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Sang Iii CJ, de Visser R, Krallman R, Pai CW, Montgomery D, Moser CA, Kline-Rogers E, DuRussel-Weston J, Eagle KA, Chinapaw M, Jackson EA. Cardiometabolic Risk and Dietary Behaviors in Middle-School Children Consuming School-Sourced Lunch. Acad Pediatr 2023; 23:1605-1613. [PMID: 37543082 DOI: 10.1016/j.acap.2023.07.018] [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: 01/31/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE Childhood obesity remains a major public health issue. This study assessed the association between school-sourced lunches and cardiometabolic risk factors in middle-school students. METHODS Data from health behavior surveys and physiologic screenings in a Michigan middle-school wellness program between 2005 and 2019 were used to analyze the association of school lunch consumption with cardiometabolic risk factors (overweight/obesity, non-fasting lipids/glucose, blood pressure) and dietary behaviors (fruit/vegetable consumption, intake of sugar-sweetened beverages/foods). Students were divided into three groups based on their responses to the survey item if they 1) always, 2) sometimes, or 3) never consumed school-sourced lunches. Groups were compared using descriptive statistics and chi-squared tests. RESULTS Students consuming school-sourced lunches were more likely to have overweight or obesity, without significant differences in total, HDL, or LDL cholesterol. There was no difference in non-fasting glucose levels, blood pressure, or resting heart rate. Students consuming school sourced lunch were more likely to have increased sugary and fatty food or beverage consumption. Students consuming school sourced lunch were more likely to attend school in a low or middle socioeconomic status region. CONCLUSIONS In this large cohort of middle-school children, consuming school-sourced lunches was associated with a greater prevalence of overweight and obesity and consumption of fatty foods and sugary beverages. School-based interventions should target methods to reduce consumption of sugary beverages and unhealthy snacks and promote consumption of fruits and vegetables, particularly among high-risk individuals.
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Affiliation(s)
- Charlie J Sang Iii
- Division of Cardiology (CJ Sang III), Department of Medicine, University of North Carolina at Chapel Hill
| | - Rosa de Visser
- Michigan Clinical Outcomes Research and Reporting Program (R de Visser, R Krallman, C-W Pai, D Montgomery, E Kline-Rogers, and EA Jackson), Michigan Medicine, Ann Arbor, Mich; Amsterdam UMC (M Chinapaw), Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Health Behavior and Chronic Diseases and Methodology, Amsterdam, the Netherlands
| | - Rachel Krallman
- Michigan Clinical Outcomes Research and Reporting Program (R de Visser, R Krallman, C-W Pai, D Montgomery, E Kline-Rogers, and EA Jackson), Michigan Medicine, Ann Arbor, Mich
| | - Chih-Wen Pai
- Michigan Clinical Outcomes Research and Reporting Program (R de Visser, R Krallman, C-W Pai, D Montgomery, E Kline-Rogers, and EA Jackson), Michigan Medicine, Ann Arbor, Mich
| | - Daniel Montgomery
- Michigan Clinical Outcomes Research and Reporting Program (R de Visser, R Krallman, C-W Pai, D Montgomery, E Kline-Rogers, and EA Jackson), Michigan Medicine, Ann Arbor, Mich
| | - Cydni A Moser
- Operations Administration, Mayo Clinic (CA Moser), Phoenix, Ariz
| | - Eva Kline-Rogers
- Michigan Clinical Outcomes Research and Reporting Program (R de Visser, R Krallman, C-W Pai, D Montgomery, E Kline-Rogers, and EA Jackson), Michigan Medicine, Ann Arbor, Mich
| | | | - Kim A Eagle
- Division of Cardiovascular Medicine (KA Eagle), Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Mai Chinapaw
- Amsterdam UMC (M Chinapaw), Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Health Behavior and Chronic Diseases and Methodology, Amsterdam, the Netherlands
| | - Elizabeth A Jackson
- Michigan Clinical Outcomes Research and Reporting Program (R de Visser, R Krallman, C-W Pai, D Montgomery, E Kline-Rogers, and EA Jackson), Michigan Medicine, Ann Arbor, Mich; Division of Cardiovascular Disease (EA Jackson), Department of Medicine, University of Alabama at Birmingham.
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Trimarchi S, Mandigers TJ, Bissacco D, Nienaber C, Isselbacher EM, Evangelista A, Suzuki T, Bossone E, Pape LA, Januzzi JL, Harris KM, O'Gara PT, Gilon D, Hutchison S, Patel HJ, Woznicki EM, Montgomery D, Kline-Rogers E, Eagle KA. Twenty-five years of observations from the International Registry of Acute Aortic Dissection (IRAD) and its impact on the cardiovascular scientific community. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00608-6. [PMID: 37453718 DOI: 10.1016/j.jtcvs.2023.06.021] [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: 04/24/2023] [Revised: 06/21/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE The International Registry of Acute Aortic Dissection (IRAD) celebrated its 25th anniversary in January 2021. This study evaluated IRAD's role in promoting the understanding and management of acute aortic dissection (AD) over these years. METHODS IRAD studies were identified, analyzed, and ranked according to their citations per year (c/y) to determine the most-cited IRAD studies and topics. A systematic search of the literature identified cardiovascular guidelines on the diagnosis and management of acute AD. Consequently, IRAD's presence and impact were quantified using these documents. RESULTS Ninety-seven IRAD studies were identified, of which 82 obtained more than 10 cumulative citations. The median c/y index was 7.33 (25th-75th percentile, 4.01-16.65). Forty-two studies had a greater than median c/y index and were considered most impactful. Of these studies, most investigated both type A and type B AD (n = 17, 40.5%) and short-term outcomes (n = 26, 61.9%). Nineteen guideline documents were identified from 26 cardiovascular societies located in Northern America, Europe, and Japan. Sixty-nine IRAD studies were cited by these guidelines, including 38 of the 42 most-impactful IRAD studies. Among them, partial thrombosis of the false lumen as a predictor of postdischarge mortality and aortic diameters as a predictor of type A occurrence were determined as most-impactful specific IRAD topics by their c/y index. CONCLUSIONS IRAD has had and continues to have an important role in providing observations, credible knowledge, and research questions to improve the outcomes of patients with acute AD.
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Affiliation(s)
- Santi Trimarchi
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Tim J Mandigers
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daniele Bissacco
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Christoph Nienaber
- Department of Cardiology, Cardiology and Aortic Centre, The Royal Brompton & Harefield NHS Trust, Imperial College, London, United Kingdom
| | - Eric M Isselbacher
- Cardiology Department, Thoracic Aortic Center, Massachusetts General Hospital, Boston, Mass
| | - Arturo Evangelista
- Cardiology Department, Hospital General Universitari Vall d'Hebron, Barcelona, Spain
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | | | - Linda A Pape
- Department of Medicine, University of Massachusetts Hospital, Worcester, Mass
| | - James L Januzzi
- Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Mass; Cardiology Division, Massachusetts General Hospital, Boston, Mass
| | - Kevin M Harris
- Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minn
| | - Patrick T O'Gara
- Department of Cardiology, Brigham & Women's Hospital, Boston, Mass
| | - Dan Gilon
- Department of Non-invasive Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Stuart Hutchison
- Department of Cardiac Sciences, University of Calgary Medical Centre, Calgary, Canada
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | | | | | | | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor, Mich
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Sang CJ, Song X, de Visser RSF, Krallman R, Montgomery D, Pai CW, Kline-Rogers E, DuRussel-Weston J, Eagle KA, Jackson EA. Lifestyle Behaviors and Cardiometabolic Health in Middle-School Children. Child Obes 2022; 18:361-368. [PMID: 34871088 DOI: 10.1089/chi.2021.0135] [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] [Indexed: 11/12/2022]
Abstract
Background: Lifestyle behaviors (LB), defined by diet and physical activity, are associated with cardiometabolic health among adults. The association of LB with cardiometabolic health among middle-school children is uncertain. Methods: An abbreviated version of the School Physical Activity and Nutrition survey was used to examine LB among students participating in a wellness program between 2004 and 2018. Students were incorporated into three groups determined by self-reported healthy LB (≥6, 4-5, ≤3 behaviors), including; ≤1 serving/day sugary foods/beverages; ≤1 serving/day fried/fatty foods; ≥1 serving/day fruits and vegetables; ≤2 hours of screen time/day; ≥1 day/week of physical education; ≥1 team sport/year; and ≥1 session/week of moderate to vigorous activity. Baseline cardiometabolic parameters [BMI, lipids, glucose, and blood pressure (BP)], resting heart rate (HR), and HR recovery were examined in association with LB groups. Results: Of 2538 children, 488 (19.2%) reported ≥6, 1219 (48.0%) reported 4-5, and 831 (32.7%) reported ≤3 LB. White or Asian race and higher socioeconomic status were associated with ≥6 LB (p < 0.001). Students performing ≤3 LB exhibited higher BMI (p < 0.001), BP (p = 0.001), resting HR (p < 0.001), and HR recovery (p < 0.001). Students performing ≥6 LB were less likely to be overweight (p < 0.001), obese (p < 0.001), or have low high-density lipoprotein (p = 0.05); however, more likely to have elevated triglycerides (p < 0.01). Conclusions: Among middle-school students, baseline BMI, BP, resting, and recovery HR were higher among children reporting fewer healthy LB. Students performing more healthy LB were less likely to be overweight or obese. Efforts to improve LB among middle-school children may be important for primordial cardiovascular prevention efforts.
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Affiliation(s)
- Charlie J Sang
- Department of Internal Medicine and Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ximou Song
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Rosa S F de Visser
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Rachel Krallman
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Daniel Montgomery
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Chih-Wen Pai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Eva Kline-Rogers
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | | | - Kim A Eagle
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA
| | - Elizabeth A Jackson
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Cholack G, Garfein J, Krallman R, Feldeisen D, Montgomery D, Kline-Rogers E, Barnes GD, Eagle K, Rubenfire M, Bumpus S. Predictors of Early (0-7 Days) and Late (8-30 Days) Readmission in a Cohort of Acute Coronary Syndrome Patients. Int J Med Stud 2022; 10:38-48. [PMID: 35444833 PMCID: PMC9017796 DOI: 10.5195/ijms.2022.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Readmissions following acute coronary syndrome are unevenly distributed across the 30-day post-discharge period. There is limited data on predictors of all-cause readmission in early (0–7 day) and late (8–30 day) post-discharge periods for this population; the purpose of this retrospective cohort study was to identify predictors of early and late readmission. Methods: Patients at Michigan Medicine (Ann Arbor, Michigan, United States) with a principal discharge diagnosis of unstable angina, ST-segment elevation myocardial infarction, or non-ST segment elevation myocardial infarction between April 2008 and November 2017 were identified. Predictors of early and late readmission were analyzed with multivariable logistic regression models. Results: Of 1120 patients hospitalized following acute coronary syndrome, 198 (17.68%) were readmitted within 30 days while 70 (6.25%) were readmitted within 7 days of discharge. Of 30-day readmissions, early readmissions were more likely in females [OR 2.26, 95% confidence interval (CI) 1.23, 4.16], non-white individuals (p=0.05), or patients requiring intensive care unit admission during hospitalization (OR 2.20, 95% CI 1.14, 4.24). Relative to patients not readmitted within 7 days, patients who were female, had history of atrial fibrillation, principal discharge diagnosis of non-ST segment elevation myocardial infarction, or required intensive care unit admission were more likely readmitted early. History of congestive heart failure was a predictor of late readmission when compared to patients not readmitted in 30 days. Conclusion: Following acute coronary syndrome, predictors of readmission varied between early and late readmission groups. Readmission predictors provides healthcare providers with information useful in minimizing readmissions and concomitant financial penalties.
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Affiliation(s)
- George Cholack
- Medical student, MSc. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI; Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| | - Joshua Garfein
- MPH. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States
| | - Rachel Krallman
- BS. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States
| | - Delaney Feldeisen
- BA. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States
| | - Daniel Montgomery
- BS. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States
| | - Eva Kline-Rogers
- NP. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States
| | - Geoffrey D Barnes
- MD, MSc. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States
| | - Kim Eagle
- MD. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States
| | - Melvyn Rubenfire
- MD. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, United States
| | - Sherry Bumpus
- PhD, FNP-BC. Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI; Eastern Michigan University, College of Health and Human Services, School of Nursing, Ypsilanti, MI, United States
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5
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Reutersberg B, Trimarchi S, Gilon D, Kaiser C, Harris K, Shalhub S, Reece TB, Nienaber C, Ehrlich M, Isselbacher E, De Oliveira N, Montgomery D, Eagle K, Tolva V, Chen EP, Eckstein HH. Pleural effusion: a potential surrogate marker for higher-risk patients with acute type B aortic dissections. Eur J Cardiothorac Surg 2021; 61:816-825. [PMID: 34966915 DOI: 10.1093/ejcts/ezab540] [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: 04/22/2021] [Revised: 08/31/2021] [Accepted: 11/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Pleural effusions (PEffs) are known to occur in type B acute aortic dissection (TBAAD). We investigated the relationship between pleural effusion and the development of early or late complications following TBAAD. METHODS The incidence of PEff (defined as at least an obliteration of the costophrenic angle in a frontal projection) diagnosed on their initial chest X-ray in patients with TBAAD enrolled in the International Registry of Acute Aortic Dissection was examined. We analysed in-hospital outcomes and long-term survival separately for patients with and without PEffs (PEff+ versus PEff-, respectively). RESULTS Included were 1252 patients with TBAAD, of whom 224 (17.9%) had PEff. Compared with patients without PEff in the initial chest X-ray, these were significantly older [mean age 67 (SD: 14.7) vs 63.4 (SD: 14.2) years, P = 0.001] and more often female (42.4% vs 34.2%, P = 0.021) and had more comorbidities (known aortic aneurysm, chronic obstructive pulmonary disease, chronic renal failure, diabetes, congestive heart failure or mitral valve disease). PEff was associated with higher in-hospital mortality (16.1% vs 9.1%, P = 0.002) and increased rates of neurological complications (16.6% vs 11.1%, P = 0.029), acute renal failure (27.2% vs 19.7%, P = 0.017) and hypotension (17.4% vs 9.6%, P = 0.001). In addition, patients with PEff underwent aortic repair more frequently (44.6% vs 32.5%, P < 0.001). In the long-term patients with PEff showed lower 5-year post-discharge survival (67.6% vs 77.6%, P = 0.004). Multivariable analysis with propensity-matched data showed that PEff was not an independent risk factor for in-hospital mortality (odds ratio 1.9, 95% CI 0.8-4.4, P = 0.141). CONCLUSIONS Patients with TBAAD and evidence of PEff showed a higher in-hospital mortality, are more likely to develop additional in-hospital complications and have a decreased likelihood of survival during follow-up. However, according to propensity-matched analysis, PEff remained not as an independent predictor of worse outcome but might serve as an early surrogate marker to identify higher-risk patients.
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Affiliation(s)
- Benedikt Reutersberg
- Department for Vascular and Endovascular Surgery, Munich Aortic Center (MAC), Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Santi Trimarchi
- Department of Clinical and Community Sciences-University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Dan Gilon
- Department of Noninvasive Cardiology and Echocardiography, Heart Institute, Hadassah-Hebrew University Medical Center, Faculty of Medicine, Jerusalem, Israel
| | - Clayton Kaiser
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin Harris
- Department of Cardiology, Minneapolis Heart Institute, Abbott, Northwestern Hospital, Minneapolis, MN, USA
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, WA, USA
| | - T Brett Reece
- Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christoph Nienaber
- Department of Cardiology, The Royal Brompton & Harefield NHS Trust, Cardiology and Aortic Centre, Imperial College, London, UK
| | - Marek Ehrlich
- Department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
| | - Eric Isselbacher
- Division of Cardiac Surgery, Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nilto De Oliveira
- Division of Cardiac Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Daniel Montgomery
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.,Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Kim Eagle
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.,Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Valerio Tolva
- Department of Vascular Surgery, Policlinico di Monza Hospital, Centro Cuore. Policlinico di Monza, Monza, Italy
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Munich Aortic Center (MAC), Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
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6
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Garfein J, Cholack G, Krallman R, Feldeisen D, Montgomery D, Kline-Rogers E, Eagle K, Rubenfire M, Bumpus S. Cardiac Transitional Care Effectiveness: Does Overall Comorbidity Burden Matter? Am J Med 2021; 134:1506-1513. [PMID: 34273282 PMCID: PMC8688268 DOI: 10.1016/j.amjmed.2021.06.018] [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: 05/29/2021] [Revised: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of mortality and hospitalization in the United States. Transitional care initiatives can improve outcomes for cardiac patients, but it is unclear whether patients with different baseline comorbidity burden benefit equally. We evaluated the effectiveness of the Bridging the Discharge Gap Effectively (BRIDGE) program, a nurse-practitioner-led transitional care clinic, in mitigating adverse clinical outcomes in cardiac patients with varying Charlson comorbidity index (CCI). METHODS We studied patients referred to BRIDGE between 2008 and 2017 postdischarge for a cardiac condition. Using proportional hazards regression models, we evaluated associations between attendance at BRIDGE and hospital readmission, emergency department (ED) visit, and a composite outcome consisting of readmission, ED visit, or mortality, and assessed interaction between BRIDGE attendance and CCI. RESULTS Of 4559 patients, 3256 (71.4%) attended BRIDGE. In patients with low CCI, attendance at BRIDGE was inversely associated with hospital readmission (adjusted hazard ratio = 0.82, 95% confidence interval [CI]: 0.69, 0.97, P = .02) and the composite endpoint (adjusted hazard ratio = 0.84, 95% CI: 0.72, 0.98, P = .02). Associations of BRIDGE attendance with both readmission and ED visit were significantly weaker in patients with high CCI (adjusted P, interaction = .007 and .03, respectively). Overall, BRIDGE attendance was associated with an 11% lower hazard of developing the composite endpoint (95% CI: 2%, 19%, P = .01). CONCLUSIONS Attendance at a transitional care clinic is inversely associated with risk of readmission and a composite endpoint in cardiac patients with low CCI. Future research should investigate modified transitional care programs in patients with varying comorbidity burden.
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Affiliation(s)
| | - George Cholack
- Michigan Medicine, Ann Arbor; Oakland University William Beaumont School of Medicine, Rochester, Mich
| | | | | | | | | | | | | | - Sherry Bumpus
- Michigan Medicine, Ann Arbor; Eastern Michigan University, School of Nursing, Ypsilanti.
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7
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Cholack G, Garfein J, Krallman R, Montgomery D, Kline-Rogers E, Rubenfire M, Bumpus S, Md TC, Barnes GD. Trends in Calcium Channel Blocker Use in Patients with Heart Failure with Reduced Ejection Fraction and Comorbid Atrial Fibrillation. Am J Med 2021; 134:1413-1418.e1. [PMID: 34245675 PMCID: PMC8605988 DOI: 10.1016/j.amjmed.2021.06.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Heart failure with reduced ejection fraction and atrial fibrillation commonly coexist. Most calcium channel blockers are not recommended in heart failure with reduced ejection fraction, but their use has been seldom evaluated. For patients with heart failure with reduced ejection fraction and comorbid atrial fibrillation, we sought to 1) determine the proportion discharged on contraindicated calcium channel blockers, 2) describe how clinicians' use of these medications at discharge have changed over time, and 3) identify predictors for contraindicated calcium channel blocker prescription at discharge. METHODS We analyzed 395 patients discharged with heart failure with reduced ejection fraction and atrial fibrillation between 2008 and 2018. Discharge on a contraindicated calcium channel blocker (any calcium channel blocker except amlodipine) was the primary outcome. Changes in calcium channel blocker prescription over time were evaluated with a Cochran-Armitage trend test. Multivariable logistic regression was used to identify predictors of calcium channel blocker prescription at discharge. RESULTS Twenty-nine (7.3%) patients were discharged on a contraindicated calcium channel blocker without change over time (Ptrend = .38). Of these, 26 (86.7%) were discharged on multiple atrioventricular nodal blocking medications. Hypertension (odds ratio [OR] 7.87; 95% confidence interval [CI], 1.04-59.40) and female sex (OR 3.01; 95% CI, 1.36-6.67) were both associated with contraindicated calcium channel blocker prescription at discharge while diabetes mellitus was negatively associated with this outcome (OR 0.34; 95% CI, 0.14-0.88). CONCLUSION One in 14 patients with heart failure with reduced ejection fraction and comorbid atrial fibrillation were discharged on a contraindicated calcium channel blocker, without change over time. Most patients were discharged on multiple atrioventricular nodal blockers, highlighting potential need for greater coordination between discharging physicians, pharmacists, and electrophysiology.
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Affiliation(s)
- George Cholack
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor; Oakland University William Beaumont School of Medicine, Rochester, Mich
| | - Joshua Garfein
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor
| | - Rachel Krallman
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor
| | - Daniel Montgomery
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor
| | - Eva Kline-Rogers
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor
| | - Melvyn Rubenfire
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor
| | - Sherry Bumpus
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor; School of Nursing, College of Health and Human Services, Eastern Michigan University, Ypsilanti
| | - Thomas Cascino Md
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor
| | - Geoffrey D Barnes
- Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor.
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8
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Cholack G, Garfein J, Errickson J, Krallman R, Montgomery D, Kline-Rogers E, Eagle K, Rubenfire M, Bumpus S, Barnes GD. Early (0-7 day) and late (8-30 day) readmission predictors in acute coronary syndrome, atrial fibrillation, and congestive heart failure patients. Hosp Pract (1995) 2021; 49:364-370. [PMID: 34474638 DOI: 10.1080/21548331.2021.1976558] [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] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Thirty-day readmission following hospitalization for acute coronary syndrome (ACS), atrial fibrillation (AF), or congestive heart failure (CHF) is common, and many occur within one week of discharge. Using a cohort of patients hospitalized for ACS, AF, or CHF, we sought to identify predictors of 30-day, early (0-7 day), and late (8-30 day) all-cause readmission. METHODS We identified 3531 hospitalizations for ACS, AF, or CHF at a large academic medical center between 2008 and 2018. Multivariable logistic regression models were created to identify predictors of 30-day, early, and late unplanned, all-cause readmission, adjusting for discharge diagnosis and other demographics and comorbidities. RESULTS Of 3531 patients hospitalized for ACS, AF, or CHF, 700 (19.8%) were readmitted within 30 days, and 205 (29.3%) readmissions were early. Of all 30-day readmissions, 34.8% of ACS, 16.8% of AF, and 26.0% of the CHF cohorts' readmissions occurred early. Higher hemoglobin was associated with lower 30-day readmission [adjusted (adj) OR 0.92, 95% CI 0.88-0.97] while patients requiring intensive care unit (ICU) admission were more likely readmitted within 30 days (adj OR 1.31, 95% CI 1.03-1.67). Among patients with a 30-day readmission, females (adj OR 1.73, 95% CI 1.22, 2.47) and patients requiring ICU admission (adj OR 2.03, 95% CI 1.27, 3.26) were more likely readmitted early than late. Readmission predictors did not vary substantively by discharge diagnosis. CONCLUSION Patients admitted to the ICU were more likely readmitted in the early and 30-day periods. Other predictors varied between readmission groups. Since outpatient follow-up often occurs beyond 1 week of discharge, early readmission predictors can help healthcare providers identify patients who may benefit from particular post-discharge services.
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Affiliation(s)
- George Cholack
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA.,Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Joshua Garfein
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Josh Errickson
- Department of Statistics, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Krallman
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Daniel Montgomery
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Eva Kline-Rogers
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Kim Eagle
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Melvyn Rubenfire
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
| | - Sherry Bumpus
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA.,College of Health and Human Services, School of Nursing, Eastern Michigan University, Ypsilanti, MI, USA
| | - Geoffrey D Barnes
- Michigan Medicine, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI, USA
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9
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Bernardo S, Krallman R, Kline-Rogers E, Montgomery D, Brown AM, DuRussel-Weston J, Eagle KA, Jackson EA. Physiological and Lifestyle Factors Associated With Abnormal Blood Pressure in Adolescents Before and After a School-Based Wellness Program in Michigan: A Report From Project Healthy Schools. J Adolesc Health 2021; 69:127-133. [PMID: 33280975 DOI: 10.1016/j.jadohealth.2020.10.025] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/20/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Hypertension (HTN) is associated with increased cardiovascular risk and unhealthy lifestyles in adults. However, data on both physiological and lifestyle factors associated with abnormal blood pressure (BP) in adolescents, as well as the effectiveness of interventions in improving these factors among adolescents with abnormal BP, is scarce. METHODS Students enrolled in a middle-school-based wellness program, Project Healthy Schools (PHS), between 2005-2016 were eligible. Three systolic (SBP) and diastolic (DBP) BP measurements were taken pre-PHS and post-PHS; averages of the final two were analyzed. Students were grouped by baseline BP: abnormal BP (≥90th percentile for SBP and/or DBP, or ≥120/80 mmHg) or normal BP (<90th percentile for SBP and/or DBP, or <120/80 mmHg). Demographics, physiologic measures, and health behaviors were compared between groups pre- and post-PHS. RESULTS Of 2,865 students, 812 (28.3%) had abnormal BP. Median SBP was 119 mmHg in abnormal BP students and 103 mmHg in normal BP students (p < .001). Females were less likely to have abnormal BP than males (48.4% vs. 51.6%, p < .01). Pre-PHS, abnormal BP students were more likely to be overweight (62.3% vs. 28.2%, p < .001) or obese (38.9% vs. 11.3%, p < .001) than normal BP students. Their total cholesterol, triglycerides, random glucose, resting, and recovery heart rates were also higher, and they had worse dietary and sedentary habits. Post-PHS, abnormal BP students demonstrated greater reduction in SBP (-4.0 vs. 2.8 mmHg, p < .001) and DBP (-3.3 vs. .8 mmHg, p < .001) than normal BP students. CONCLUSIONS Abnormal BP was prevalent and associated with worse cardiometabolic health parameters and behaviors at baseline. Abnormal BP students demonstrated significant improvements in BP post-PHS, suggesting school-based programs may be effective as nonpharmacological lifestyle interventions in this population.
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Affiliation(s)
- Sabrina Bernardo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Rachel Krallman
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Eva Kline-Rogers
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Daniel Montgomery
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Ashley M Brown
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California
| | | | - Kim A Eagle
- Division of Cardiovascular Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
| | - Elizabeth A Jackson
- Division of Cardiovascular Disease, Department of Internal Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
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10
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Anderson PM, Krallman R, Montgomery D, Kline-Rogers E, Bumpus SM. The Relationship Between Patient Satisfaction With Hospitalization and Outcomes Up to 6 Months Post-Discharge in Cardiac Patients. J Patient Exp 2021; 7:1685-1692. [PMID: 33457631 PMCID: PMC7786784 DOI: 10.1177/2374373520948389] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Little is known about the relationship between patient satisfaction with inpatient care and post-discharge outcomes. This study examined inpatient hospital satisfaction after a cardiac event and outcomes through 6 months post-discharge. We examined 327 cardiac patients from the Bridging the Discharge Gap Effectively database who completed a patient satisfaction survey about their hospital admission and had post-discharge outcomes data. Higher patient satisfaction with the discharge process correlated with fewer readmissions at 90 days post-discharge. Higher patient satisfaction with hospital staff management of personal issues correlated with fewer emergency department visits at 6 months post-discharge. Higher patient satisfaction with overall assessment of care and hospitalization correlated with lower mortality rate at 6 months post-discharge. Being nonwhite correlated with lower nursing care satisfaction. Associations between cardiac patient satisfaction and outcomes exist. In this population, higher patient satisfaction correlated with better outcomes. Patient satisfaction data may be able to inform areas for health system improvement.
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Affiliation(s)
| | - Rachel Krallman
- Michigan Clinical Outcomes Research and Reporting Program, University of Michigan Health System, Ann Arbor, MI, USA
| | - Daniel Montgomery
- Michigan Clinical Outcomes Research and Reporting Program, University of Michigan Health System, Ann Arbor, MI, USA
| | - Eva Kline-Rogers
- Michigan Clinical Outcomes Research and Reporting Program, University of Michigan Health System, Ann Arbor, MI, USA
| | - Sherry M Bumpus
- Michigan Clinical Outcomes Research and Reporting Program, University of Michigan Health System, Ann Arbor, MI, USA.,School of Nursing, Eastern Michigan University, Ypsilanti, MI, USA
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11
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Bumpus S, Krallman R, McMahon C, Gupta A, Montgomery D, Kline-Rogers E, Vaishnava P. Insights into hospital readmission patterns of atrial fibrillation patients. Eur J Cardiovasc Nurs 2020; 19:545-550. [PMID: 32148075 DOI: 10.1177/1474515120911607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Patients admitted to the hospital with atrial fibrillation have associated morbidity and mortality and incur significant costs. Data characterizing atrial fibrillation patients at high risk for readmission are scarce. We sought to inform this area by characterizing and categorizing unplanned readmissions of atrial fibrillation patients. METHODS Retrospective data were abstracted from the charts of patients discharged from 2008 to 2012 after an index hospitalization for atrial fibrillation and referred to the nurse practitioner-led transitional care program, Bridging the Discharge Gap Effectively. Unplanned readmissions were dichotomized as early (⩽30 days) or late (31-180 days) and further classified as either "atrial fibrillation/atrial fibrillation-related" (AF/AF-related), "Cardiac; not AF/AF-related," or "Not cardiac-related." Case classifications were adjudicated by a senior cardiologist. Patient demographics and readmission characteristics were then compared. RESULTS Of 255 patients, 97 (38.0%) had unplanned readmissions within 180 days of discharge; 45 (46.4%) were early and 52 (53.6%) were late. Atrial fibrillation and cardiac causes accounted for 68.9% (n=31) of early readmissions and 65.4% (n=34) of late. Patients with late readmissions were more likely to have diabetes (32.7% vs. 17.7%, p=.022) and higher CHA2DS2VASc scores (3.63 vs. 2.98, p=0.026) than those not readmitted. No other differences in baseline characteristics were seen within or between groups. The 30-day all-cause readmission rate in this sample was 17.6% (n=45). CONCLUSION Readmissions following hospital discharge for atrial fibrillation are common; approximately 50% of these readmissions are for reasons unrelated to atrial fibrillation. In order to reduce atrial fibrillation-related readmissions, further research is needed to characterize predictors of readmission and to develop effective transitional care interventions.
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Affiliation(s)
- Sherry Bumpus
- Eastern Michigan University, Ypsilanti, USA.,Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA
| | - Rachel Krallman
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA
| | - Colin McMahon
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA
| | - Ashwin Gupta
- Department of Internal Medicine, Division of Hospital Medicine, University of Michigan Health System, Ann Arbor, USA.,Veterans Administration Ann Arbor Health Care Center, USA
| | - Daniel Montgomery
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA
| | - Eva Kline-Rogers
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Health System, Ann Arbor, USA
| | - Prashant Vaishnava
- Mount Sinai Hospital, Department of Internal Medicine, Division of Cardiology, New York City, USA
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12
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Kimball A, Kerbusch T, van Aarle F, Kulkarni P, Li Q, Blauvelt A, Papp K, Reich K, Montgomery D. How many people develop anti-drug antibodies to the biologic drug tildrakizumab, and what impact does this have on the effectiveness of their treatment. Br J Dermatol 2020. [DOI: 10.1111/bjd.18662] [Citation(s) in RCA: 1] [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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13
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Kimball A, Kerbusch T, van Aarle F, Kulkarni P, Li Q, Blauvelt A, Papp K, Reich K, Montgomery D. 有多少人开发生物制剂 tildrakizumab 的抗药抗体, 以及这对其治疗有效性产生哪些影响. Br J Dermatol 2020. [DOI: 10.1111/bjd.18679] [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: 11/27/2022]
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14
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Kimball A, Kerbusch T, van Aarle F, Kulkarni P, Li Q, Blauvelt A, Papp K, Reich K, Montgomery D. Assessment of the effects of immunogenicity on the pharmacokinetics, efficacy and safety of tildrakizumab. Br J Dermatol 2020; 182:180-189. [PMID: 30916381 PMCID: PMC6972989 DOI: 10.1111/bjd.17918] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND We evaluated antidrug antibody (ADA) development in patients with chronic plaque psoriasis from three clinical trials of tildrakizumab, a humanized anti-interleukin-23p19 monoclonal antibody (P05495, reSURFACE 1 and reSURFACE 2). OBJECTIVES To determine the effects of immunogenicity on the pharmacokinetics, efficacy and safety of tildrakizumab. METHODS In 1400 (weeks 12-16) and 780 (weeks 52-64) evaluable patients randomized to tildrakizumab 100 or 200 mg, treatment-emergent ADA-positive (TE-POS) patients were identified and characterized for neutralizing antibodies (NAbs). Pharmacokinetics, safety and efficacy were evaluated by ADA status. RESULTS In patients treated with tildrakizumab 100 or 200 mg continuously, < 7% were inconclusive at 52-64 weeks. In long-term data through 52-64 weeks, the incidence of TE-POS was 6·5% (100 mg) and 8·2% (200 mg) and the incidence of TE-POS NAb-POS was 2·5% (100 mg) and 3·2% (200 mg). TE-POS NAb-POS patients had modestly increased median tildrakizumab clearance (36·5%) compared with ADA-NEG patients. Percentage Psoriasis Area and Severity Index improvements in TE-POS NAb-POS vs. ADA-NEG patients on continuous treatment through week 52 were 76% (n = 10) vs. 91% (n = 342) for 100 mg and 77% (n = 12) vs. 87% (n = 299) for 200 mg. The incidence of potential immunogenicity-related adverse events did not indicate a clear trend in any positive ADA patient category compared with ADA-NEG patients through weeks 52-64. The effects of ADA on pharmacokinetics, efficacy and safety at 12-16 weeks were also summarized. CONCLUSIONS ADA development with tildrakizumab treatment for 52-64 weeks was low; around 3% of patients developed TE-POS NAb-POS ADAs and showed lower serum concentrations and corresponding reduced efficacy. No relationship between ADAs and safety was observed. What's already known about this topic? Unwanted immune responses - for example immunogenicity and antidrug antibodies (ADAs) - have been observed with therapeutic monoclonal antibodies and can affect efficacy and safety. Tildrakizumab is a humanized monoclonal antibody targeting interleukin-23 and is currently approved for patients with plaque psoriasis. What does this study add? ADA development in tildrakizumab-treated patients with psoriasis over 52 weeks was low. The small proportion of patients who had treatment-emergent ADAs and had neutralizing antibodies experienced lower serum tildrakizumab concentrations and reduced efficacy. No relationship between ADAs and safety events was observed.
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Affiliation(s)
| | | | | | | | - Q. Li
- Merck & Co., Inc.KenilworthNJU.S.A
| | - A. Blauvelt
- Oregon Medical Research CenterPortlandORU.S.A
| | - K.A. Papp
- Probity Medical ResearchWaterlooONCanada
| | - K. Reich
- Center for Translational Research in Inflammatory Skin Diseases, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg‐Eppendorf, and Skinflammation centerHamburgGermany
- DermatologikumBerlinGermany
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15
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Van Bakel T, Patel H, van Bogerijen G, Upchurch G, Bismuth J, de Beaufort H, Montgomery D, Nienaber C, Isselbacher E, Myrmel T, Desai N, Bavaria J, Di Eusanio M, Sundt T, Gleason T, Williams D, Eagle K, Trimarchi S. Tevar for Acute Type B Aortic Dissection: Results from the International Registry of Acute Aortic Dissection Interventional Cohort (IRAD-IVC). Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.06.892] [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: 11/29/2022]
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16
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Contrady A, Francis S, Montgomery D. Fresh Conversations: Helping Older Adults Make Lifestyle Changes. J Acad Nutr Diet 2019. [DOI: 10.1016/j.jand.2019.06.195] [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: 10/26/2022]
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17
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Guo E, Krallman R, Bernardo S, Montgomery D, DuRussel-Weston J, Kline-Rogers E, Eagle KA, Jackson EA. Abstract 228: Comparison of the Effect of Local and Long-Distance Delivery Models for a School-Based Wellness Intervention on Health Behaviors of Middle School Students. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background:
Michigan’s upper peninsula (UP) is a remote area with only 3% of the state’s population, making it difficult to reach with health interventions. Nearly half of the UP counties have higher adult obesity rates than the state average. The Project Healthy Schools (PHS) middle school-based wellness program uses local and long-distance delivery models in Michigan’s lower peninsula (LP) and UP, respectively. Schools utilizing the local model (LP schools) have routine staff visits to assist in program implementation; conversely, long-distance model schools (UP) rely on telecommunication with PHS staff to implement the program. This study sought to determine if differences exist in health behaviors of LP and UP students at baseline, as well as post-PHS intervention to determine the effectiveness of the local and long-distance PHS delivery models.
Methods:
Data from 6
th
grade students enrolled in PHS between 2014-2017 were analyzed. Students were divided into two groups, UP and LP students. Demographics and health behaviors at baseline and post-intervention were compared between groups.
Results:
Of 21,459 students, 695 (3.2%) were from the UP. Compared to LP students, UP students were more likely to be White and from lower and middle socioeconomic status communities. Pre-PHS intervention, UP students ate more fruits, vegetables, and chocolate candy, engaged in more moderate exercise, and spent less time on TV, computers, video games, and mobile devices than LP students. No significant differences in post-intervention impact on health behaviors were seen between UP and LP students.
Conclusions:
At baseline, UP students reported better health behaviors than LP students. However, the lack of differences in post-intervention impact suggest the local and long-distance delivery models were equally effective in influencing health behaviors. Future investigation of the effect of school-based interventions in remote communities, like the UP, are warranted.
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Affiliation(s)
- Emily Guo
- Univ of Michigan Health System, Ann Arbor, MI
| | | | | | | | | | | | - Kim A Eagle
- Univ of Michigan Health System, Ann Arbor, MI
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18
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Pfeifer L, Krallman R, Bernardo S, Montgomery D, DuRussel-Weston J, Kline-Rogers E, Eagle KA, Jackson EA. Abstract 261: Gender-Specific Differences in Behavioral and Physiological Risk Factors Associated with Childhood Obesity. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background:
Prior research has shown differences in physiologic and behavioral measurements of adolescent boys and girls. This study sought to determine if similar gender-specific differences exist between participants of the Project Healthy Schools (PHS) school-based wellness program, both at baseline and post-PHS intervention.
Methods:
Demographics, physiological measures and health behaviors were compared between 6
th
grade girls and boys enrolled in PHS between 2004-2017 at baseline and post-PHS intervention.
Results:
Health behavior data were collected in 19,995 students (46.1% girls); physiological measures were collected in 2,922 students (52.7% girls). Boys within the physiological sample were older than girls (11.62 v. 11.55, p<0.001). At baseline, girls had lower HDL cholesterol and higher resting and recovery heart rates, but reported greater consumption of fruits and vegetables and less sugary beverages and fried meats than boys. Boys reported more vigorous exercise but greater hours of television and video game screen time than girls. Post-intervention, girls showed greater improvement in resting heart rate, fruit consumption and video game time.
Conclusion:
Girls had better health behaviors but poorer physiological markers at baseline. Lower rates of physical activity in girls at baseline highlight a potential area of focus for the PHS intervention in this population. Future exploration of gender-specific targeted strategies to improve health behaviors is warranted.
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Affiliation(s)
| | | | | | | | | | | | - Kim A Eagle
- Univ of Michigan Health Systems, Ann Arbor, MI
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19
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Lee M, Krallman R, Feldeisen D, Montgomery D, Kline-Rogers E, Eagle KA, Bumpus SM. Abstract 241: An Investigation of Sex Differences in the BRIDGE Transitional Care Clinic Population. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background:
Although cardiovascular disease (CVD) is the leading cause of death in men and women, women are less likely than men to received certain evidence-based treatments for CVD or be enrolled in CVD clinical trials. This study sought to identify sex differences in outcomes among patients referred to the BRIDGE transitional care clinic following hospitalization for a cardiac event.
Methods:
Retrospective data on patients referred to BRIDGE from 2008-2016 were analyzed. Demographics and outcomes (readmissions, emergency department [ED] visits, death) were compared between male and female patients in five populations: 1) the total BRIDGE population, 2) acute coronary syndrome (ACS) patients, 3) congestive heart failure (CHF) patients, 4) atrial fibrillation/flutter (AF) patients, and 5) patients who attended BRIDGE clinic.
Results:
Of 4159 patients, 1710 (41.1%) were female. In the total population, women were significantly older than men (66.8 v 64.8, p=0.010), were less likely to be married (45.2% v 68.2%, p≤0.001), and had higher Charlson Comorbidity Index (CCI) scores (4.90 v 4.60, p=0.001). Women were also less likely to have ACS (20.7% v 28.6%, p≤0.001), more likely to have CHF (25.1% v 20.9%, p=0.001), and were more likely to have an ED visit within 6 months post-discharge. No significant differences were seen in outcomes between males and females in the CHF and AF populations; however, female ACS patients were more likely to have had an ED visit within 6 months of discharge than male ACS patients. In regards to transitional care, women were less likely to attend their BRIDGE appointment (68.7% v 72.4%, p=0.008). Among BRIDGE attendees, females were older (66.8 v 64.9, p=0.001), less likely to be married (45.9% v 68.8%, p=0.001), and had higher CCI scores (4.80 v 4.55, p=0.016) than males. Female attendees were more likely than male attendees to have had an ED visit both within 30 days and 6 months.
Conclusions:
Among the total population, BRIDGE attendees, and ACS patients, women were more likely to visit the ED than men. Additionally, women were less likely than men to attend their BRIDGE transitional care appointment. Efforts should be made to improve BRIDGE clinic attendance among women and develop targeted strategies to improve outcomes for female patients, specifically those with a primary diagnosis of ACS.
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Affiliation(s)
- Monica Lee
- Univ of Michigan Health System, Ann Arbor, MI
| | | | | | | | | | - Kim A Eagle
- Univ of Michigan Health System, Ann Arbor, MI
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20
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Harden L, Krallman R, Feldeisen D, Montgomery D, Kline-Rogers E, Eagle KA, Bumpus SM. Abstract 231: Outcome Variations Between Patients Prescribed Direct Oral Anticoagulant or Warfarin. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background:
Patients with cardiovascular disease (CVD) require antithromobotic therapy to reduce risk of embolization. Direct oral anticoagulants (DOAC) were introduced to widespread clinic use in 2010. This study explores differences in demographics and outcomes (readmission, ED visit, death) between patients on a DOAC or warfarin, and the impact of attending a cardiac transitional care appointment (BRIDGE) on outcomes between groups.
Methods:
Data from patients in the BRIDGE dataset from 2010-2017 were analyzed, excluding those with an adverse event prior to their BRIDGE appointment. Demographics and outcomes of patients prescribed warfarin were compared with those prescribed a DOAC. Outcomes for each group were further compared by BRIDGE clinic attendance.
Results:
Prescribing of DOACs has linearly increased from 2010-2017. Of 666 anticoagulated patients, 22.5% (n=150) were prescribed a DOAC and 77.5% (n=516) were prescribed warfarin, for any indication. Warfarin patients had higher CHA2DS2-VASc scores and were more likely to visit the ED within 30 days than DOAC patients. DOAC patients were more likely to be readmitted within 6 months. Both warfarin and DOAC patients who attended BRIDGE were less likely to have a readmission within 6 months than patients who did not attend. DOAC patients who attended BRIDGE were also less likely to have an ED visit within 6 months than DOAC patients who did not attend. However, patients with a 30 day adverse event were more likely to have attended BRIDGE (readmission: DOAC 90%, 9/10; warfarin 73.8%, 31/42; ED: DOAC 100%, 5/5; warfarin 78.7, 37/47).
Conclusion:
Since introduction, DOAC prescription has continuously increased. Warfarin patients had higher CHA2DS2-VASc scores and higher rates of early adverse events (ED visit) than DOAC patients. DOAC patients had higher rates of late adverse events (readmission in 6 months). The differences in early and late readmissions may be partially explained by the necessity of early follow up for those prescribed warfarin at discharge. However, early readmissions overall were more likely to have attended BRIDGE. This suggests that early follow up frequently identifies anticoagulated patients in need of hospitalization, and the importance of prompt transitional care among this population.
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Affiliation(s)
| | | | | | | | | | - Kim A Eagle
- Univ of Michigan Health System, Ann Arbor, MI
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21
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Khan S, Krallman R, Feldeisen D, Montgomery D, Kline-Rogers E, Eagle KA, Bumpus SM. Abstract 236: Investigation of the Effects of the Affordable Care Act within the BRIDGE Population. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.236] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background:
The U.S. Patient Protection and Affordable Care Act (ACA) aimed to provide all United States citizens access to health care and reform the way healthcare was delivered. A key provision of the ACA was the Readmission Reduction Program (RRP) that penalizes hospitals for excessive readmissions. This study sought to determine if changes exist after ACA implementation in demographics and outcomes of myocardial infarction (MI) and heart failure (CHF) patients referred for transitional care (BRIDGE).
Methods:
MI and CHF patients referred to BRIDGE between 2008-2016 were divided into pre-ACA (2008-2013) and post-ACA (2014-2016) cohorts. Demographics and outcomes (ED visits, readmissions) were compared between groups. Post-hoc, a subset of patients of low socioeconomic status (SES) were analyzed. Low SES was defined as a median household income (based on the patient’s zip code) less than the 2012 household income for the state of Michigan ($46,859).
Results:
Compared to pre-ACA patients, post-ACA patients had higher Charlson comorbidity scores and were more likely to be readmitted within 6-months. In addition, when examined independently, both MI and CHF patient subsets had higher Charlson scores post-ACA. Similar differences were seen in the subset of low SES patients, with post-ACA patients having higher Charlson scores, 6-month readmission rates, and 6-month ED visits rates than pre-ACA patients.
Conclusions:
There were few differences in outcomes between pre-ACA and post-ACA groups in this sample. Overall, post-ACA patients were sicker. There were no differences in participation in the BRIDGE transitional care program or in early readmissions or ED visits. Notably, there were higher rates of readmission and ED visits within 6-months, potentially suggesting greater access to care. This finding was consistent both in the total MI and CHF population as well as among those of low SES. More research is needed to determine whether changes as a result of ACA implementation can in part explain these findings.
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Affiliation(s)
- Sarah Khan
- Univ of Michigan Health System, Ann Arbor, MI
| | | | | | | | | | - Kim A Eagle
- Univ of Michigan Health System, Ann Arbor, MI
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22
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Reutersberg B, Gleason T, Desai N, Ehrlich MP, Evangelista-Masip A, Braverman A, Myrmel T, Chen E, Estrera A, Schermerhorn M, Bossone E, Montgomery D, Eagle K, Sundt T, Patel H, Trimarchi S, Eckstein HH. NEUROLOGICAL EVENT RATES AND ASSOCIATED RISK FACTORS IN ACUTE TYPE B AORTIC DISSECTIONS TREATED ENDOVASCULARLY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32660-9] [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: 10/27/2022]
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23
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Philip S, Chen E, Hutchison S, O'Gara P, Missov E, Hughes GC, Gilon D, Conklin L, Shalhub S, Khoynezhad A, Bekeredjian R, Montgomery D, Geuzebroek G, Taylor B, Tolva V, Isselbacher E, Nienaber C, Eagle K. NEW MURMUR OF AORTIC INSUFFICIENCY IN ACUTE AORTIC DISSECTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32731-7] [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: 10/27/2022]
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Foley N, Peterson M, Levack M, Bekeredjian R, Braverman A, Pacini D, Ehrlich M, Brinster D, Harris K, Hutchison S, Fanola C, Mussa FF, Montgomery D, Nienaber C, Isselbacher E, Gleason T, Eagle K. ABSOLUTE AORTIC SIZE BUT NOT INDEXED AORTIC SIZE PREDICTS LATE OUTCOMES FOR FEMALES UNDERGOING MEDICAL MANAGEMENT OF TYPE B DISSECTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32710-x] [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: 11/16/2022]
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Smith DA, Brinster D, Evangelista-Masip A, Trimarchi S, Harris K, Bossone E, Braverman A, O'Gara P, Hughes GC, Suzuki T, Korach A, Montgomery D, Mussa FF, De Oliveira N, Arnaoutakis G, Nienaber C, Isselbacher E, Eagle K. ASSESSING THE ACCURACY OF THE SIMPLE RISK PREDICTION MODEL FOR ACUTE TYPE A AORTIC DISSECTION OVER TIME. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)32711-1] [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: 11/30/2022]
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26
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Philip S, Missov E, Gilon D, Hutchison S, Khoynezhad A, Evangelista A, Bonaca M, Conklin L, Appoo J, Di Eusanio M, Braverman A, Forteza A, Montgomery D, Nienaber C, Isselbacher E, Eagle K. Head and Neck Pain in Patients Presenting with Acute Aortic Dissection. Aorta (Stamford) 2018; 6:130-138. [PMID: 31018236 PMCID: PMC6482025 DOI: 10.1055/s-0039-18388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/05/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Head and neck pain is an atypical presentation of acute aortic dissection. Classic teaching associates this pain with proximal dissections, but this has not been extensively studied. METHODS Patients enrolled in the International Registry of Acute Aortic Dissection from January 1996 to March 2015 were included in this study. We analyzed the demographics, presentation, treatment, and outcomes of Type A aortic dissection patients presenting with head and neck pain (n = 812, 25.8%) and compared it with those without these symptoms (n = 2,341, 74.2%). RESULTS Patients with head and neck pain were more likely to be white, female, with a family history of aortic disease. Patients with head and neck pain had higher percentages of back pain (43.3% vs. 37.5%, p = 0.005) and chest pain (87.6% vs. 79.3%, p < 0.001). On imaging, a higher percentage of those with head and neck pain had arch vessel involvement (44.3% vs. 38%, p = 0.010) and intramural hematoma (11.7% vs. 8.1%, p = 0.003). Surgical management was more common in patients with head and neck pain (89.8% vs. 85.2%, p = 0.001). Regarding outcomes, patients with head and neck pain had significantly higher rates of stroke than those without head and neck pain (13% vs. 9.9%, p = 0.016); however, overall mortality was lower for those with head and neck pain (19.5% vs. 23%, p = 0.038). Those with head and neck pain only had higher overall mortality compared to those with head and neck pain with chest or back pain (34.6% vs. 19.9%, p = 0.013). A logistic regression of mortality revealed that preoperative hypotension and age > 65 years were significantly associated with increased mortality. CONCLUSION Presence of head and neck pain in Type A dissection is associated with more arch involvement, intramural hematoma, and stroke. When isolating those with head and neck pain only, there appear to be a higher rate of comorbidity burden and higher overall mortality.
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Affiliation(s)
- Stephen Philip
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Emil Missov
- Department of Internal Medicine, University of Minnesota Physicians Heart Practice, Minneapolis, Minnesota
| | - Dan Gilon
- Department of Non-invasive Cardiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Stuart Hutchison
- Libin Cardiovascular Institute, University of Calgary Medical Centre, Calgary, Canada
| | - Ali Khoynezhad
- Department of Cardiovascular Surgery, Long Beach Medical Center, Los Angeles, California
| | - Arturo Evangelista
- Department of Cardiology, Hospital General Universitari Vall D'hebron, Barcelona, Spain
| | - Mark Bonaca
- Department of Cardiovascular Medicine, Brigham & Women's Hospital, Boston, Massachusetts
| | - Lori Conklin
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia
| | - Jehangir Appoo
- Libin Cardiovascular Institute, University of Calgary Medical Centre, Calgary, Canada
| | - Marco Di Eusanio
- Department of Cardiovascular Surgery, Ospedali Riuniti Ancona, Ancona, Italy
| | - Alan Braverman
- Deparment of Cardiology, Washington University, School of Medicine, St. Louis, Missouri
| | - Alberto Forteza
- Department of Cardiac Surgery, Hospital Universitario Puerta De Hierro, Madrid, Spain
| | - Daniel Montgomery
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Christoph Nienaber
- Cardiology and Aortic Centre, The Royal Brompton & Harefield Nhs Trust, London, United Kingdom
| | - Eric Isselbacher
- Thoracic Aortic Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Kim Eagle
- Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan
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Abstract
Background & objectives: Beta-blockers have been shown to improve survival in both type A and type B acute aortic dissection (AAD) patients. Calcium channel blockers have been shown to selectively improve survival only in type B AAD patients. There is a lack of data on medication adherence in AAD survivors. The purpose of this study was to assess medication adherence in patients who survived an AAD. Methods: This was a cross-sectional survey-based study of individuals from a single medical centre which was part of the larger International Registry of Acute Aortic Dissection (IRAD). Patients with type A or B AAD who survived to discharge were included in this study. Individuals who were deceased based on the results of an online Social Security Death Index were excluded from the study. Data were obtained from both a survey and also from abstraction from the local academic institution's IRAD registry. A survey packet was sent to patients. One section of this survey was dedicated to assessing medication adherence using the 4-item Morisky scale. Results: Eighty two completed surveys were returned; 74 patients completed the section of the survey pertaining to medication adherence (response rate 38%). Morisky score was ≥1.0 for 27 (36%) patients and 0 for 47 (64%) patients. Thirty three patients reported yes to ‘forget to take medications’ and eight reported yes to ‘careless with medications.’ Medication non-adherence (defined as a score of ≥1.0 on Morisky) was associated with increased follow up recurrence of chest pain at one year of follow up. Only two patients stopped their antihypertensive on their own and did not cite a reason for doing this. Interpretation & conclusions: The medication adherence rate for patients who survived an AAD was 64 per cent at a median (Q1, Q3) of 7.1 yr (5.6, 11.5) after discharge, as per the Morisky scale. The clinicians should educate their patients on the importance of antihypertensive therapy and assess for forgetfulness and carelessness at each clinic visit, as well as understand patients’ beliefs about drug therapy, all of which have been shown to increase medication adherence.
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Affiliation(s)
- Ashish Chaddha
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Steven Erickson
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Eva Kline-Rogers
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel Montgomery
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Elise Woznicki
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Justin Jabara
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Kim Eagle
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
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Gajar A, Krallman R, Montgomery D, Morgan S, Kline-Rogers E, Eagle KA, Bumpus SM. Abstract 139: Examining the Effect of Post-Hospital Syndrome on Outcomes in Patients Discharged After an Acute Coronary Syndrome. Circ Cardiovasc Qual Outcomes 2018. [DOI: 10.1161/circoutcomes.11.suppl_1.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background:
Hospital readmissions are increasingly observed and reported as quality indicators. The literature is critical of studies that use
all cause
readmission definitions, suggesting that not every readmission is related to the index admission diagnosis. However, hospitals are not a therapeutic environment. Patients are often kept on ”nothing by mouth” (NPO) status, subjected to testing at irregular hours, placed on bed rest, and discharged on new medications. Thus, patients may be more vulnerable to adverse outcomes at discharge; some have characterized this phenomenon as “post-hospital syndrome.” This study sought to compare these inpatient stressors (NPO status, after-hours testing, new medications, and bed rest) to patient outcomes (ED visits, readmissions).
Methods:
A retrospective chart review of 100 randomly selected ACS patients referred to a cardiac transitional care program (BRIDGE) between 2014-2015 was conducted. Associations between hours NPO, number of new medications, number of tests at irregular hours (11pm-5am), prescribed bed rest and outcomes at 30 and 180 days were analyzed.
Results:
Of 100 patients, 72% were male with a mean age of 65.87 ± 12.33 and a mean Charlson comorbidity score of 5.42 ± 2.58. Bed rest was prescribed for 69% of patients. The average patient was prescribed 4.43 new medications at discharge, underwent 4.37 tests at irregular hours, and spent 11.40 hours NPO. Median length of stay was 3 days (range: 0-18 days). Number of tests at irregular hours was positively correlated with readmission at 30 days (r=0.272, p=0.006), and 180 day ED visits (r=0.282, p=0.004) and readmissions (r=0.363, p<0.001). No other significant correlations were observed between inpatient stressors and outcomes.
Conclusions:
NPO status and tests at irregular hours were correlated with negative short and longer-term outcomes. Efforts should be made to limit these inpatient stressors or to stabilize patients prior to discharge. Future research on post hospital syndrome is warranted to better understand potential longer-term relationships and to better plan for care transitions.
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Affiliation(s)
| | | | | | | | | | - Kim A Eagle
- Univ of Michigan Health System, Ann Arbor, MI
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Feldeisen D, Krallman R, Morgan S, Montgomery D, Kline-Rogers E, Eagle KA, Bumpus SM. Abstract 117: Presence of Mental Health Disorders, Low Socioeconomic Status, More Closely Associated With Adverse Cardiovascular Outcomes After a Recent Hospitalization. Circ Cardiovasc Qual Outcomes 2018. [DOI: 10.1161/circoutcomes.11.suppl_1.117] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background:
BRIDGE is a cardiac transitional care program. In previous studies, lower socioeconomic status (SES) and mental health disorders (MHD) have been associated with higher readmission rates. No research has been done on the combined effects of low SES and MHD on outcomes. This study sought to describe outcomes (ED Visits, readmission, and death) of patients by SES and MHD.
Methods:
All patients referred to BRIDGE between 2008-2015 were included in this study. Data were analyzed in three ways: 1) by SES and then by presence (or absence) of MHD (depression, anxiety, substance abuse), 2) by MHD and then by SES, and 3) patients of low SES without MHD compared to patients of high SES with a MHD (data not shown in Table 1). High and low SES were defined as above or below the state of Michigan median household income ($46,859), estimated by patients’ home zip code. Demographics and outcomes were compared within and between groups.
Results:
Among 3051 patients divided first by SES, there were a number of significant differences in demographics and outcomes between patients with and without MHD. Regardless of SES, patients with MHD were more often younger, female, single, and had higher rates of ED visits and readmissions at 180 days post-discharge than patients without MHD. Among high SES patients, patients with MHD had higher rates of ED visits within 30 days despite lower Charlson Comorbidity scores. In contrast, when divided by presence or absence of MHD first, fewer differences existed between SES groups. Regardless of presence or absence of MHDs, patients of low SES were younger and more racially diverse than patients of high SES; however, there were no differences in outcomes between these SES groups. Among patients without a MHD, low SES patients were less likely to attend BRIDGE. Patients of low SES without MHD were more likely than patients of high SES with MHD to be male (61.4% v. 51.2%, p<0.001), married (60.8% v. 52.2%, p=0.013), and non-White (75.3% v. 89.5%, p<0.001), and were less likely to have an ED visit within 180 days (31.9% v. 43.9%, p<0.001).
Conclusions:
The presence of MHDs appears to be more strongly associated with negative outcomes than low SES. Efforts to develop and improve interventional care strategies that target patients with MHDs should be made to reduce these health disparities.
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Affiliation(s)
| | | | | | | | | | - Kim A Eagle
- Univ of Michigan Health System, Ann Arbor, MI
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Brown K, Krallman R, Montgomery D, Morgan S, Fried S, Kline-Rogers E, Eagle KA, Bumpus SM. Abstract 217: Smoking Cessation and Patient Outcomes in the BRIDGE Clinic Population. Circ Cardiovasc Qual Outcomes 2018. [DOI: 10.1161/circoutcomes.11.suppl_1.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background:
Cigarette smoking is associated with significant morbidity and mortality among patients with cardiovascular disease. Yet, nearly 1 in 6 people in the US continue to smoke. This study sought to determine the prevalence of smoking and smoking cessation education in the BRIDGE post-discharge cardiac transitional care clinic and associated outcomes.
Methods:
Chart review was conducted of 133 randomly selected patients who attended their BRIDGE appointment between 2011-2015 and were current smokers. Demographics and outcomes were compared between patients who did and did not have documentation of smoking cessation education at their BRIDGE clinic visit and between those who did and did not quit smoking at 30 and 180 days post-discharge.
Results:
At 30 days post-discharge, 32 (24.1%) patients had quit smoking. At 180 days, 8 patients (6.0%) had resumed smoking, but an additional 10 (7.5%) had quit. There were no demographic differences between those who did and did not quit at 30 or 180 days. Further, there were no differences in readmission (21.9% v. 12.9%, p=0.214) or death (0.0% v. 1.0%, p=1.000) rates between patients who did and did not quit at 30 days post-discharge. However, patients who had quit at 180 days were more often readmitted compared to those who had not quit (55.9% v. 25.3%, p=0.001). Of 133 patients, smoking cessation was discussed with 55 (41.4%). Smoking cessation education was provided at similar rates to patients who did and did not quit smoking at 30 and 180 days (30 day, 28.1% v. 45.5%, p=0.081; 180 day, 32.4% v. 44.4%, p=0.217), and there were no demographic differences between these groups. However, those who discussed smoking cessation were more likely to visit the ED within 180 days post-discharge (50.9% v. 26.9%, p=0.005).
Conclusions:
A quarter of patients who quit smoking at 30 days post-discharge had resumed smoking at 180 days. Surprisingly, patients who quit smoking had higher readmission rates at 180 days. This study should be repeated with a larger sample size and explore other potential factors influencing these outcomes. For example, documentation of smoking cessation education was far lower than anticipated and may not be representative of actual discussion frequency. Efforts to design better strategies to encourage smoking cessation and reduce relapse are critical.
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Affiliation(s)
- Kiera Brown
- Univ of Michigan Health System, Ann Arbor, MI
| | | | | | | | - Sarah Fried
- Univ of Michigan Health System, Ann Arbor, MI
| | | | - Kim A Eagle
- Univ of Michigan Health System, Ann Arbor, MI
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Bismuth J, Zubair M, Sechtem U, Harris K, Suzuki T, Khoynezhad A, Pape L, Missov E, Bhan A, Braverman A, Trimarchi S, Nienaber C, Montgomery D, Eagle K, Estrera AL, Isselbacher E, Evangelista A. ANTICOAGULATION THERAPY FOLLOWING ACUTE AORTIC DISSECTION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32615-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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32
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Bernardo S, Krallman R, Montgomery D, DuRussel-Weston J, Kline-Rogers EM, Eagle K, Jackson E. CARDIOVASCULAR RISK FACTORS ASSOCIATED WITH ADOLESCENT HYPERTENSION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32330-1] [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: 11/28/2022]
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Conroy J, Krallman R, Montgomery D, DuRussel-Weston J, Kline-Rogers EM, Eagle K, Jackson E. PHYSIOLOGICAL OUTCOMES BASED ON FRUIT AND VEGETABLE CONSUMPTION OF ADOLESCENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32436-7] [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: 11/27/2022]
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Myrmel T, Braverman A, Peterson M, Chen EP, Bossone E, Gleason T, Evangelista A, Eusanio MD, Desai N, O'Gara PT, Sechtem U, Montgomery D, Isselbacher E, Nienaber C, Hughes GC, Eagle K. PREDICTING FACTORS FOR 5 YEAR ADVERSE EVENTS AFTER TREATMENT FOR ACUTE AORTIC DISSECTIONS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32575-0] [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: 10/17/2022]
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35
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Lee J, Krallman R, Montgomery D, DuRussel-Weston J, Kline-Rogers EM, Jackson E, Eagle K. TRENDS IN MOBILE DEVICE USAGE, PHYSICAL ACTIVITY, AND SEDENTARY SCREEN TIME IN PROJECT HEALTHY SCHOOLS STUDENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32343-x] [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: 11/25/2022]
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36
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Reutersberg B, Trimarchi S, Gilon D, Kaiser C, Harris K, Shalhub S, Reece TB, Nienaber C, Ehrlich M, Isselbacher E, De Oliveira N, Montgomery D, Eagle K, Tolva V, Chen EP, Eckstein HH. PLEURAL EFFUSION IS A SURROGATE MARKER FOR COMPLICATIONS IN TYPE B AORTIC DISSECTIONS: OBSERVATIONS FROM THE INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION (IRAD). J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32613-5] [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: 11/25/2022]
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Banskota S, Evangelista A, Gleason T, Pacini D, Myrmel T, Hughes GC, Brinster D, Ouzounian M, Montgomery D, Isselbacher E, Nienaber C, De Oliveira N, Schermerhorn M, Coselli J, Hutchison S, Eagle K. PREDICTORS AND OUTCOMES ASSOCIATED WITH POST-OPERATIVE PERICARDIAL TAMPONADE IN TYPE A ACUTE AORTIC DISSECTION PATIENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32607-x] [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: 10/17/2022]
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Montgomery D, Barber K, Edayilam N, Oqujiuba K, Young S, Biotidara T, Gathers A, Danjaji M, Tharayil N, Martinez N, Powell B. The influence of citrate and oxalate on 99Tc VII, Cs, Np V and U VI sorption to a Savannah River Site soil. J Environ Radioact 2017; 172:130-142. [PMID: 28351009 DOI: 10.1016/j.jenvrad.2017.03.017] [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: 11/21/2016] [Revised: 03/07/2017] [Accepted: 03/11/2017] [Indexed: 06/06/2023]
Abstract
Batch sorption experiments were conducted with 0.5-50 ppb 99Tc, 133Cs, 237Np and U in the presence and absence of citrate and/or oxalate in a 25 g/L Savannah River Site (SRS) soil suspension. Citrate and oxalate were the ligands of choice due to their relevancy to plant exudates, the nuclides were selected for their wide range of biogeochemical behavior, and the soil from SRS was selected as a model Department of Energy (DOE) site soil. Batch samples were continually mixed on a rotary shaker and maintained at a pH of approximately 5. Analysis via ICP-MS indicated that sorption of 237Np increased with ligand concentration compared to baseline studies, as did sorption of 99Tc although to a lesser extent. The increased sorption of 237Np is proposed to be due to a combination of factors that are dependent on the ligand(s) present in the specific system including, ligand dissolution of the soil by citrate and formation of tertiary soil-oxalate-Np complexes. The increased 99Tc sorption is attributed to the dissolution of the soil by the ligands, leading to an increase in the number of available sorption sites for 99Tc. Uranium sorption decreased and dissolution of native uranium was also observed with increasing ligand concentration, thought to be a result of the formation of strong U-ligand complexes remaining in the aqueous phase. The majority of these effects were observed at the highest ligand concentrations of 50 mgC/L. No notable changes were observed for the 133Cs system which is ascribed to the minimal interaction of Cs+ with these organic ligands.
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Affiliation(s)
- D Montgomery
- Clemson University, Clemson, SC 29634, United States.
| | - K Barber
- Clemson University, Clemson, SC 29634, United States
| | - N Edayilam
- Clemson University, Clemson, SC 29634, United States
| | - K Oqujiuba
- South Carolina State University, Orangeburg, SC 29115, United States
| | - S Young
- South Carolina State University, Orangeburg, SC 29115, United States
| | - T Biotidara
- South Carolina State University, Orangeburg, SC 29115, United States
| | - A Gathers
- South Carolina State University, Orangeburg, SC 29115, United States
| | - M Danjaji
- South Carolina State University, Orangeburg, SC 29115, United States
| | - N Tharayil
- Clemson University, Clemson, SC 29634, United States
| | - N Martinez
- Clemson University, Clemson, SC 29634, United States.
| | - B Powell
- Clemson University, Clemson, SC 29634, United States
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Jabara J, Trimarchi S, Braverman A, Di Eusanio M, Myrmel T, Ehrlich M, Eckstein HH, Ouzounian M, Upchurch G, Khoynezhad A, Taylor B, Montgomery D, Nienaber C, Eagle K, Isselbacher E, Patel H. BODY MASS INDEX AND ACUTE AORTIC DISSECTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35438-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Bradford M, Krallman R, McMahon C, Montgomery D, Kline-Rogers E, Eagle KA, Rubenfire M, Bumpus SM. Abstract 095: Lessons Learned from the BRIDGE Registry: Major Findings From 8 Years of BRIDGE. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/circoutcomes.10.suppl_3.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background:
Readmissions after cardiac hospitalizations are frequent and costly in the United States. Delays in follow-up and lack of adherence to guidelines may contribute to high unplanned readmission rates. Bridging the Discharge Gap Effectively (BRIDGE) is a nurse practitioner (NP) led, transitional care clinic for cardiac patients, aimed at reducing readmissions. Data on patients referred to BRIDGE has been collected since 2009; herein we report a summary of significant findings from these data.
Methods:
A qualitative review of results and conclusions from all published abstracts, oral presentations, and papers from the BRIDGE registry (June 2008-August 2015) was conducted. Content analysis was used to synthesize findings across studies.
Results:
Data from 3982 patients referred to BRIDGE have been collected. Seven themes were identified in the analysis of BRIDGE publications. During BRIDGE, NPs focused on medical history, symptoms, medication management (in 24.8% of visits), patient education, and referrals. In addition to addressing provider priorities, addressing patient concerns (daily living and clinical questions, feelings and fears) was highly salient, resulting in a high level of patient-NP connectedness as evidenced by high patient-reported scores on the Consultation and Relational Empathy scale (mean 43.5 ± 2.8; possible range 0, 50) and the Patient-Doctor Relationship Questionnaire (mean 43.05 ± 3.1; possible range 5, 45). Readmissions within 30 days were consistently lower for acute coronary syndrome (ACS) patients who attended BRIDGE compared to those who did not (6.4% v. 13.1%; p<0.01); similar results were not seen in heart failure (HF) (15.4% v. 15.7%; p=0.944) or atrial fibrillation (AF) (8.5% v. 5.2%; p=0.343) patients. A spike in HF readmissions was seen between 8-14 days post-discharge, suggesting the need for a sooner appointment. However, follow-up within 7 days of discharge did not show reduced readmissions in HF patients. AF readmissions were also difficult to avoid; in a subset of AF patients readmitted within 30 days, 51.1% (n=23) were readmitted for non-AF diagnoses. High risk patients (i.e. those with an adverse event before BRIDGE) were older, had higher Charlson comorbidity scores, and were more likely to have depression. However, marriage was associated with fewer readmissions.
Conclusions:
Data from the BRIDGE registry have shown that clinic attendance reduced ACS readmissions; has characterized older, depressed patients with higher Charlson comorbidity scores as being those most likely to be readmitted; and has identified areas for improvement in transitional care (e.g. AF and HF) where readmissions are difficult to avoid. Continuous quality improvement and real-time monitoring of patient outcomes have translated this research into more prompt transitional care, illustrating the importance of registry-based research.
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Shalhub S, Ouzounian M, Bossone E, Harris K, O'Gara P, Bhan A, Pappas P, DiScipio A, Kaiser C, Chen E, Nienaber C, Montgomery D, Isselbacher E, Eagle K, Lindsay M, Evangelista A. INFLUENCE OF FAMILY HISTORY OF AORTIC DISEASE ON TYPE B AORTIC DISSECTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35463-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fette C, Krallman R, McMahon C, Montgomery D, Wang J, Erjavac B, Kline-Rogers E, Eagle KA, Bumpus SM. Abstract 097: Effects of BRIDGE Attendance on the Outcomes of Diabetic Patients. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/circoutcomes.10.suppl_3.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background:
Prior studies have shown that patients with diabetes mellitus (DM) have increased risk for developing cardiovascular disease. BRIdging the Discharge Gap Effectively (BRIDGE) is a nurse practitioner-delivered cardiac transitional care program for patients who have been recently discharged following a cardiac event. Previous research has shown BRIDGE to be effective in improving patient outcomes. This study sought to describe differences in outcomes 1) of heart failure (HF), acute coronary syndrome (ACS), and atrial fibrillation (AF) patients with and without concomitant DM, and 2) between diabetic patients who did and did not attend BRIDGE.
Methods:
Retrospective data were abstracted for HF, ACS, and AF patients from 2008-2014. Patients were divided into cohorts based on presence or absence of DM and BRIDGE attendance versus non-attendance. Outcomes (readmissions, ED visits, death) within each primary diagnosis (HF, ACS, AF) were compared between DM and non-DM patients and between those who attended BRIDGE versus those who did not for all DM patients.
Results:
Of 2197 patients referred to BRIDGE, 723 (32.9%) had concomitant DM. DM patients had similar outcomes to non-DM patients for most post-discharge outcomes; however, DM ACS patients had higher readmission (42.2% v 29.6%, p<0.001) and death (10.5% v. 4.5%, p=0.001) rates within 6 months, and DM AF patients had higher readmission rates within 6 months (52.1% v 37.9%, p=0.006). HF patients with DM who attended BRIDGE had lower mortality rates within 6 months of discharge than those who did not (10.3% vs. 22.1%, p=0.014). No other significant differences in outcomes were seen between BRIDGE attendees and non-attendees.
Conclusions:
Though not significant, patients with DM had worse post-discharge outcomes than those without DM for all primary diagnoses. In the subset of DM patients, the 30-day readmission rate for ACS patients who attended BRIDGE was half of those who did not attend. Conversely, 30-day readmission rates for HF patients were greater if they attended. This may in part explain the significantly lower mortality rate among BRIDGE attenders with HF, where patients who needed readmission were identified during their BRIDGE appointment. Due to the high prevalence of DM, efforts to tailor transitional care for this population are needed.
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Harish A, Myrmel T, Di Eusanio M, Ota T, Braverman A, Pyeritz R, Suzuki T, Hughes GC, Peterson M, Appoo J, Conklin L, Montgomery D, Reece TB, Nienaber C, Isselbacher E, Eagle K. UNCONTROLLED HYPERTENSION IN ACUTE AORTIC DISSECTION FOLLOW-UP. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35473-6] [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: 10/20/2022]
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44
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Patel M, Sundt T, Myrmel T, Chen E, Braverman A, Evangelista A, Gleason T, Sechtem U, Pyeritz R, Bossone E, Suzuki T, Montgomery D, Nienaber C, Isselbacher E, Trimarchi S, Eagle K. PREDICTIVE FACTORS FOR RAPID AORTIC GROWTH FOLLOWING ACUTE TYPE A AORTIC DISSECTION PATIENTS: A STUDY FROM THE INTERNATIONAL REGISTRY OF ACUTE AORTIC DISSECTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35471-2] [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: 10/20/2022]
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45
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Chen Y, Gleason T, Sechtem U, Harris K, Korach A, Ota T, Shalhub S, Pape L, Hughes GC, Greason K, Eagle K, Montgomery D, Isselbacher E, Nienaber C, Ehrlich M, Patel H. ANALYSIS OF THE TIMING OF THORACIC ENDOVASCULAR AORTIC REPAIR AND ITS INDICATIONS AND OUTCOMES IN TYPE B AORTIC DISSECTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35466-9] [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: 11/16/2022]
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46
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Hussain K, McMahon C, Krallman R, Montgomery D, Feldeisen T, Morgan S, Koelling T, Rubenfire M, Kline-Rogers E, Eagle KA, Bumpus SM. Abstract 098: The Prevalence of Racial and Socioeconomic Disparities in an Outpatient Transitional Care Clinic. Circ Cardiovasc Qual Outcomes 2017. [DOI: 10.1161/circoutcomes.10.suppl_3.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/16/2022]
Abstract
Background:
Bridging the Discharge Gap Effectively (BRIDGE) is a cardiac transitional care clinic. BRIDGE has demonstrated improved patient outcomes for some populations. This study sought to determine if differences in outcomes (readmissions, ED visits, death) exist for Caucasian and non-Caucasian patients based on BRIDGE attendance and socioeconomic status (SES).
Methods:
Data on patients referred to BRIDGE from 2008-2014 were analyzed. Patients were split into two cohorts (Caucasian and non-Caucasian) and outcomes for each were independently compared by BRIDGE attendance and SES. Non-low SES was defined as income > $48,600 (200% poverty line for a family of 4) and low SES was income ≤ $48,600. Demographics and outcomes were compared between groups.
Results:
Of 2964 patients, 15.1% were non-Caucasian (n=448). Caucasians were significantly older than non-Caucasians (66.16±14.29 v 59.14±14.75, p<0.001), and were more likely to have primary diagnoses of acute coronary syndrome (28.2% v 23.5%, p=0.039) or atrial fibrillation (16.8% v 9.3%, p<0.001). Among Caucasian patients, BRIDGE attenders had significantly lower 30-day readmission rates (8.6% v 11.3%, p=0.038) and fewer ED visits within 6 months (1.80±1.3 v 2.10±2.0, p=0.049). Non-Caucasians, however, were more likely to have an ED visit within 6 months (40.9% v 33.7%, p=0.012; data not shown). Non-Caucasians of low SES were more likely to be readmitted within 6 months (40.5% v 29.5%, p=0.029) and less likely to attend BRIDGE (64.9% v 76.4%, p=0.016) than non-low SES non-Caucasians. There were no significant differences between non-low and low SES Caucasian patients. Among BRIDGE attenders, 6-month mortality rates were significantly lower for both groups (Caucasian: 5.2% v 10.8%, p<0.001; non -Caucasian: 4.3% v 10.7%, p=0.013).
Conclusions:
BRIDGE attendance was associated with improved outcomes in Caucasians that were not seen in non-Caucasians, with the exception of reduced mortality. Also, SES appears to impact non-Caucasians more than Caucasians, with low SES non-Caucasians having higher readmission rates and lower BRIDGE attendance than non-low SES non-Caucasians. Differences seen may be biased due to unevenly distributed groups (i.e. age and diagnosis). Efforts to target these vulnerable populations are warranted to reduce disparities.
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Dussán KB, Leidal A, Corriveau N, Montgomery D, Eagle KA, LaHood BJ. Increasing Medical Trainees' Empathy Through Volunteerism and Mentorship. J Med Educ Curric Dev 2017; 4:2382120517737995. [PMID: 29349343 PMCID: PMC5757631 DOI: 10.1177/2382120517737995] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/11/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Within medical education, there have been recent calls for increased understanding and exposure to poverty to increase trainees' empathy toward the underserved. Students participating in Michigan Cardiovascular Outcomes Research and Reporting Program research program volunteered at World Medical Relief (WMR) in Detroit, Michigan, a nonprofit organization which recycles medical equipment for developing countries and within greater Detroit. Participants' perceptions of the underserved were measured before and after the experience. METHODS Preliminary questionnaires were given to participants prior to and after exposures at WMR. Questionnaires examined participants' attitudes toward the underserved, knowledge of medical supply reuse, and their perceived ability to impact change. P values of <.025 were considered significant. RESULTS A total of 39 participants completed the survey, 77% previously volunteered, 33% had volunteered internationally. Participants were >4× more likely than previously to have knowledge of the variety of recycled medical supplies at WMR. Prior to volunteering, 48.7% of participants gave little thought to how excess medical supplies could be collected versus 0% after exposure. Participants were 1.5× more likely to agree that the experience was enhanced working with their peers and 2.7× more likely to consider starting their own organization/intervention for medical supply donations. Those participants that never previously volunteered were 1.3× more likely to do so with encouragement from a mentor. CONCLUSIONS Encouraging exposure to such service programs resulted in enhanced knowledge of community resources and increased motivation to participate in outreach and belief of individual responsibility to care for the underserved. Incorporating volunteerism into traditional education programs offers the opportunity to build awareness and interest in students reaching out to the underserved.
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Affiliation(s)
- Kathleen Bronson Dussán
- Department of Internal Medicine, VA Ann Arbor Healthcare System and University of Michigan, Ann Arbor, MI, USA
| | - Adam Leidal
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Nicole Corriveau
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Montgomery
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Kim A Eagle
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
- Medical School, University of Michigan, Ann Arbor, MI, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Barbara J LaHood
- Department of Internal Medicine-Cardiology, University of Michigan, Ann Arbor, MI, USA
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48
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Datte PS, Ross JS, Froula DH, Daub KD, Galbraith J, Glenzer S, Hatch B, Katz J, Kilkenny J, Landen O, Manha D, Manuel AM, Molander W, Montgomery D, Moody J, Swadling GF, Weaver J. The design of the optical Thomson scattering diagnostic for the National Ignition Facility. Rev Sci Instrum 2016; 87:11E549. [PMID: 27910656 DOI: 10.1063/1.4962043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The National Ignition Facility (NIF) is a 192 laser beam facility designed to support the Stockpile Stewardship, High Energy Density and Inertial Confinement Fusion (ICF) programs. We report on the design of an Optical Thomson Scattering (OTS) diagnostic that has the potential to transform the community's understanding of NIF hohlraum physics by providing first principle, local, time-resolved measurements of under-dense plasma conditions. The system design allows operation with different probe laser wavelengths by manual selection of the appropriate beam splitter and gratings before the shot. A deep-UV probe beam (λ0-210 nm) will be used to optimize the scattered signal for plasma densities of 5 × 1020 electrons/cm3 while a 3ω probe will be used for experiments investigating lower density plasmas of 1 × 1019 electrons/cm3. We report the phase I design of a two phase design strategy. Phase I includes the OTS telescope, spectrometer, and streak camera; these will be used to assess the background levels at NIF. Phase II will include the design and installation of a probe laser.
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Affiliation(s)
- P S Datte
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J S Ross
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D H Froula
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - K D Daub
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Galbraith
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - S Glenzer
- SLAC National Accelerator Laboratory, Menlo Park, California 94025, USA
| | - B Hatch
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Katz
- Laboratory for Laser Energetics, University of Rochester, Rochester, New York 14623, USA
| | - J Kilkenny
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - O Landen
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Manha
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A M Manuel
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - W Molander
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - D Montgomery
- Los Alamos National Laboratory, Los Alamos, New Mexico 87545, USA
| | - J Moody
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - G F Swadling
- Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - J Weaver
- Plasma Physics Division, Naval Research Laboratory, Washington, DC 20375, USA
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49
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Trinidad RM, Brostrom R, Morello MI, Montgomery D, Thein CC, Gajitos ML, Heetderks A, Chorba T. Tuberculosis screening at a diabetes clinic in the Republic of the Marshall Islands. J Clin Tuberc Other Mycobact Dis 2016; 5:4-7. [PMID: 31723690 PMCID: PMC6850250 DOI: 10.1016/j.jctube.2016.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 10/12/2016] [Accepted: 10/21/2016] [Indexed: 11/30/2022] Open
Abstract
Setting Tuberculosis (TB) and diabetes mellitus (DM) are prominent public health problems in the Republic of the Marshall Islands, a small island nation with high rates of tuberculosis and diabetes. Objective Evaluate the rate of active and latent TB in a Pacific Island DM clinic. Design In one DM clinic on the island of Ebeye, 213 adult patients aged 27–86 years completed tuberculin skin testing and TB work-up between April 2010 and March 2012. Results Screening for TB led to the diagnosis of 77 patients with TB infection and 11 patients with TB disease. From these data, the prevalence of TB disease among DM patients in the clinic exceeded 5% (95% CI 2.2%–8.1%). All patients who completed TB screening were at high risk of TB disease, and those with DM aged ≤ 50 years had a higher risk of TB disease than those with DM over age 50 (RR 3.1, C.I. 1.0–9.7, p = 0.05). Conclusion The experience at the Ebeye Diabetes Clinic demonstrates that screening DM patients for TB can identify significant rates of TB infection and TB disease, and should be considered for other settings with a high background TB incidence. Further assessment of TB risks should explore age, gender, and level of diabetes control.
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Affiliation(s)
| | - R Brostrom
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, United States
| | - M I Morello
- Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services, Atlanta, GA, United States
| | - D Montgomery
- Centers for Disease Control and Prevention, Office of Surveillance, Epidemiology, and Laboratory Services, Atlanta, GA, United States
| | - C C Thein
- Kwajalein Atoll Healthcare Bureau, Kwajalein, Marshall Islands
| | - M L Gajitos
- Kwajalein Atoll Healthcare Bureau, Kwajalein, Marshall Islands
| | - A Heetderks
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, United States
| | - T Chorba
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Tuberculosis Elimination, Atlanta, GA, United States
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50
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Isselbacher EM, Bonaca MP, Di Eusanio M, Froehlich J, Bassone E, Sechtem U, Pyeritz R, Patel H, Khoynezhad A, Eckstein HH, Jondeau G, Ramponi F, Abbasi M, Montgomery D, Nienaber CA, Eagle K, Lindsay ME. Recurrent Aortic Dissection. Circulation 2016; 134:1013-1024. [DOI: 10.1161/circulationaha.115.019359] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [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] [Received: 09/04/2015] [Accepted: 08/23/2016] [Indexed: 01/01/2023]
Abstract
Background:
Improved medical care after initial aortic dissection (AD) has led to increased survivorship and a population of individuals at risk for further cardiovascular events, including recurrent AD. Reports describing recurrent ADs have been restricted to small numbers of patients from single institutions. We used the IRAD (International Registry of Acute Aortic Dissection) database to examine the clinical profiles and outcomes of patients with recurrent AD.
Methods:
We identified 204 patients enrolled in IRAD with recurrent AD. For the primary analysis, patient characteristics, interventions, and outcomes were analyzed and compared with 3624 patients with initial AD. Iterative logistic modeling was performed to investigate variables associated with recurrent AD. Cox regression analyses were used to determine variables associated with 5-year survival. A subset of recurrent AD patients was analyzed for anatomic and demographic details of initial and recurrent ADs.
Results:
Patients with recurrent AD were more likely to have Marfan syndrome (21.5% versus 3.1%;
P
<0.001) but not bicuspid aortic valve (3.6% versus 3.2%;
P
=0.77). Descending aortic dimensions were greater in patients with recurrent AD than in patients with initial AD independently of sentinel dissection type (type A: 4.3 cm [3.5–5.6 cm] versus 3.3 cm [2.9–3.7 cm],
P
<0.001; type B: 5.0 cm [3.9–6.0 cm] versus 4.0 cm [3.5–4.8 cm],
P
<0.001), and this observation was accentuated among patients with Marfan syndrome. In multivariate analysis, the diagnosis of Marfan syndrome independently predicted recurrent AD (hazard ratio, 8.6; 95% confidence interval, 5.8–12.8;
P
<0.001). Patients with recurrent AD who presented with proximal followed by distal AD were younger than patients who experienced distal followed by proximal dissection AD (42.1±16.1 versus 54.3±14.8 years;
P
=0.004).
Conclusions:
Among those suffering acute aortic dissection, 5% have a history of a prior aortic dissection. Recurrent AD is strongly associated with Marfan syndrome.
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Affiliation(s)
- Eric M. Isselbacher
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Marc P. Bonaca
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Marco Di Eusanio
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - James Froehlich
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Eduardo Bassone
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Udo Sechtem
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Reed Pyeritz
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Himanshu Patel
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Ali Khoynezhad
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Hans-Henning Eckstein
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Guillaume Jondeau
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Fabio Ramponi
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Mohammad Abbasi
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Daniel Montgomery
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Christoph A. Nienaber
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Kim Eagle
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
| | - Mark E. Lindsay
- From Thoracic Aortic Center (E.M.I., M.A., M.E.L.), Cardiology Division, Department of Medicine (E.M.I., M.E.L.), Cardiovascular Research Center (M.A., M.E.L.), and Pediatric Cardiology Division, Department of Pediatrics (M.E.L.), Massachusetts General Hospital and Harvard Medical School, Boston, MA; Brigham and Women’s Hospital, Cardiology Division, Boston, MA (M.P.B.); Cardiac Surgery Department, University Hospital S. Orsola, Bologna, Italy (M.D.E.); Cardiovascular Center (J.F., D.M., K.E.) and
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