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Affiliation(s)
- Brent C Lampert
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Jeffrey J Teuteberg
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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Lampert BC, Teuteberg JJ, Shullo MA, Holtz J, Smith KJ. Cost-Effectiveness of Routine Surveillance Endomyocardial Biopsy After 12 Months Post–Heart Transplantation. Circ Heart Fail 2014; 7:807-13. [DOI: 10.1161/circheartfailure.114.001199] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Despite low risk of late rejection after heart transplant (HT), surveillance endomyocardial biopsies (EMBs) are often continued for years. We assessed the cost-effectiveness of routine EMB after 12 months post-HT.
Methods and Results—
Markov model compared the following surveillance EMB strategies to baseline strategy of stopping EMB 12 months post-HT: (1) every 4 months during year 2 post-HT, (2) every 6 months during year 2, (3) every 4 months for years 2 to 3, and (4) every 6 months for years 2 to 3. Patients entered the model 12 months post-HT and were followed until 36 months. In all strategies, patients had EMB with symptoms; in biopsy strategies after 12 months, EMB was also performed as scheduled regardless of symptoms. One-way and Monte Carlo sensitivity analyses were performed. Stopping EMB at 12 months was dominant (more effective, less costly), saving $2884 per patient compared with the next best strategy (every 6 months for year 2) and gaining 0.0011 quality-adjusted life-years. Increasing the annual risk of asymptomatic rejection in years 2 to 3 from previously reported 2.5% to 8.5% resulted in the biopsy every 6 months for year 2 strategy gaining 0.0006 quality-adjusted life-years, but cost $4 913 599 per quality-adjusted life-year gained. EMB for 12 months was also no longer dominant when mortality risk from untreated asymptomatic rejection approached 11%; competing strategies still cost >$200 000 per quality-adjusted life-year as that risk approached 99%.
Conclusions—
Surveillance EMB for 12 months post-HT is more effective and less costly than EMB performed after 12 months, unless risks of asymptomatic cellular rejection and its mortality are strikingly higher than previously observed.
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Affiliation(s)
- Brent C. Lampert
- From the Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus (B.C.L.); Heart and Vascular Institute (J.J.T., J.H.), Pharmacy and Therapeutics (M.A.S.), and Division of General Internal Medicine (K.J.S.), University of Pittsburgh, PA
| | - Jeffrey J. Teuteberg
- From the Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus (B.C.L.); Heart and Vascular Institute (J.J.T., J.H.), Pharmacy and Therapeutics (M.A.S.), and Division of General Internal Medicine (K.J.S.), University of Pittsburgh, PA
| | - Michael A. Shullo
- From the Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus (B.C.L.); Heart and Vascular Institute (J.J.T., J.H.), Pharmacy and Therapeutics (M.A.S.), and Division of General Internal Medicine (K.J.S.), University of Pittsburgh, PA
| | - Jonathan Holtz
- From the Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus (B.C.L.); Heart and Vascular Institute (J.J.T., J.H.), Pharmacy and Therapeutics (M.A.S.), and Division of General Internal Medicine (K.J.S.), University of Pittsburgh, PA
| | - Kenneth J. Smith
- From the Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus (B.C.L.); Heart and Vascular Institute (J.J.T., J.H.), Pharmacy and Therapeutics (M.A.S.), and Division of General Internal Medicine (K.J.S.), University of Pittsburgh, PA
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Lampert BC, Eckert C, Weaver S, Scanlon A, Lockard K, Allen C, Kunz N, Bermudez C, Bhama JK, Shullo MA, Kormos RL, Dew MA, Teuteberg JJ. Blood Pressure Control in Continuous Flow Left Ventricular Assist Devices: Efficacy and Impact on Adverse Events. Ann Thorac Surg 2014; 97:139-46. [DOI: 10.1016/j.athoracsur.2013.07.069] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/15/2013] [Accepted: 07/18/2013] [Indexed: 11/30/2022]
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Lampert BC, Teuteberg JJ. Mechanical circulatory support in 2012 - raising the bar or closing the door, for xenotransplantation? Xenotransplantation 2012. [DOI: 10.1111/xen.12006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lampert BC, Moore HJ, Amdur RL, Karasik PE, Lewis BM, Singh SN, Fletcher RD. Long-term mortality outcomes according to the frequency of right ventricular pacing in veterans. Cardiol Res Pract 2010; 2010:310768. [PMID: 20454580 PMCID: PMC2864481 DOI: 10.4061/2010/310768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2009] [Revised: 02/15/2010] [Accepted: 02/22/2010] [Indexed: 11/20/2022] Open
Abstract
Background. Right ventricular pacing (RVP) has been associated with adverse outcomes, including heart failure and death. Minimizing RVP has been proposed as a therapeutic goal for a variety of pacing devices and indications.
Objective. Quantify survival according to frequency of RVP in veterans with pacemakers. Methods. We analyzed electrograms from transtelephonic monitoring of veterans implanted with pacemakers between 1995 and 2005 followed by the Eastern Pacemaker Surveillance Center. We compared all cause mortality and time to death between patients with less than 20% and more than 80% RVP. Results. Analysis was limited to the 7198 patients with at least six trans-telephonic monitoring records (mean = 21). Average follow-up was 5.3 years. Average age at pacemaker implant was significantly lower among veterans with <20% RVP (67 years versus 72 years; P < .0001). An equal proportion of deaths during follow-up were noted for each group: 126/565 patients (22%) with <20% RVP and 1113/4968 patients (22%) with >80% RVP. However, average post-implant survival was 4.3 years with <20% RVP versus 4.7 years with >80% RVP (P < .0001). Conclusions. Greater frequency (>80%) of RVP was not associated with higher mortality in this population of veterans. Those veterans utilizing <20% RVP had a shortened adjusted survival rate (P = .0016).
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Affiliation(s)
- Brent C Lampert
- School of Medicine, Georgetown University, Washington, DC 20057, USA
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