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Zafeiropoulos S, Farmakis IT, Milioglou I, Doundoulakis I, Gorodeski EZ, Konstantinides SV, Cooper L, Zanos S, Stavrakis S, Giamouzis G, Butler J, Giannakoulas G. Pharmacological Treatments in Heart Failure With Mildly Reduced and Preserved Ejection Fraction: Systematic Review and Network Meta-Analysis. JACC Heart Fail 2024; 12:616-627. [PMID: 37656079 DOI: 10.1016/j.jchf.2023.07.014] [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: 05/05/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Medical treatment for heart failure with preserved ejection (HFpEF) and heart failure with mildly reduced ejection fraction (HFmrEF) has weaker evidence compared with reduced ejection fraction, despite recent trials with an angiotensin receptor neprilysin inhibitor (ARNI) and sodium glucose co-transporter 2 inhibitors (SGLT2is). OBJECTIVES The authors aimed to estimate the aggregate therapeutic benefit of drugs for HFmrEF and HFpEF. METHODS The authors performed a systematic review of MEDLINE, CENTRAL, and Web of Science for randomized trials including patients with heart failure (HF) and left ventricular ejection fraction (LVEF) >40%, treated with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (analyzed together as renin-angiotensin system inhibitors [RASi]), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), digoxin, ARNI, and SGLT2i. An additive component network meta-analysis was performed. The primary outcome was a composite of cardiovascular (CV) death and first hospitalization for heart failure (HHF); secondary outcomes were CV death, total HHF, and all-cause mortality. RESULTS The authors identified 13 studies with a total of 29,875 patients and a mean LVEF of 56.3% ± 8.7%. ARNI, MRA, and SGLT2i separately, but not RASi, BB, or digoxin, reduced the primary composite outcome compared with placebo. The combination of ARNI, BB, MRA, and SGLT2i was the most effective (HR: 0.47 [95% CI: 0.31-0.70]); this was largely explained by the triple combination of ARNI, MRA, and SGLT2i (HR: 0.56 [95% CI 0.43-0.71]). Results were similar for CV death (HR: 0.63 [95% CI 0.43-0.91] for ARNI, MRA, and SGLT2i) or total HHF (HR: 0.49 [95% CI 0.33-0.71] for ARNI, MRA, and SGLT2i) alone. In a subgroup analysis, only SGLT2i had a consistent benefit among all LVEF subgroups, whereas the triple combination had the greatest benefit in HFmrEF, robust benefit in patients with LVEF 50% to 59%, and a statistically marginal benefit in patients with LVEF ≥60%. CONCLUSIONS In patients with HF and LVEF>40%, the quadruple combination of ARNI, BB, MRA, and SGLT2i provides the largest reduction in the risk of CV death and HHF; driven by the robust effect of the triple combination of ARNI, MRA, and SGLT2i. The benefit was more pronounced in HFmrEF patients.
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Affiliation(s)
- Stefanos Zafeiropoulos
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, New York, USA; Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA
| | - Ioannis T Farmakis
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany; Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
| | - Ioannis Milioglou
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Ioannis Doundoulakis
- Athens Heart Center, Athens Medical Center, Athens, Greece; First Department of Cardiology, National and Kapodistrian University, "Hippokration" Hospital, Athens, Greece
| | - Eiran Z Gorodeski
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Germany; Department of Cardiology, Democritus University of Thrace, Alexandroupoli, Greece
| | - Lauren Cooper
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA; Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, New York, USA
| | - Stavros Zanos
- Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA
| | - Stavros Stavrakis
- Heart Rhythm Institute, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma, USA
| | - Grigorios Giamouzis
- Department of Cardiology, University of Thessaly, Larissa, Greece; Faculty of Medicine, School of Health Sciences, University of Thessaly, Greece
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA; Baylor Scott and White Research Institute, Dallas, Texas, USA
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Gorodeski EZ, Goyal P. Cognitive Impairment Is Our Job Too. J Card Fail 2024; 30:423-424. [PMID: 38485294 DOI: 10.1016/j.cardfail.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Eiran Z Gorodeski
- University Hospitals Harrington Heart & Vascular Institute, and Case Western Reserve University School of Medicine Cleveland, OH, USA.
| | - Parag Goyal
- Program for the Care and Study of the Aging Heart, Department of Medicine, Weill Cornell Medicine New York, NY, USA
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Deo SV, Al-Kindi S, Motairek I, McAllister D, Shah ASV, Elgudin YE, Gorodeski EZ, Virani S, Petrie MC, Rajagopalan S, Sattar N. Impact of Residential Social Deprivation on Prediction of Heart Failure in Patients With Type 2 Diabetes: External Validation and Recalibration of the WATCH-DM Score Using Real World Data. Circ Cardiovasc Qual Outcomes 2024; 17:e010166. [PMID: 38328913 DOI: 10.1161/circoutcomes.123.010166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/20/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Patients with type 2 diabetes are at risk of heart failure hospitalization. As social determinants of health are rarely included in risk models, we validated and recalibrated the WATCH-DM score in a diverse patient-group using their social deprivation index (SDI). METHODS We identified US Veterans with type 2 diabetes without heart failure that received outpatient care during 2010 at Veterans Affairs medical centers nationwide, linked them to their SDI using residential ZIP codes and grouped them as SDI <20%, 21% to 40%, 41% to 60%, 61% to 80%, and >80% (higher values represent increased deprivation). Accounting for all-cause mortality, we obtained the incidence for heart failure hospitalization at 5 years follow-up; overall and in each SDI group. We evaluated the WATCH-DM score using the C statistic, the Greenwood Nam D'Agostino test χ2 test and calibration plots and further recalibrated the WATCH-DM score for each SDI group using a statistical correction factor. RESULTS In 1 065 691 studied patients (mean age 67 years, 25% Black and 6% Hispanic patients), the 5-year incidence of heart failure hospitalization was 5.39%. In SDI group 1 (least deprived) and 5 (most deprived), the 5-year heart failure hospitalization was 3.18% and 11%, respectively. The score C statistic was 0.62; WATCH-DM systematically overestimated heart failure risk in SDI groups 1 to 2 (expected/observed ratios, 1.38 and 1.36, respectively) and underestimated the heart failure risk in groups 4 to 5 (expected/observed ratios, 0.95 and 0.80, respectively). Graphical evaluation demonstrated that the recalibration of WATCH-DM using an SDI group-based correction factor improved predictive capabilities as supported by reduction in the χ2 test results (801-27 in SDI groups I; 623-23 in SDI group V). CONCLUSIONS Including social determinants of health to recalibrate the WATCH-DM score improved risk prediction highlighting the importance of including social determinants in future clinical risk prediction models.
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Affiliation(s)
- Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, OH (S.V.D., Y.E.E.)
- Case School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (S.V.D., Y.E.E., E.Z.G., S.R.)
- School of Health and Wellbeing (S.V.D., D.M.), University of Glasgow, United Kingdom
| | - Sadeer Al-Kindi
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX (S.A.-K.)
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (I.M., E.Z.G., S.R.)
| | - David McAllister
- School of Health and Wellbeing (S.V.D., D.M.), University of Glasgow, United Kingdom
| | - Anoop S V Shah
- London School of Hygiene and Tropical Medicine, London, United Kingdom (A.S.V.S.)
| | - Yakov E Elgudin
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, OH (S.V.D., Y.E.E.)
- Case School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (S.V.D., Y.E.E., E.Z.G., S.R.)
| | - Eiran Z Gorodeski
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (I.M., E.Z.G., S.R.)
| | - Salim Virani
- The Aga Khan University, Karachi, Pakistan (S.V.)
- Division of Cardiology, Baylor School of Medicine, Houston, TX (S.V.)
| | - Mark C Petrie
- BHF Cardiovascular Research Center, School of Cardiovascular and Metabolic Health (M.C.P., N.S.), University of Glasgow, United Kingdom
- Robertson Center for Biostatistics (M.C.P.), University of Glasgow, United Kingdom
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (I.M., E.Z.G., S.R.)
| | - Naveed Sattar
- BHF Cardiovascular Research Center, School of Cardiovascular and Metabolic Health (M.C.P., N.S.), University of Glasgow, United Kingdom
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Goyal P, Didomenico RJ, Pressler SJ, Ibeh C, White-Williams C, Allen LA, Gorodeski EZ. Cognitive Impairment in Heart Failure: A Heart Failure Society of America Scientific Statement. J Card Fail 2024; 30:488-504. [PMID: 38485295 DOI: 10.1016/j.cardfail.2024.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 03/19/2024]
Abstract
Cognitive impairment is common among adults with heart failure (HF), as both diseases are strongly related to advancing age and multimorbidity (including both cardiovascular and noncardiovascular conditions). Moreover, HF itself can contribute to alterations in the brain. Cognition is critical for a myriad of self-care activities that are necessary to manage HF, and it also has a major impact on prognosis; consequently, cognitive impairment has important implications for self-care, medication management, function and independence, and life expectancy. Attuned clinicians caring for patients with HF can identify clinical clues present at medical encounters that suggest cognitive impairment. When present, screening tests such as the Mini-Cog, and consideration of referral for comprehensive neurocognitive testing may be indicated. Management of cognitive impairment should focus on treatment of underlying causes of and contributors to cognitive impairment, medication management/optimization, and accommodation of deficiencies in self-care. Given its implications on care, it is important to integrate cognitive impairment into clinical decision making. Although gaps in knowledge and challenges to implementation exist, this scientific statement is intended to guide clinicians in caring for and meeting the needs of an increasingly complex and growing subpopulation of patients with HF.
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Affiliation(s)
- Parag Goyal
- Program for the Care and Study of the Aging Heart, Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Robert J Didomenico
- University of Illinois Chicago College of Pharmacy, Department of Pharmacy Practice, Chicago, IL
| | | | - Chinwe Ibeh
- Columbia University Irving Medical Center, New York, NY
| | | | - Larry A Allen
- University of Colorado School of Medicine, Aurora, CO
| | - Eiran Z Gorodeski
- University Hospitals, Harrington Heart & Vascular Institute, and Case Western Reserve University School of Medicine, Cleveland, OH.
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Drazner MH, Ambardekar AV, Berlacher K, Blumer V, Chatur S, Cheng R, Cheng RK, Grandin EW, Gorodeski EZ, Kataria R, Katz JN, Kittleson MM, Krishnamoorthy A, Lala A, Lenneman AJ, Lohr NL, Margulies KB, Mentz RJ, Reza N, Wilcox J, Youmans QR, Zieroth S, Teerlink JR. The HFSA Advanced Heart Failure and Transplant Cardiology Fellowship Consensus Conference. J Card Fail 2024; 30:391-398. [PMID: 37806488 DOI: 10.1016/j.cardfail.2023.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
There is waning interest among cardiology trainees in pursuing an Advanced Heart Failure/Transplant Cardiology (AHFTC) fellowship as evidenced by fewer applicants in the National Resident Matching Program match to this specialty. This trend has generated considerable attention across the heart failure community. In response, the Heart Failure Society of America convened the AHFTC Fellowship Task Force with a charge to develop strategies to increase the value proposition of an AHFTC fellowship. Subsequently, the HFSA sponsored the AHFTC Fellowship Consensus Conference April 26-27, 2023. Before the conference, interviews of 44 expert stakeholders diverse across geography, site of practice (traditional academic medical center or other centers), specialty/area of expertise, sex, and stage of career were conducted virtually. Based on these interviews, potential solutions to address the declining interest in AHFTC fellowship were categorized into five themes: (1) alternative training pathways, (2) regulatory and compensation, (3) educational improvements, (4) exposure and marketing for pipeline development, and (5) quality of life and mental health. These themes provided structure to the deliberations of the AHFTC Fellowship Consensus Conference. The recommendations from the Consensus Conference were subsequently presented to the HFSA Board of Directors to inform strategic plans and interventions. The HFSA Board of Directors later reviewed and approved submission of this document. The purpose of this communication is to provide the HF community with an update summarizing the processes used and concepts that emerged from the work of the HFSA AHFTC Fellowship Task Force and Consensus Conference.
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Affiliation(s)
- Mark H Drazner
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Amrut V Ambardekar
- Department of Medicine, Division of Cardiology; University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kathryn Berlacher
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Vanessa Blumer
- Inova Schar and Vascular Institute, Falls Church, Virginia
| | - Safia Chatur
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Richard Cheng
- Division of Cardiology, Department of Internal Medicine; University of California San Francisco, San Francisco, California
| | - Richard K Cheng
- Division of Cardiology, University of Washington, Seattle, Washington
| | - E Wilson Grandin
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Eiran Z Gorodeski
- Harrington Heart & Vascular Institute, University Hospitals, and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rachna Kataria
- Department of Cardiology, Lifespan Cardiovascular Institute, Brown University, Providence, Rhode Island
| | - Jason N Katz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute-Cedars Sinai Medical Center, Los Angeles, California
| | | | - Anuradha Lala
- Zena and Michael A. Wiener Cardiovascular Institute & Department of Population Health Science & Policy at Icahn School of Medicine at Mount Sinai, New York, New York
| | - Andrew J Lenneman
- Division of Cardiovascular Disease; University of Alabama at Birmingham, Birmingham, Alabama
| | - Nicole L Lohr
- Division of Cardiovascular Disease; University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth B Margulies
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert J Mentz
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jane Wilcox
- Division of Cardiovascular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Quentin R Youmans
- Division of Cardiovascular Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California
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6
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Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP, Lopez-Cabanillas N, Ellenbogen KA, Hua W, Ikeda T, Mackall JA, Mason PK, McLeod CJ, Mela T, Moore JP, Racenet LK. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. J Arrhythm 2023; 39:681-756. [PMID: 37799799 PMCID: PMC10549836 DOI: 10.1002/joa3.12872] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eugene H Chung
- University of Michigan Medical School Ann Arbor Michigan USA
| | | | | | | | | | - Anne M Dubin
- Stanford University, Pediatric Cardiology Palo Alto California USA
| | - Douglas P Ensch
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Taya V Glotzer
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
| | - Michael R Gold
- Medical University of South Carolina Charleston South Carolina USA
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
| | - Peter B Imrey
- Cleveland Clinic Cleveland Ohio USA
- Case Western Reserve University Cleveland Ohio USA
| | - Julia H Indik
- University of Arizona, Sarver Heart Center Tucson Arizona USA
| | - Saima Karim
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
| | - Peter P Karpawich
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
| | - Yaariv Khaykin
- Southlake Regional Health Center Newmarket Ontario Canada
| | | | - Jordana Kron
- Virginia Commonwealth University Richmond Virginia USA
| | | | - Mark S Link
- University of Texas Southwestern Medical Center Dallas Texas USA
| | - Joseph E Marine
- Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
| | - Seung-Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
| | | | | | - Rajeev Kumar Pathak
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
| | | | | | | | | | | | - Morio Shoda
- Tokyo Women's Medical University Tokyo Japan
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - David J Slotwiner
- Weill Cornell Medicine Population Health Sciences New York New York USA
| | | | - Uma N Srivatsa
- University of California Davis Sacramento California USA
| | | | | | | | | | - Cynthia M Tracy
- George Washington University Washington District of Columbia USA
| | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
| | | | | | - Wojciech Zareba
- University of Rochester Medical Center Rochester New York USA
| | | | - Nestor Lopez-Cabanillas
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Kenneth A Ellenbogen
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Wei Hua
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Takanori Ikeda
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Judith A Mackall
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Pamela K Mason
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Christopher J McLeod
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Theofanie Mela
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Jeremy P Moore
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
| | - Laurel Kay Racenet
- Cleveland Clinic Cleveland Ohio USA
- University of Washington Seattle Washington USA
- University of Hong Kong Hong Kong China
- Hospital SOS Cárdio Florianópolis Brazil
- Duke University Medical Center Durham North Carolina USA
- Indraprastha Apollo Hospital New Delhi India
- University of California San Diego Health La Jolla California USA
- Mayo Clinic, Rochester Rochester Minnesota USA
- University of Michigan Medical School Ann Arbor Michigan USA
- Temple University Philadelphia Pennsylvania USA
- University at Buffalo Buffalo New York USA
- Medical University of Łódź, Łódź Poland
- Virginia Mason Franciscan Health Tacoma Washington USA
- Stanford University, Pediatric Cardiology Palo Alto California USA
- Hackensack Meridian School of Medicine Hackensack New Jersey USA
- Medical University of South Carolina Charleston South Carolina USA
- University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
- Kansas City Heart Rhythm Institute Overland Park Kansas USA
- University Hospitals and Case Western Reserve University School of Medicine Cleveland Ohio USA
- University of Minnesota Minneapolis Minnesota USA
- McMaster University Hamilton Ontario Canada
- First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- Case Western Reserve University Cleveland Ohio USA
- University of Arizona, Sarver Heart Center Tucson Arizona USA
- MetroHealth Medical Center Case Western Reserve University Cleveland Ohio USA
- The Children's Hospital of Michigan Central Michigan University Detroit Michigan USA
- Southlake Regional Health Center Newmarket Ontario Canada
- Sentara Norfolk Virginia USA
- Virginia Commonwealth University Richmond Virginia USA
- University of Rochester Medical Center Rochester New York USA
- University of Texas Southwestern Medical Center Dallas Texas USA
- Johns Hopkins University School of Medicine Baltimore Maryland USA
- Ziekenhuis Oost-Limburg Genk Belgium and Hasselt University Hasselt Belgium
- Sungkyunkwan University School of Medicine, Samsung Medical Center Seoul Republic of Korea
- QEII Health Sciences Center Halifax Nova Scotia Canada
- Clinica Corazones Unidos Santo Domingo Dominican Republic
- Australian National University, Canberra Hospital Garran Australian Capital Territory Australia
- Santojanni Hospital Buenos Aires Argentina
- Yale University School of Medicine New Haven Connecticut USA
- National University Hospital Singapore Singapore
- Mayo Clinic Phoenix Arizona USA
- Tokyo Women's Medical University Tokyo Japan
- Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Weill Cornell Medicine Population Health Sciences New York New York USA
- University of California Davis Sacramento California USA
- Oregon Health & Science University Portland Oregon USA
- Indiana University Indianapolis Indiana USA
- Fundación Cardioinfantil Instituto de Cardiologia Bogotá Colombia
- George Washington University Washington District of Columbia USA
- University of Chicago Medicine Chicago Illinois USA
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center Maastricht The Netherlands
- Geisinger Health System Wilkes-Barre Pennsylvania USA
- Dartmouth Hitchcock Medical Center New Hampshire Lebanon
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7
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Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, Birgersdotter-Green UM, Cha YM, Chung EH, Cronin EM, Curtis AB, Cygankiewicz I, Dandamudi G, Dubin AM, Ensch DP, Glotzer TV, Gold MR, Goldberger ZD, Gopinathannair R, Gorodeski EZ, Gutierrez A, Guzman JC, Huang W, Imrey PB, Indik JH, Karim S, Karpawich PP, Khaykin Y, Kiehl EL, Kron J, Kutyifa V, Link MS, Marine JE, Mullens W, Park SJ, Parkash R, Patete MF, Pathak RK, Perona CA, Rickard J, Schoenfeld MH, Seow SC, Shen WK, Shoda M, Singh JP, Slotwiner DJ, Sridhar ARM, Srivatsa UN, Stecker EC, Tanawuttiwat T, Tang WHW, Tapias CA, Tracy CM, Upadhyay GA, Varma N, Vernooy K, Vijayaraman P, Worsnick SA, Zareba W, Zeitler EP. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. Heart Rhythm 2023; 20:e17-e91. [PMID: 37283271 PMCID: PMC11062890 DOI: 10.1016/j.hrthm.2023.03.1538] [Citation(s) in RCA: 67] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 06/08/2023]
Abstract
Cardiac physiologic pacing (CPP), encompassing cardiac resynchronization therapy (CRT) and conduction system pacing (CSP), has emerged as a pacing therapy strategy that may mitigate or prevent the development of heart failure (HF) in patients with ventricular dyssynchrony or pacing-induced cardiomyopathy. This clinical practice guideline is intended to provide guidance on indications for CRT for HF therapy and CPP in patients with pacemaker indications or HF, patient selection, pre-procedure evaluation and preparation, implant procedure management, follow-up evaluation and optimization of CPP response, and use in pediatric populations. Gaps in knowledge, pointing to new directions for future research, are also identified.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eugene H Chung
- University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | | | | | - Anne M Dubin
- Stanford University, Pediatric Cardiology, Palo Alto, California
| | | | - Taya V Glotzer
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Michael R Gold
- Medical University of South Carolina, Charleston, South Carolina
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | | | - Weijian Huang
- First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Peter B Imrey
- Cleveland Clinic, Cleveland, Ohio; Case Western Reserve University, Cleveland, Ohio
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Saima Karim
- MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Peter P Karpawich
- The Children's Hospital of Michigan, Central Michigan University, Detroit, Michigan
| | - Yaariv Khaykin
- Southlake Regional Health Center, Newmarket, Ontario, Canada
| | | | - Jordana Kron
- Virginia Commonwealth University, Richmond, Virginia
| | | | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Joseph E Marine
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wilfried Mullens
- Ziekenhuis Oost-Limburg Genk, Belgium and Hasselt University, Hasselt, Belgium
| | - Seung-Jung Park
- Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Ratika Parkash
- QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | | | - Rajeev Kumar Pathak
- Australian National University, Canberra Hospital, Garran, Australian Capital Territory, Australia
| | | | | | | | | | | | - Morio Shoda
- Tokyo Women's Medical University, Tokyo, Japan
| | - Jagmeet P Singh
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David J Slotwiner
- Weill Cornell Medicine Population Health Sciences, New York, New York
| | | | | | | | | | | | | | - Cynthia M Tracy
- George Washington University, Washington, District of Columbia
| | | | | | - Kevin Vernooy
- Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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8
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Abramov D, Kobo O, Gorodeski EZ, Rana JS, Walsh MN, Parwani P, Myint PK, Sauer AJ, Mamas MA. Incidence, Predictors, and Outcomes of Major Bleeding Among Patients Hospitalized With Acute Heart Failure. Am J Cardiol 2023; 191:59-65. [PMID: 36640601 DOI: 10.1016/j.amjcard.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/09/2022] [Accepted: 12/18/2022] [Indexed: 01/15/2023]
Abstract
Acute heart failure (AHF) is a common etiology of hospitalization and is associated with morbidity, including bleeding. In this study, the authors sought to assess the incidence, types, and associates of major bleeding in patients hospitalized with AHF. The National Inpatient Sample from October 2015 to December 2018 was used to identify patients with AHF. The incidence of common bleeding etiologies, and patient demographics, co-morbidities, associated acute cardiac diagnoses, and invasive procedures, were identified. The multivariable logistic regression was used to identify predictors of bleeding and the association of bleeding episodes with inpatient mortality. During the study period, 1,106,634 patients were admitted with a primary diagnosis of AHF, of whom 58,955 (5.3%) had an episode of bleeding. Common bleeding sources were gastrointestinal (25.7%), hematuria (24%), respiratory (23.6%), and procedure-related bleeding (2.5%). Major bleeding was more common in patients with AHF with preserved ejection fraction (odds ratio 1.14, confidence interval 1.12 to 1.16, p <0.001) versus AHF with reduced ejection fraction and in men (odds ratio 1.3, confidence interval 1.29 to 1.31, p <0.001). Major bleeding was associated with higher mortality (7.0% vs 2.4%, p <0.001), longer length of stay (7 vs 4 days, p <0.001), and higher inpatient costs ($49,658 vs $27,636, p <0.001). In conclusion, major bleeding occurs in 5.3% of patients hospitalized with AHF and is associated with higher inpatient mortality and costs and longer length of stay.
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Affiliation(s)
- Dmitry Abramov
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Ofer Kobo
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom; Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Eiran Z Gorodeski
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio; Division of Cardiovascular Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jamal S Rana
- Department of Cardiology, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, California
| | | | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California
| | - Phyo K Myint
- Aberdeen Diabetes and Cardiovascular Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom; Ageing Clinical and Experimental Research Team, University of Aberdeen, Aberdeen, United Kingdom
| | - Andrew J Sauer
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom.
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9
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Pham R, Gorodeski EZ, Al-Kindi S. SOCIAL VULNERABILITY AND LOCATION OF DEATH IN HEART FAILURE IN THE UNITED STATES. Curr Probl Cardiol 2023; 48:101689. [PMID: 36906162 DOI: 10.1016/j.cpcardiol.2023.101689] [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] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Majority of patients with heart failure (HF) die in either nursing homes or inpatient facilities. Social vulnerability captures multiple domains of socioeconomic position and has been linked with higher HF mortality. We sought to investigate the trends in location of death in patients with HF and its association with social vulnerability. METHODS We utilized the multiple cause of death files from the US (1999-2021) to identify decedents with HF as the underlying cause of death and linked them with county-level social vulnerability index (SVI) available from CDC/ATSDR database. RESULTS Approximately 1.7 million HF deaths were examined across 3003 US counties. Most patients (63%) died in a nursing home or inpatient facility, followed by home (28%), and only 4% died in hospice. Death at home had a positive correlation with higher SVI with Pearson's r = 0.26 (p<0.001) as well as deaths in an inpatient facility r = 0.33 (p<0.001). Death in a nursing home correlated negatively with SVI with r = -0.46 (p<0.001). There was no association between hospice utilization and SVI. Locations of death varied by geographic residence. More patients died at home during the COVID-19 pandemic (OR 1.39, p<0.001). CONCLUSIONS Social vulnerability was associated with location of death in patients with HF in the US. These associations varied by geographic location. Future studies should focus on social determinants of health and end-of-life care in HF.
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Affiliation(s)
- Richard Pham
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, US; School of Medicine, Case Western Reserve University, Cleveland, Ohio, US.
| | - Eiran Z Gorodeski
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, US; School of Medicine, Case Western Reserve University, Cleveland, Ohio, US.
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, US; School of Medicine, Case Western Reserve University, Cleveland, Ohio, US.
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10
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Lanfear DE, Njoroge JN, Adams KF, Anand I, Fang JC, Ramires F, Sliwa-Hahnle K, Badat A, Burgess L, Gorodeski EZ, Williams C, Diaz R, Felker GM, McMurray JJV, Metra M, Solomon S, Miao ZM, Claggett BL, Heitner SB, Kupfer S, Malik FI, Teerlink JR. Omecamtiv Mecarbil in Black Patients With Heart Failure and Reduced Ejection Fraction: Insights From GALACTIC-HF. JACC Heart Fail 2023; 11:569-579. [PMID: 36881396 DOI: 10.1016/j.jchf.2022.11.021] [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] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Omecamtiv mecarbil improves cardiovascular outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). Consistency of drug benefit across race is a key public health topic. OBJECTIVES The purpose of this study was to evaluate the effect of omecamtiv mecarbil among self-identified Black patients. METHODS In GALACTIC-HF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) patients with symptomatic HF, elevated natriuretic peptides, and left ventricular ejection fraction (LVEF) ≤35% were randomized to omecamtiv mecarbil or placebo. The primary outcome was a composite of time to first event of HF or cardiovascular death. The authors analyzed treatment effects in Black vs White patients in countries contributing at least 10 Black participants. RESULTS Black patients accounted for 6.8% (n = 562) of overall enrollment and 29% of U.S. enrollment. Most Black patients enrolled in the United States, South Africa, and Brazil (n = 535, 95%). Compared with White patients enrolled from these countries (n = 1,129), Black patients differed in demographics, comorbid conditions, received higher rates of medical therapy and lower rates of device therapies, and experienced higher overall event rates. The effect of omecamtiv mecarbil was consistent in Black vs White patients, with no difference in the primary endpoint (HR = 0.83 vs 0.88, P-interaction = 0.66), similar improvements in heart rate and N-terminal pro-B-type natriuretic peptide, and no significant safety signals. Among endpoints, the only nominally significant treatment-by-race interaction was the placebo-corrected change in blood pressure from baseline in Black vs White patients (+3.4 vs -0.7 mm Hg, P-interaction = 0.02). CONCLUSIONS GALACTIC-HF enrolled more Black patients than other recent HF trials. Black patients treated with omecamtiv mecarbil had similar benefit and safety compared with White counterparts.
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Affiliation(s)
| | - Joyce N Njoroge
- University of California San Francisco, San Francisco, California, USA
| | | | - Inder Anand
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Felix Ramires
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Aysha Badat
- Wits Clinical Research, Johannesburg, South Africa
| | - Lesley Burgess
- TREAD Research, Cardiology Unit, Department of Internal Medicine, Tygerberg Hospital and Stellenbosch University, Parow, South Africa
| | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Rafael Diaz
- Estudios Clínicos Latino América, Rosario, Argentina
| | - Gary M Felker
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, Glasgow, United Kingdom
| | | | - Scott Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Brian L Claggett
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Stuart Kupfer
- Cytokinetics Inc, South San Francisco, California, USA
| | - Fady I Malik
- Cytokinetics Inc, South San Francisco, California, USA
| | - John R Teerlink
- San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California, USA
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11
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Blumer V, Kittleson MM, Teerlink JR, Drazner MH, Walsh MN, Gorodeski EZ, Mentz RJ, Lala A. A Roadmap to Reinvigorating Training Pathways Focused on the Care of Patients With Heart Failure: Shifting From Failure to Function. J Card Fail 2023; 29:527-530. [PMID: 36610557 DOI: 10.1016/j.cardfail.2022.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Vanessa Blumer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - John R Teerlink
- Heart Failure Society of America (HFSA), Washington, DC; Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California-San Francisco, San Francisco, California
| | - Mark H Drazner
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Mary N Walsh
- Ascension St Vincent Heart Center, Ascension St Vincent Cardiovascular Research Institute, Indianapolis, Indiana
| | - Eiran Z Gorodeski
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Robert J Mentz
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Anuradha Lala
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.
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12
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Gilstrap LG, Gorodeski EZ, Goyal P. Heart failure and cognitive impairment: Complexity that requires a new approach. J Am Geriatr Soc 2022; 70:1652-1654. [DOI: 10.1111/jgs.17779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Lauren G. Gilstrap
- The Dartmouth Institute, Geisel School of Medicine, Dartmouth Hanover New Hampshire USA
- Dartmouth‐Hitchcock Medical Center, Heart and Vascular Center Lebanon New Hampshire USA
| | - Eiran Z. Gorodeski
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center Cleveland Ohio USA
- Case Western Reserve University School of Medicine Cleveland Ohio USA
| | - Parag Goyal
- Department of Medicine Weill Cornell Medicine New York New York USA
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13
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Affiliation(s)
- Jennifer T Thibodeau
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas(J.T.T.)
| | - Eiran Z Gorodeski
- Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, OH (E.Z.G.)
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14
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Mann DL, Greene SJ, Givertz MM, Vader JM, Starling RC, Ambrosy AP, Shah P, McNulty SE, Mahr C, Gupta D, Redfield MM, Lala A, Lewis GD, Mohammed SF, Gilotra NA, DeVore AD, Gorodeski EZ, Desvigne-Nickens P, Hernandez AF, Braunwald E. Sacubitril/Valsartan in Advanced Heart Failure With Reduced Ejection Fraction: Rationale and Design of the LIFE Trial. JACC Heart Fail 2020; 8:789-799. [PMID: 32641226 PMCID: PMC7286640 DOI: 10.1016/j.jchf.2020.05.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/11/2022]
Abstract
The PARADIGM-HF (Prospective Comparison of Angiotensin II Receptor Blocker Neprilysin Inhibitor With Angiotensin-Converting Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial reported that sacubitril/valsartan (S/V), an angiotensin receptor-neprilysin inhibitor, significantly reduced mortality and heart failure (HF) hospitalization in HF patients with a reduced ejection fraction (HFrEF). However, fewer than 1% of patients in the PARADIGM-HF study had New York Heart Association (NYHA) functional class IV symptoms. Accordingly, data that informed the use of S/V among patients with advanced HF were limited. The LIFE (LCZ696 in Hospitalized Advanced Heart Failure) study was a 24-week prospective, multicenter, double-blinded, double-dummy, active comparator trial that compared the safety, efficacy, and tolerability of S/V with those of valsartan in patients with advanced HFrEF. The trial planned to randomize 400 patients ≥18 years of age with advanced HF, defined as an EF ≤35%, New York Heart Association functional class IV symptoms, elevated natriuretic peptide concentration (B-type natriuretic peptide [BNP] ≥250 pg/ml or N-terminal pro-B-type natriuretic peptide [NT-proBNP] ≥800 pg/ml), and ≥1 objective finding of advanced HF. Following a 3- to 7-day open label run-in period with S/V (24 mg/26 mg twice daily), patients were randomized 1:1 to S/V titrated to 97 mg/103 mg twice daily versus 160 mg of V twice daily. The primary endpoint was the proportional change from baseline in the area under the curve for NT-proBNP levels measured through week 24. Secondary and tertiary endpoints included clinical outcomes and safety and tolerability. Because of the COVID-19 pandemic, enrollment in the LIFE trial was stopped prematurely to ensure patient safety and data integrity. The primary analysis consists of the first 335 randomized patients whose clinical follow-up examination results were not severely impacted by COVID-19. (Entresto [LCZ696] in Advanced Heart Failure [LIFE STUDY] [HFN-LIFE]; NCT02816736).
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Affiliation(s)
- Douglas L Mann
- Department of Medicine, Washington University, St. Louis, Missouri.
| | - Stephen J Greene
- Department of Medicine, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Michael M Givertz
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Justin M Vader
- Department of Medicine, Washington University, St. Louis, Missouri
| | - Randall C Starling
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Andrew P Ambrosy
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Palak Shah
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Steven E McNulty
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Claudius Mahr
- Department of Medicine, University of Washington, Seattle, Washington
| | - Divya Gupta
- Department of Medicine, Emory University, Atlanta, Georgia
| | | | - Anuradha Lala
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Gregory D Lewis
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Nisha A Gilotra
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adam D DeVore
- Department of Medicine, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Eiran Z Gorodeski
- Department of Medicine, Harrington Heart and Vascular Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Baltimore, Maryland
| | - Adrian F Hernandez
- Department of Medicine, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Eugene Braunwald
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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15
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Gorodeski EZ, Moennich LA, Riaz H, Jehi L, Young JB, Tang WW. Virtual Versus In-Person Visits and Appointment No-Show Rates in Heart Failure Care Transitions. Circ Heart Fail 2020; 13:e007119. [DOI: 10.1161/circheartfailure.120.007119] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eiran Z. Gorodeski
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (E.Z.G.)
| | - Laurie Ann Moennich
- Heart, Vascular, and Thoracic Institute Research and Registries, Cleveland Clinic, OH (L.A.M.)
| | - Haris Riaz
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH (H.R., J.B.Y., W.H.W.T.)
| | - Lara Jehi
- Epilepsy Center, Neurological Institute, Cleveland Clinic, OH (L.J.)
| | - James B. Young
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH (H.R., J.B.Y., W.H.W.T.)
| | - W.H. Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, OH (H.R., J.B.Y., W.H.W.T.)
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16
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Feeny AK, Rickard J, Trulock KM, Patel D, Toro S, Moennich LA, Varma N, Niebauer MJ, Gorodeski EZ, Grimm RA, Barnard J, Madabhushi A, Chung MK. Machine Learning of 12-Lead QRS Waveforms to Identify Cardiac Resynchronization Therapy Patients With Differential Outcomes. Circ Arrhythm Electrophysiol 2020; 13:e008210. [PMID: 32538136 DOI: 10.1161/circep.119.008210] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 12/11/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) improves heart failure outcomes but has significant nonresponse rates, highlighting limitations in ECG selection criteria: QRS duration (QRSd) ≥150 ms and subjective labeling of left bundle branch block (LBBB). We explored unsupervised machine learning of ECG waveforms to identify CRT subgroups that may differentiate outcomes beyond QRSd and LBBB. METHODS We retrospectively analyzed 946 CRT patients with conduction delay. Principal component analysis (PCA) dimensionality reduction obtained a 2-dimensional representation of preCRT 12-lead QRS waveforms. k-means clustering of the 2-dimensional PCA representation of 12-lead QRS waveforms identified 2 patient subgroups (QRS PCA groups). Vectorcardiographic QRS area was also calculated. We examined following 2 primary outcomes: (1) composite end point of death, left ventricular assist device, or heart transplant, and (2) degree of echocardiographic left ventricular ejection fraction (LVEF) change after CRT. RESULTS Compared with QRS PCA Group 2 (n=425), Group 1 (n=521) had lower risk for reaching the composite end point (HR, 0.44 [95% CI, 0.38-0.53]; P<0.001) and experienced greater mean LVEF improvement (11.1±11.7% versus 4.8±9.7%; P<0.001), even among patients with LBBB with QRSd ≥150 ms (HR, 0.42 [95% CI, 0.30-0.57]; P<0.001; mean LVEF change 12.5±11.8% versus 7.3±8.1%; P=0.001). QRS area also stratified outcomes but had significant differences from QRS PCA groups. A stratification scheme combining QRS area and QRS PCA group identified patients with LBBB with similar outcomes to non-LBBB patients (HR, 1.32 [95% CI, 0.93-1.62]; difference in mean LVEF change: 0.8% [95% CI, -2.1% to 3.7%]). The stratification scheme also identified patients with LBBB with QRSd <150 ms with comparable outcomes to patients with LBBB with QRSd ≥150 ms (HR, 0.93 [95% CI, 0.67-1.29]; difference in mean LVEF change: -0.2% [95% CI, -2.7% to 3.0%]). CONCLUSIONS Unsupervised machine learning of ECG waveforms identified CRT subgroups with relevance beyond LBBB and QRSd. This method may assist in objective classification of bundle branch block morphology in CRT.
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Affiliation(s)
- Albert K Feeny
- Cleveland Clinic Lerner College of Medicine (A.K.F., N.V., M.J.N., E.Z.G., R.A.G., J.B., M.K.C.), Case Western Reserve University, Cleveland, OH
| | - John Rickard
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., K.M.T., D.P., S.T., L.A.M., N.V., M.J.N., E.Z.G.), Cleveland Clinic, OH
| | - Kevin M Trulock
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., K.M.T., D.P., S.T., L.A.M., N.V., M.J.N., E.Z.G.), Cleveland Clinic, OH
| | - Divyang Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., K.M.T., D.P., S.T., L.A.M., N.V., M.J.N., E.Z.G.), Cleveland Clinic, OH
| | - Saleem Toro
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., K.M.T., D.P., S.T., L.A.M., N.V., M.J.N., E.Z.G.), Cleveland Clinic, OH
| | - Laurie Ann Moennich
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., K.M.T., D.P., S.T., L.A.M., N.V., M.J.N., E.Z.G.), Cleveland Clinic, OH
| | - Niraj Varma
- Cleveland Clinic Lerner College of Medicine (A.K.F., N.V., M.J.N., E.Z.G., R.A.G., J.B., M.K.C.), Case Western Reserve University, Cleveland, OH.,Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., K.M.T., D.P., S.T., L.A.M., N.V., M.J.N., E.Z.G.), Cleveland Clinic, OH
| | - Mark J Niebauer
- Cleveland Clinic Lerner College of Medicine (A.K.F., N.V., M.J.N., E.Z.G., R.A.G., J.B., M.K.C.), Case Western Reserve University, Cleveland, OH.,Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., K.M.T., D.P., S.T., L.A.M., N.V., M.J.N., E.Z.G.), Cleveland Clinic, OH
| | - Eiran Z Gorodeski
- Cleveland Clinic Lerner College of Medicine (A.K.F., N.V., M.J.N., E.Z.G., R.A.G., J.B., M.K.C.), Case Western Reserve University, Cleveland, OH.,Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., K.M.T., D.P., S.T., L.A.M., N.V., M.J.N., E.Z.G.), Cleveland Clinic, OH
| | - Richard A Grimm
- Cleveland Clinic Lerner College of Medicine (A.K.F., N.V., M.J.N., E.Z.G., R.A.G., J.B., M.K.C.), Case Western Reserve University, Cleveland, OH
| | - John Barnard
- Cleveland Clinic Lerner College of Medicine (A.K.F., N.V., M.J.N., E.Z.G., R.A.G., J.B., M.K.C.), Case Western Reserve University, Cleveland, OH.,Department of Quantitative Health Sciences, Lerner Research Institute (J.B.), Cleveland Clinic, OH
| | - Anant Madabhushi
- Department of Biomedical Engineering (A.M.), Case Western Reserve University, Cleveland, OH.,Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH (A.M.)
| | - Mina K Chung
- Cleveland Clinic Lerner College of Medicine (A.K.F., N.V., M.J.N., E.Z.G., R.A.G., J.B., M.K.C.), Case Western Reserve University, Cleveland, OH.,Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute (M.K.C.), Cleveland Clinic, OH
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17
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Gorodeski EZ, Goyal P, Cox ZL, Thibodeau JT, Reay RE, Rasmusson K, Rogers JG, Starling RC. Virtual Visits for Care of Patients with Heart Failure in the Era of COVID-19: A Statement from the Heart Failure Society of America. J Card Fail 2020; 26:448-456. [PMID: 32315732 PMCID: PMC7166039 DOI: 10.1016/j.cardfail.2020.04.008] [Citation(s) in RCA: 127] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 12/15/2022]
Abstract
In response to the COVID-19 pandemic, US federal and state governments have implemented wide-ranging stay-at-home recommendations as a means to reduce spread of infection. As a consequence, many US healthcare systems and practices have curtailed ambulatory clinic visits—pillars of care for patients with heart failure (HF). In this context, synchronous audio/video interactions, also known as virtual visits (VVs), have emerged as an innovative and necessary alternative. This scientific statement outlines the benefits and challenges of VVs, enumerates changes in policy and reimbursement that have increased the feasibility of VVs during the COVID-19 era, describes platforms and models of care for VVs, and provides a vision for the future of VVs.
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Affiliation(s)
- Eiran Z Gorodeski
- Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center, Cleveland, OH.
| | | | - Zachary L Cox
- Lipscomb University College of Pharmacy and Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Kismet Rasmusson
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
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18
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Abstract
Cardiovascular clinicians tend to pay little attention to issues related to cognition, and yet those caring for older adults will encounter a variety of conditions that may lead to cognitive impairment. Most commonly, these include cardiovascular disease-specific conditions such as cerebrovascular disease or heart failure, but may also include neurodegenerative conditions, mood disorders, medication side effects and polypharmacy, and nutritional deficiencies and metabolic derangements among others. This review presents evidence supporting the importance of assessing cognitive status in older adults with cardiovascular disease, and suggests a practical approach to assessment and management of cognitive impairment in this population when it is found. Special attention is paid to the importance of collaboration between cardiovascular and geriatric specialists, and the value it may bring to patients.
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Affiliation(s)
- Eiran Z. Gorodeski
- Department of MedicineCase Western Reserve University School of MedicineClevelandOhio
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical CenterClevelandOhio
| | - Ardeshir Z. Hashmi
- Center for Geriatric Medicine, Medicine Institute, Cleveland ClinicClevelandOhio
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19
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Abstract
Cardiac rehabilitation (CR) is an inherently patient-centered program that provides holistic care to adults with cardiovascular conditions to promote lifelong health and fitness, facilitate self-care and self-efficacy, and improve clinical outcomes. CR offers an excellent platform for patient-centered optimization of medication regimens for older adults with heart failure through its potential to address several aspects of care that have historically served as major challenges to clinicians-diuretic management, the use of guideline-directed medical therapy, review and reconciliation of noncardiovascular medications, and optimization of medication adherence. In this review, these challenges are described and strategies offered for leveraging CR toward addressing them.
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Affiliation(s)
- Parag Goyal
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA; Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 420 East 70th Street, 3rd floor. LH340, New York, NY 10021, USA.
| | - Eiran Z Gorodeski
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Desk J3-4, 9500 Euclid Avenue, Cleveland, OH 44195, USA. https://twitter.com/EiranGorodeski
| | - Zachary A Marcum
- Department of Pharmacy, School of Pharmacy, University of Washington, 1959 Northeast Pacific Street Box 357630, Seattle, WA 98195, USA. https://twitter.com/ZacharyAMarcum
| | - Daniel E Forman
- Section of Geriatric Cardiology, Cardiac Rehabilitation and GeroFit, VA Pittsburgh Healthcare System, University of Pittsburgh, 3471 Fifth Avenue, Suite 500, Kaufmann Medical Building, Pittsburgh, PA 15213, USA
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21
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Goyal P, Gorodeski EZ, Flint KM, Goldwater DS, Dodson JA, Afilalo J, Maurer MS, Rich MW, Alexander KP, Hummel SL. Perspectives on Implementing a Multidomain Approach to Caring for Older Adults With Heart Failure. J Am Geriatr Soc 2019; 67:2593-2599. [PMID: 31625160 DOI: 10.1111/jgs.16183] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND/OBJECTIVES The American College of Cardiology (ACC) Geriatric Cardiology Section Leadership Council recently outlined 4 key domains (which are composed of 14 subdomains) that are important to assess in older adults with heart failure (HF). We sought to determine which geriatric domains/subdomains are routinely assessed, how they are assessed, and how they impact clinical management in the care of ambulatory older adults with HF. DESIGN Survey. SETTING Ambulatory. PARTICIPANTS Fifteen active ACC member physicians from the geriatric cardiology community. MEASUREMENTS Electronic survey assessing which domains/subdomains are currently assessed in these selected real-world practices, how they are assessed, and how they are incorporated into clinical management. RESULTS Of 15 clinicians, 14 responded to the survey. The majority routinely assess 3 to 4 domains (median, 3; interquartile range, 3-4) and a range of 4 to 12 subdomains (median, 8; interquartile range, 6-11). All respondents routinely assess the medical and physical function domains, 71% routinely assess the mind/emotion domain, and 50% routinely assess the social domain. The most common subdomains included comorbidity burden (100%), polypharmacy (100%), basic function (93%), mobility (86%), falls risk (71%), frailty (64%), and cognition (57%). Sensory impairment (50%), social isolation (50%), nutritional status (43%), loneliness (7%), and financial means (7%) were least frequently assessed. There was significant heterogeneity with regard to the tools used to assess subdomains. Common themes for how the subdomains influenced clinical care included informing prognosis, informing risk-benefit of pharmacologic therapy and invasive procedures, and consideration for palliative care. CONCLUSIONS While respondents routinely assess multiple domains and subdomains and view these as important to clinical care, there is substantial heterogeneity regarding which subdomains are assessed and the tools used to assess them. These observations provide a foundation that inform a research agenda with regard to providing holistic and patient-centered care to older adults with HF. J Am Geriatr Soc 67:2593-2599, 2019.
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Affiliation(s)
| | - Eiran Z Gorodeski
- Case Western Reserve University School of Medicine, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kelsey M Flint
- Rocky Mountain Regional Veterans Affairs (VA) Medical Center, University of Colorado School of Medicine, Aurora, Colorado
| | | | - John A Dodson
- New York University School of Medicine, New York, New York
| | - Jonathan Afilalo
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Mathew S Maurer
- Columbia University Irving Medical Center, New York, New York
| | - Michael W Rich
- Washington University School of Medicine, St Louis, Missouri
| | - Karen P Alexander
- Duke University, Duke Clinical Research Institute, Durham, North Carolina
| | - Scott L Hummel
- University of Michigan and Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
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Gorodeski EZ, Magnelli-Reyes C, Moennich LA, Grimaldi A, Rickard J. Cardiac resynchronization therapy-heart failure (CRT-HF) clinic: A novel model of care. PLoS One 2019; 14:e0222610. [PMID: 31536565 PMCID: PMC6752801 DOI: 10.1371/journal.pone.0222610] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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] [Received: 05/27/2019] [Accepted: 09/03/2019] [Indexed: 11/18/2022] Open
Abstract
Background Post-implant care of patients with heart failure (HF) undergoing cardiac resynchronization therapy (CRT) is not addressed in current HF or CRT guidelines and is often fragmented with poor communication between specialties. We sought to develop a new model of post-CRT care which could be implemented in busy clinical settings. Methods and results We designed a novel, multidisciplinary approach to standardizing post CRT care. All patients receiving a CRT device at the Cleveland Clinic between March 2017 and August 2018 were invited to be seen in the clinic 6 months post implant. A one-time collaborative visit encompassing cardiac imaging, heart failure, and electrophysiology care was performed. We recorded the operational feasibility of the clinic in terms of patient throughput as well as patient characteristics, interventions, and new diagnoses made. Between September 2017 and February 2019, 150 patients were seen in the clinic. Of these, 125 patients had their index CRT implanted for standard indications and were included in the current analysis. Approximately 45 minutes were dedicated for each patient visit. Interventions in care were made in 95% of patients, with CRT non-responders offered a higher number of interventions as compared to responders (median 3 versus 2 interventions). Types of interventions were device-related (26% of population), medication-related (74%), and referral for alternate medical services (80%). Conclusions Multidisciplinary post-implant care of patients with HF receiving CRT devices, regardless of CRT response status, is feasible and results in frequent medical interventions.
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Affiliation(s)
- Eiran Z. Gorodeski
- Section of Heart Failure and Cardiac Transplantation, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Christina Magnelli-Reyes
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Laurie Ann Moennich
- Heart and Vascular Research, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Adam Grimaldi
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - John Rickard
- Section of Cardiac Pacing and Electrophysiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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Rickard J, Gorodeski EZ, Patel D, Hussein A, Moennich LA, Cantillon D, Trulock K, Toro S, Niebauer M, Varma N, Wilkoff BL. Long term outcomes in patients with chronic right ventricular pacing upgraded to cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2019; 30:1979-1983. [PMID: 31211474 DOI: 10.1111/jce.14038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/24/2019] [Revised: 06/09/2019] [Accepted: 06/14/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In patients with chronic systolic heart failure and frequent right ventricular pacing (RVP), upgrade to cardiac resynchronization therapy (CRT) has become common practice despite a lack of randomized clinical trials. We aimed to evaluate long term outcomes in patients upgraded to CRT from chronic RVP compared with de novo CRT implants. METHODS AND RESULTS We reviewed medical charts on consecutive patients with a left ventricular ejection fraction (LVEF) ≤ 35% and a QRSd ≥ 120 ms undergoing CRT. Survival free of left ventricular assist device (LVAD) and a heart transplant was compared amongst patients on the basis of pre-CRT QRS morphology. Improvement in LVEF was also compared across groups. A total of 1260 patients met inclusion criteria of whom 233 were upgraded from chronic RVP. Over a mean follow up 6.5 ± 4.0 years there were 821 endpoints (27 LVAD, 30 heart transplants, and 764 deaths). In a multivariate Cox regression model, upgraded patients had worse outcomes (HR 1.3(1.1-1.7) P = .007) compared with those with native LBBB and similar outcomes to patients with non-LBBB(HR 0.96(0.76-1.21) P = .7). The survival curve for chronic RVP parallels native LBBB for approximately 2.5 years before dropping sharply. Patients with chronic RVP derive similar improvements in LVEF compared with those with LBBB and superior improvements compared with those with non-LBBB. CONCLUSIONS Despite achieving similar levels of LVEF improvement, patients with systolic heart failure with chronic RVP undergoing upgrade to CRT have inferior long term outcomes compared with patients with native LBBB. Long term outcomes with CRT in patients with chronic RVP, RBBB, and IVCD are similar.
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Affiliation(s)
- John Rickard
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Eiran Z Gorodeski
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Divyang Patel
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Ayman Hussein
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Laurie Anne Moennich
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Daniel Cantillon
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Kevin Trulock
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Saleem Toro
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Mark Niebauer
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Niraj Varma
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
| | - Bruce L Wilkoff
- Cleveland Clinic Heart and Vascular Institute, Section of Cardiovascular Medicine Cleveland, Cleveland, Ohio
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Feeny AK, Rickard J, Patel D, Toro S, Trulock KM, Park CJ, LaBarbera MA, Varma N, Niebauer MJ, Sinha S, Gorodeski EZ, Grimm RA, Ji X, Barnard J, Madabhushi A, Spragg DD, Chung MK. Machine Learning Prediction of Response to Cardiac Resynchronization Therapy: Improvement Versus Current Guidelines. Circ Arrhythm Electrophysiol 2019; 12:e007316. [PMID: 31216884 DOI: 10.1161/circep.119.007316] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [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: 01/06/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has significant nonresponse rates. We assessed whether machine learning (ML) could predict CRT response beyond current guidelines. METHODS We analyzed CRT patients from Cleveland Clinic and Johns Hopkins. A training cohort was created from all Johns Hopkins patients and an equal number of randomly sampled Cleveland Clinic patients. All remaining patients comprised the testing cohort. Response was defined as ≥10% increase in left ventricular ejection fraction. ML models were developed to predict CRT response using different combinations of classification algorithms and clinical variable sets on the training cohort. The model with the highest area under the curve was evaluated on the testing cohort. Probability of response was used to predict survival free from a composite end point of death, heart transplant, or placement of left ventricular assist device. Predictions were compared with current guidelines. RESULTS Nine hundred twenty-five patients were included. On the training cohort (n=470: 235, Johns Hopkins; 235, Cleveland Clinic), the best ML model was a naive Bayes classifier including 9 variables (QRS morphology, QRS duration, New York Heart Association classification, left ventricular ejection fraction and end-diastolic diameter, sex, ischemic cardiomyopathy, atrial fibrillation, and epicardial left ventricular lead). On the testing cohort (n=455, Cleveland Clinic), ML demonstrated better response prediction than guidelines (area under the curve, 0.70 versus 0.65; P=0.012) and greater discrimination of event-free survival (concordance index, 0.61 versus 0.56; P<0.001). The fourth quartile of the ML model had the greatest risk of reaching the composite end point, whereas the first quartile had the least (hazard ratio, 0.34; P<0.001). CONCLUSIONS ML with 9 variables incrementally improved prediction of echocardiographic CRT response and survival beyond guidelines. Performance was not improved by incorporating more variables. The model offers potential for improved shared decision-making in CRT (online calculator: http://riskcalc.org:3838/CRTResponseScore ). Significant remaining limitations confirm the need to identify better variables to predict CRT response.
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Affiliation(s)
- Albert K Feeny
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L.), Case Western Reserve University, OH
| | - John Rickard
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., D.P., S.T., K.M.T., N.V., M.J.N., E.Z.G., R.A.G., M.K.C.), Cleveland Clinic, OH
| | - Divyang Patel
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., D.P., S.T., K.M.T., N.V., M.J.N., E.Z.G., R.A.G., M.K.C.), Cleveland Clinic, OH
| | - Saleem Toro
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., D.P., S.T., K.M.T., N.V., M.J.N., E.Z.G., R.A.G., M.K.C.), Cleveland Clinic, OH
| | - Kevin M Trulock
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., D.P., S.T., K.M.T., N.V., M.J.N., E.Z.G., R.A.G., M.K.C.), Cleveland Clinic, OH
| | - Carolyn J Park
- Division of Cardiology, The Johns Hopkins Hospital, Baltimore, MD (C.J.P., S.S., D.D.S.)
| | - Michael A LaBarbera
- Cleveland Clinic Lerner College of Medicine (A.K.F., M.A.L.), Case Western Reserve University, OH
| | - Niraj Varma
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., D.P., S.T., K.M.T., N.V., M.J.N., E.Z.G., R.A.G., M.K.C.), Cleveland Clinic, OH
| | - Mark J Niebauer
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., D.P., S.T., K.M.T., N.V., M.J.N., E.Z.G., R.A.G., M.K.C.), Cleveland Clinic, OH
| | - Sunil Sinha
- Division of Cardiology, The Johns Hopkins Hospital, Baltimore, MD (C.J.P., S.S., D.D.S.)
| | - Eiran Z Gorodeski
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., D.P., S.T., K.M.T., N.V., M.J.N., E.Z.G., R.A.G., M.K.C.), Cleveland Clinic, OH
| | - Richard A Grimm
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., D.P., S.T., K.M.T., N.V., M.J.N., E.Z.G., R.A.G., M.K.C.), Cleveland Clinic, OH
| | - Xinge Ji
- Department of Quantitative Health Sciences, Lerner Research Institute (X.J., J.B.), Cleveland Clinic, OH
| | - John Barnard
- Department of Quantitative Health Sciences, Lerner Research Institute (X.J., J.B.), Cleveland Clinic, OH
| | - Anant Madabhushi
- Department of Biomedical Engineering (A.M.), Case Western Reserve University, OH.,Louis Stokes Cleveland Veterans Administration Medical Center, OH (A.M.)
| | - David D Spragg
- Division of Cardiology, The Johns Hopkins Hospital, Baltimore, MD (C.J.P., S.S., D.D.S.)
| | - Mina K Chung
- Department of Cardiovascular Medicine, Heart and Vascular Institute (J.R., D.P., S.T., K.M.T., N.V., M.J.N., E.Z.G., R.A.G., M.K.C.), Cleveland Clinic, OH
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Affiliation(s)
- Eiran Z Gorodeski
- Section of Heart Failure and Cardiac Transplant Medicine, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH; Lerner College of Medicine of Case Western Reserve University, Cleveland, OH.
| | - Michael W Rich
- Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Paul J Hauptman
- Department of Medicine, Saint Louis University School of Medicine, St Louis, MO
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Gorodeski EZ, Rosenfeldt AB, Fang K, Kubu C, Rao SM, Jansen AE, Dey T, Alberts JL. AN IPAD-BASED MEASURE OF PROCESSING SPEED IN OLDER ADULTS HOSPITALIZED FOR HEART FAILURE. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31604-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Patel D, Trulock KM, Toro S, Grimaldi A, Gonzalez M, Moennich LA, Gorodeski EZ, Joyce E, Niebauer M, Wilkoff BL, Varma N, Rickard JW. Effect of Cardiac Resynchronization Therapy on Left Ventricular Remodeling in Patients With Cardiac Sarcoidosis. Am J Cardiol 2019; 123:329-333. [PMID: 30471710 DOI: 10.1016/j.amjcard.2018.09.044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 09/23/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
Cardiac resynchronization therapy (CRT) has been shown to be beneficial in patients with medically refractory heart failure. Although it has been found to be effective in a wide range of etiologies for nonischemic cardiomyopathy, its role in improving remodeling and survival of patients with cardiac sarcoidosis (CS) remains undefined. We performed a retrospective review of all patients at our institution with CS who underwent implantation of a CRT device from 2007 to 2017. The outcomes of this population were compared with the outcomes of a cohort of patients with nonischemic cardiomyopathy with an etiology other than sarcoidosis. Nineteen patients in our institution with CS underwent CRT implantation during the time period. This group was compared with 311 consecutive patients with other etiologies of nonischemic cardiomyopathy who underwent CRT implantation. CRT improved left ventricular ejection fraction (LVEF) from 28.8% to 35.9% (p <0.05) in CS, whereas it improved LVEF from 25% to 36.6% (p <0.01) in non-CS group (difference in means of 0.13). CRT significantly improved diastolic and systolic LV diameters, mitral regurgitation, and right ventricular systolic function in non-CS patients but failed to improve same parameters in CS patients. In conclusion, CRT significantly improved LVEF in patients with CS. There is no significant evidence that survival outcomes of CRT patients with CS are significantly worse than other etiologies of nonischemic cardiomyopathy.
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Sperry BW, Ikram A, Alvarez PA, Perez AL, Kendall K, Gorodeski EZ, Starling RC. Standardized Psychosocial Assessment Before Left Ventricular Assist Device Implantation. Circ Heart Fail 2019; 12:e005377. [DOI: 10.1161/circheartfailure.118.005377] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brett W. Sperry
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio (B.W.S., A.I., P.A.A., A.L.P., K.K., E.Z.G., R.C.S.)
- Mid America Heart Institute, Saint Luke’s Hospital of Kansas City, MO (B.W.S.)
| | - Asad Ikram
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio (B.W.S., A.I., P.A.A., A.L.P., K.K., E.Z.G., R.C.S.)
| | - Paulino A. Alvarez
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio (B.W.S., A.I., P.A.A., A.L.P., K.K., E.Z.G., R.C.S.)
- Department of Cardiovascular Medicine, University of Iowa (P.A.)
| | - Antonio L. Perez
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio (B.W.S., A.I., P.A.A., A.L.P., K.K., E.Z.G., R.C.S.)
| | - Kay Kendall
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio (B.W.S., A.I., P.A.A., A.L.P., K.K., E.Z.G., R.C.S.)
| | - Eiran Z. Gorodeski
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio (B.W.S., A.I., P.A.A., A.L.P., K.K., E.Z.G., R.C.S.)
| | - Randall C. Starling
- Department of Cardiovascular Medicine, Cleveland Clinic, Ohio (B.W.S., A.I., P.A.A., A.L.P., K.K., E.Z.G., R.C.S.)
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Gandesbery B, Dobbie K, Joyce E, Hoeksema L, Perez Protto S, Gorodeski EZ. Surgical Versus Medical Team Assignment and Secondary Palliative Care Services for Patients Dying in a Cardiac Hospital. Am J Hosp Palliat Care 2018; 36:316-320. [DOI: 10.1177/1049909118819462] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Secondary palliative care (SPC) provides several benefits for patients with cardiovascular disease, but historically, it has been underutilized in this population. Prior research suggests a low rate of SPC consultation by surgical teams in general, but little is known about how surgical teams utilize SPC in the setting of severe cardiovascular disease. Aim: To determine if surgical team assignment affects the probability of SPC for inpatients dying of cardiovascular disease. Design: Retrospective, cohort study. Methods: We identified all inpatients at a large cardiac hospital who had anticipated death under the care of a cardiology, cardiac surgery, or vascular surgery team in 2016. Our primary outcome was referral to SPC, including palliative medicine consultation or inpatient hospice care. Informed by univariate analysis, we created a multivariable logistic regression model, the significance of which was assessed with the Wald test. Results: Two hundred thirty-seven patients were included in our analysis: 93 (39%) received SPC and 144 (61%) were “missed opportunities.” Secondary palliative care was less frequent in patients assigned to a surgical, versus medical, team (11% vs 47%, P < .001). On multivariate analysis, surgical versus medical team assignment was the strongest risk-adjusted predictor of SPC (odds ratio [OR]: 0.10, P < .001). Other predictors of SPC included do not resuscitate status on admission (OR: 14, P < .001), length of stay (OR = 1.05/day, P < .001), and having Medicare (OR = 3.9, P = .002). Conclusions: Primary inpatient care by a surgical team had a strong inverse relationship with SPC. This suggests a possible cultural barrier within surgical disciplines to SPC.
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Joyce E, Howell EH, Senapati A, Starling RC, Gorodeski EZ. Prospective assessment of combined handgrip strength and Mini-Cog identifies hospitalized heart failure patients at increased post-hospitalization risk. ESC Heart Fail 2018; 5:948-952. [PMID: 29893487 PMCID: PMC6165927 DOI: 10.1002/ehf2.12300] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/25/2018] [Accepted: 04/16/2018] [Indexed: 12/22/2022] Open
Abstract
Aims The utility of combined assessment of both frailty and cognitive impairment in hospitalized heart failure (HF) patients for incremental post‐discharge risk stratification, using handgrip strength and Mini‐Cog as feasible representative parameters, was investigated. Methods and results A prospective, single‐centre cohort study of older adults (age ≥65) hospitalized for HF being discharged to home was performed. Pre‐discharge, grip strength was assessed using a dynamometer (Jamar hydrolic hand dynamometer, Lafayette Instruments, Lafayette, IN, USA) and was defined as weak if the maximal value was below the gender‐derived and body mass index‐derived cut‐offs according to Fried criteria. Cognition was assessed using the Mini‐Cog. The presence of impairment was defined as a score of <2. Outcome measures were all‐cause readmission or emergency department visit (primary) or all‐cause mortality (secondary) at 6 months. A total of 56 patients (mean age 77 ± 7 years, 73% male) were enrolled. The majority (n = 33, 59%) had weak grip strength, either with (n = 5) or without (n = 28) cognitive impairment. The highest risk for both readmission and mortality occurred in those with weak grip strength and cognitive impairment in combination (log‐rank P < 0.0001 and P = 0.01, respectively). Conclusions Patients who are frail by grip strength assessment and cognitively impaired according to severely reduced Mini‐Cog performance show the worst midterm post‐discharge outcomes after HF hospitalization.
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Affiliation(s)
- Emer Joyce
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Desk J3-4, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Erik H Howell
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Alpana Senapati
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Randall C Starling
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Desk J3-4, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Eiran Z Gorodeski
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Desk J3-4, 9500 Euclid Ave., Cleveland, OH, 44195, USA.,Center for Connected Care, Cleveland Clinic, Cleveland, OH, USA
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Halkar M, Nowacki AS, Kendall K, Efeovbokhan N, Gorodeski EZ, Moazami N, Starling RC, Young JB, Lee S, Tang WW. Utility of the Psychosocial Assessment of Candidates for Transplantation in Patients Undergoing Continuous-Flow Left Ventricular Assist Device Implantation. Prog Transplant 2018; 28:220-225. [DOI: 10.1177/1526924818781559] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: Psychosocial assessment of patients comprises an important element in the selection process of appropriate candidates for left ventricular assist device (LVAD) implantation. We sought to determine the association of the well-validated psychosocial assessment of candidates for transplantation (PACT) scale to clinical outcomes post-LVAD implantation. Materials and Methods: The PACT scale was used retrospectively to reconstruct psychosocial profiles of all patients who underwent a continuous-flow LVAD implantation for all indications at our institution between March 2008 and August 2012 (N = 230). Psychosocial elements including social support, psychological health, lifestyle factors, comprehension of the operation, and follow-up were evaluated. The primary outcome was overall survival, and the secondary outcomes were hospital readmission, pump thrombosis, hemolysis, gastrointestinal (GI) bleeding, and LVAD driveline infections. Results: The mean age of patients was 55.3 years, with 83% being male; 58% (N = 135) were bridge to transplant and 42% (N = 95) were destination therapy. Up to 1-year post-LVAD implant, there were no statistical differences among the 5 PACT candidate groups in terms of survival ( P = .79), hospital readmissions ( P = .55), suspected or confirmed pump thrombosis ( P = .31), hemolysis ( P = .43), GI bleeding ( P = .71), or driveline infections ( P = .06). Conclusions: In this single-center retrospective review, post hoc reconstruction of psychosocial profiles using the PACT scale and independent assessment of postimplant outcomes, including survival and adverse events, did not show any association. However, given the small number of patients in the low score PACT groups as well as limited duration of follow-up, further studies are required to elucidate the association.
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Affiliation(s)
- Meghana Halkar
- Department of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amy S. Nowacki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Kay Kendall
- Department of Social Work, Cleveland Clinic, Cleveland, OH, USA
| | - Nephertiti Efeovbokhan
- Department of Cardiovascular Medicine, NEA Baptist Memorial Hospital, Jonesboro, AR, USA
| | - Eiran Z. Gorodeski
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Nader Moazami
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY, USA
| | | | - James B. Young
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Sangjin Lee
- Department of Cardiovascular Medicine, Spectrum Health, Grand Rapids Michigan, MI, USA
| | - W.H. Wilson Tang
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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Gorodeski EZ, Goyal P, Hummel SL, Krishnaswami A, Goodlin SJ, Hart LL, Forman DE, Wenger NK, Kirkpatrick JN, Alexander KP. Domain Management Approach to Heart Failure in the Geriatric Patient: Present and Future. J Am Coll Cardiol 2018; 71:1921-1936. [PMID: 29699619 PMCID: PMC7304050 DOI: 10.1016/j.jacc.2018.02.059] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/22/2018] [Accepted: 02/25/2018] [Indexed: 02/07/2023]
Abstract
Heart failure (HF) is a quintessential geriatric cardiovascular condition, with more than 50% of hospitalizations occurring in adults age 75 years or older. In older patients, HF is closely linked to processes inherent to aging, which include cellular and structural changes to the myocardium, vasculature, and skeletal muscle. In addition, HF cannot be considered in isolation of physical functioning, or without the social, psychological, and behavioral dimensions of illness. The role of frailty, depression, cognitive impairment, nutrition, and goals of care are each uniquely relevant to the implementation and success of medical therapy. In this paper, we discuss a model of caring for older adults with HF through a 4-domain framework that can address the unique multidimensional needs and vulnerabilities of this population. We believe that clinicians who embrace this approach can improve health outcomes for older adults with HF.
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Affiliation(s)
- Eiran Z Gorodeski
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Parag Goyal
- Division of Cardiology and Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Scott L Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
| | - Ashok Krishnaswami
- Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California
| | - Sarah J Goodlin
- Geriatrics Section, Veterans Affairs Portland Health Care System, Portland, Oregon; Department of Medicine, Oregon Health & Sciences University, Portland, Oregon
| | - Linda L Hart
- Bon Secours Heart and Vascular Institute, Richmond, Virginia
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Geriatric Research Education and Clinical Center, Veterans Affairs Pittsburgh Healthcare Center, Pittsburgh, Pennsylvania; University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - James N Kirkpatrick
- Cardiovascular Division, Department of Medicine, Department of Bioethics and Humanities, University of Washington Medical Center, Seattle, Washington
| | - Karen P Alexander
- Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
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Xiao R, Miller JA, Zafirau WJ, Gorodeski EZ, Young JB. Impact of Home Health Care on Health Care Resource Utilization Following Hospital Discharge: A Cohort Study. Am J Med 2018; 131:395-407.e35. [PMID: 29180024 DOI: 10.1016/j.amjmed.2017.11.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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: 07/20/2017] [Revised: 11/04/2017] [Accepted: 11/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge. No studies have investigated the utility of home health care within the context of a large and diverse patient population. METHODS A retrospective cohort study was conducted between 1/1/2013 and 6/30/2015 at a single tertiary care institution to assess healthcare utilization after discharge with home health care. Control patients discharged with "self-care" were matched by propensity score to home health care patients. The primary outcome was total healthcare costs in the 365-day post-discharge period. Secondary outcomes included follow-up readmission and death. Multivariable linear and Cox proportional hazards regression were used to adjust for covariates. RESULTS Among 64,541 total patients, 11,266 controls were matched to 6,363 home health care patients across 11 disease-based Institutes. During the 365-day post-discharge period, home health care was associated with a mean unadjusted savings of $15,233 per patient, or $6,433 after adjusting for covariates (p < 0.0001). Home health care independently decreased the hazard of follow-up readmission (HR 0.82, p < 0.0001) and death (HR 0.80, p < 0.0001). Subgroup analyses revealed that home health care most benefited patients discharged from the Digestive Disease (death HR 0.72, p < 0.01), Heart & Vascular (adjusted savings of $11,453, p < 0.0001), Medicine (readmission HR 0.71, p < 0.0001), and Neurological (readmission HR 0.67, p < 0.0001) Institutes. CONCLUSIONS Discharge with home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death. These data inform development of value-based care plans.
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Affiliation(s)
- Roy Xiao
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Ohio
| | - Jacob A Miller
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Ohio
| | | | | | - James B Young
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Ohio.
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Gandesbery B, Joyce E, Dobbie K, Hoeksema L, Perez-Protto SE, Gorodeski EZ. SURGICAL VERSUS MEDICAL TEAM ASSIGNMENT AND SECONDARY PALLIATIVE CARE SERVICES FOR PATIENTS DYING IN A CARDIAC HOSPITAL. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)33175-9] [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: 11/24/2022]
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Tam E, Gandesbery BT, Young L, Borson S, Gorodeski EZ. Graphical Instructions for Administration and Scoring the Mini‐Cog: Results of a Randomized Clinical Trial. J Am Geriatr Soc 2018; 66:987-991. [DOI: 10.1111/jgs.15313] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Edlira Tam
- Department of Internal MedicineMedicine InstituteCleveland Ohio
| | | | - Laura Young
- Department of Internal MedicineMedicine InstituteCleveland Ohio
| | - Soo Borson
- University of WashingtonSeattle Washington
| | - Eiran Z. Gorodeski
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular InstituteCleveland ClinicCleveland Ohio
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Gorodeski EZ, Joyce E, Gandesbery BT, Blackstone EH, Taylor DO, Tang WHW, Starling RC, Hachamovitch R. Discordance between 'actual' and 'scheduled' check-in times at a heart failure clinic. PLoS One 2017; 12:e0187849. [PMID: 29136649 PMCID: PMC5685632 DOI: 10.1371/journal.pone.0187849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 10/29/2017] [Indexed: 11/22/2022] Open
Abstract
Introduction A 2015 Institute Of Medicine statement “Transforming Health Care Scheduling and Access: Getting to Now”, has increased concerns regarding patient wait times. Although waiting times have been widely studied, little attention has been paid to the role of patient arrival times as a component of this phenomenon. To this end, we investigated patterns of patient arrival at scheduled ambulatory heart failure (HF) clinic appointments and studied its predictors. We hypothesized that patients are more likely to arrive later than scheduled, with progressively later arrivals later in the day. Methods and results Using a business intelligence database we identified 6,194 unique patients that visited the Cleveland Clinic Main Campus HF clinic between January, 2015 and January, 2017. This clinic served both as a tertiary referral center and a community HF clinic. Transplant and left ventricular assist device (LVAD) visits were excluded. Punctuality was defined as the difference between ‘actual’ and ‘scheduled’ check-in times, whereby negative values (i.e., early punctuality) were patients who checked-in early. Contrary to our hypothesis, we found that patients checked-in late only a minority of the time (38% of visits). Additionally, examining punctuality by appointment hour slot we found that patients scheduled after 8AM had progressively earlier check-in times as the day progressed (P < .001 for trend). In both a Random Forest-Regression framework and linear regression models the most important risk-adjusted predictors of early punctuality were: later in the day appointment hour slot, patient having previously been to the hospital, age in the early 70s, and white race. Conclusions Patients attending a mixed population ambulatory HF clinic check-in earlier than scheduled times, with progressive discrepant intervals throughout the day. This finding may have significant implications for provider utilization and resource planning in order to maximize clinic efficiency. The impact of elective early arrival on patient’s perceived wait times requires further study.
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Affiliation(s)
- Eiran Z. Gorodeski
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Center for Connected Care, Medical Operations, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
| | - Emer Joyce
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Benjamin T. Gandesbery
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Eugene H. Blackstone
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - David O. Taylor
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - W. H. Wilson Tang
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Randall C. Starling
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Rory Hachamovitch
- Section of Cardiovascular Imaging, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
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Sperry BW, Perez AL, Alvarez PA, Kendall K, Gorodeski EZ, Starling RC. Medicaid Insurance and Psychosocial Status in Patients Evaluated for Heart Transplantation. J Am Coll Cardiol 2017; 70:2727-2728. [DOI: 10.1016/j.jacc.2017.09.1097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
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Gandesbery B, Dobbie K, Gorodeski EZ. Outpatient Palliative Cardiology Service Embedded Within a Heart Failure Clinic: Experiences With an Emerging Model of Care. Am J Hosp Palliat Care 2017; 35:635-639. [DOI: 10.1177/1049909117729478] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | - Krista Dobbie
- Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Eiran Z. Gorodeski
- Tomsich Family Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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Rao VU, Stark K, Lindsey D, Kowgitz M, Donnelly L, Crawford M, Roberts K, Smith R, Gorodeski EZ. Impact of Nurse Scripting on Cognitive Impairment Testing Using the Mini-Cog in Patients Hospitalized for Heart Failure. J Card Fail 2017. [DOI: 10.1016/j.cardfail.2017.07.284] [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: 11/26/2022]
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Hawwa N, Vest AR, Kumar R, Lahoud R, Young JB, Wu Y, Gorodeski EZ, Cho L. Comparison Between the Kansas City Cardiomyopathy Questionnaire and New York Heart Association in Assessing Functional Capacity and Clinical Outcomes. J Card Fail 2017; 23:280-285. [DOI: 10.1016/j.cardfail.2016.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 12/06/2016] [Accepted: 12/07/2016] [Indexed: 11/16/2022]
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Abstract
BACKGROUND About one-fifth of hospitalized Medicare beneficiaries are discharged to skilled nursing facilities (SNFs) for post-acute care. Readmissions are common but interventions to reduce readmissions are scarce. OBJECTIVE To assess the impact of a connected care model on 30-day hospital readmission rates among patients discharged to SNFs. DESIGN Retrospective cohort. SETTING SNFs that receive referrals from an academic medical center in Cleveland, Ohio. PARTICIPANTS All patients admitted to Cleveland Clinic main campus between January 1, 2011 and December 31, 2014 and subsequently discharged to 7 intervention SNFs or 103 control SNFs. INTERVENTIONS Hospital-employed physicians and advanced practice professionals (nurse practitioners and physician assistants) visited SNF patients 4 to 5 times per week. RESULTS During the study period, 13,544 patients were discharged to SNFs within a 25-miles radius of Cleveland Clinic main campus. Of these, 3334 were discharged to 7 intervention SNFs and 10,201 were discharged to 103 usualcare SNFs. During the intervention phase (2013-2014), adjusted 30-day readmission rates declined at the intervention SNFs (28.1% to 21.7%, P < 0.001), while there was a slight increase at control SNFs (27.1 % to 28.5%, P < 0.001). The absolute reductions ranged from 4.6% for patients at low risk for readmission to 9.1% for patients at high risk, and medical patients benefited more than surgical patients. CONCLUSIONS A program of frequent visits by hospital employed physicians and advanced practice professionals at SNFs can reduce 30-day readmission rates. Journal of Hospital Medicine 2017;12:238-244.
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Affiliation(s)
- Luke D Kim
- Center for Geriatric Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lei Kou
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Hu
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eiran Z Gorodeski
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute and Center for Connected Care, Cleveland Clinic, Cleveland, OH, USA
| | - Michael B Rothberg
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
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Howell EH, Senapati A, Hsich E, Gorodeski EZ. Medication self-management skills and cognitive impairment in older adults hospitalized for heart failure: A cross-sectional study. SAGE Open Med 2017; 5:2050312117700301. [PMID: 28540048 PMCID: PMC5433792 DOI: 10.1177/2050312117700301] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 02/15/2017] [Indexed: 01/07/2023] Open
Abstract
Background: Cognitive impairment is highly prevalent among older adults (aged ≥65 years) hospitalized for heart failure and has been associated with poor outcomes. Poor medication self-management skills have been associated with poor outcomes in this population as well. The presence and extent of an association between cognitive impairment and poor medication self-management skills in this population has not been clearly defined. Objective: We assessed the cognition of consecutive older adults hospitalized for heart failure, in relation to their medication self-management skills. Methods: We conducted a cross-sectional study of older adults (aged ≥65 years) who were hospitalized for heart failure and were being discharged home. Prior to discharge, we assessed cognition using the Mini-Cog. We also tested patients’ ability to read a pill bottle label, open a pill bottle safety cap, and allocate mock pills to a pill box. Pill allocation performance was assessed quantitatively (counts of errors of omission and commission) and qualitatively (patterns suggestive of knowledge-based mistakes, rule-based mistakes, or skill-based slips). Results: Of 55 participants, 22% were found to have cognitive impairment. Patients with cognitive impairment tended to be older as compared to those without cognitive impairment (mean age = 81 vs 76 years, p = NS). Patients with cognitive impairment had a higher prevalence of inability to read pill bottle label (prevalence ratio = 5.8, 95% confidence interval = 3.2–10.5, p = 0.001) and inability to open pill bottle safety cap (prevalence ratio = 3.3, 95% confidence interval = 1.3–8.4, p = 0.03). While most patients (65%) had pill-allocation errors regardless of cognition, those patients with cognitive impairment tended to have more errors of omission (mean number of errors = 48 vs 23, p = 0.006), as well as more knowledge-based mistakes (75% vs 40%, p = 0.03). Conclusion: There is an association between cognitive impairment and poor medication self-management skills. Medication taking failures due to poor medication self-management skills may be part of the pathway linking cognitive impairment to poor post-discharge outcomes among patients with heart failure transitioning from hospital to home.
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Affiliation(s)
- Erik H Howell
- Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Alpana Senapati
- Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Eileen Hsich
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Eiran Z Gorodeski
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.,Center for Connected Care, Cleveland Clinic, Cleveland, OH, USA
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Lander BS, Patel K, Blackstone EH, Nordseth T, Starling RC, Gorodeski EZ. Post-acute Care Trajectories in the First Year Following Hospital Discharge After Left Ventricular Assist Device Implantation. J Am Med Dir Assoc 2016; 17:908-12. [PMID: 27381379 DOI: 10.1016/j.jamda.2016.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Patients with advanced heart failure who undergo left ventricular assist device (LVAD) implantation are heavy users of post-acute care services. We sought to better describe the post-acute trajectories and burden of care transitions for this patient population. METHODS AND RESULTS We conducted a retrospective cohort study of 227 patients who were discharged after index hospitalization for LVAD implantation. Of these, 162 (71%) were discharged home, and 65 (29%) were discharged to a facility, including long-term acute care hospitals (n = 50), inpatient rehabilitation facilities (n = 11), and skilled nursing facilities (n = 4). Follow-up extended to 1 year, with censoring at date of heart transplantation, LVAD removal, death, or loss of follow- up. In the first year post-discharge, those patients initially discharged home spent a mean 265 days at home, 0.5 days in a facility, and 13 days in the hospital as result of readmission. Those initially discharged to a facility spent a mean 241 days at home, 37 days in a facility, and 19 days in the hospital as result of readmission. Patients initially discharged home experienced fewer care transitions, 4.2 vs 5.2 transitions per patient, compared with those initially discharged to a facility. CONCLUSIONS In the first year following index hospitalization for LVAD implantation, patients initially discharged to a facility have an increased burden of care transitions, as well as time spent in the hospital and in a facility, compared with patients initially discharged home. Specialized models of care are needed in facilities caring for patients with LVADs.
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Affiliation(s)
- Bradley S Lander
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Krishna Patel
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, OH
| | - Trond Nordseth
- Norwegian University of Science and Technology, Trondheim, Norway
| | - Randall C Starling
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Eiran Z Gorodeski
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH; Center for Connected Care, Cleveland Clinic, Cleveland, OH.
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Gorodeski EZ, Taylor DO, Joyce E, Tang WW, Starling RC, Hachamovitch R. Paradoxical Discordance between “Actual” and “Scheduled” Check-in Times at a Heart Failure Clinic. J Card Fail 2016. [DOI: 10.1016/j.cardfail.2016.06.297] [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: 11/26/2022]
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Bennett MK, Shao M, Gorodeski EZ. Home monitoring of heart failure patients at risk for hospital readmission using a novel under-the-mattress piezoelectric sensor: A preliminary single centre experience. J Telemed Telecare 2016; 23:60-67. [PMID: 26670209 PMCID: PMC5221726 DOI: 10.1177/1357633x15618810] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Introduction A piezoelectric sensor (PS) converts mechanical deformations into electrical signals. We used a contactless under-the-mattress PS to monitor physiological vibrations resulting from breathing, pumping of the heart, and body movements, among individuals at home following hospitalization for heart failure (HF). Our objectives were to assess acceptability of the device in the home, to assess physiological patterns, and to determine if altered patterns correlate with readmission. Methods We conducted a prospective observational study of 30 patients discharged home following HF hospitalization. PS data included a continuous nightly assessment of heart rate, respiration rate, movement rate, rapid and shallow respiration duration, and a behaviour score. We utilized random forest classification to classify average nightly data by readmission status. Results We collected 640 nights of PS data from 29 patients. There were nine readmissions, of which four were for HF. PS monitoring was tolerated by all but one of the participants. We inspected continuous nightly physiological profiles and noted differences between patients who were and were not readmitted. Patients readmitted for HF had higher average heart and respiration rates, and more respiration variability. Average nightly respiratory rate was most predictive of readmission. Discussion We are the first to study nocturnal physiological patterns of HF patients at home using a contactless under-the-mattress monitoring system. We noted patterns that may be unique to patients at risk for readmission due to HF. Respiratory rate was the most important risk-adjusted associate of readmission for HF. Further studies should investigate the efficacy of home PS monitoring in HF populations.
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Affiliation(s)
- Mosi K Bennett
- 1 Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mingyuan Shao
- 2 Department of Quantitative Methods, Cleveland Clinic, Cleveland, Ohio
| | - Eiran Z Gorodeski
- 3 Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.,4 Center for Connected Care, Cleveland Clinic, Cleveland, Ohio
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Abstract
OPINION STATEMENT Cognitive impairment (CI) is an inclusive term to describe trouble with memory, learning, concentration, or decision-making. CI is highly prevalent in patients with heart failure (HF) and is known to be associated with a variety of poor outcomes. While published HF guidelines recommend screening for CI, they do not indicate how, due to a lack of consensus in the literature about which instrument to use. Our recommendation is to use the Mini-Cog for this purpose because of its brevity and utility in identifying patients with HF at high risk for hospitalization or mortality. At this time, there is minimal published clinical trial evidence about how to manage CI in patients with HF. Reasonable approaches to management may include following guideline-directed medical therapy for HF, treatment of hypertension and atrial fibrillation, management of depression, proactive diagnosis and treatment of sleep apnea, and encouragement of aerobic exercise and weight loss. Left ventricular assist device (LVAD) therapy in patients with Stage D HF may improve CI in the short term after implantation, though there is a risk of worsening CI in the intermediate and long term. Clinicians who care for patients with HF should routinely screen for CI and when identified should encourage interventions to support self-care, increase family involvement, and arrange for more frequent follow-up.
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Affiliation(s)
- Edlira Yzeiraj
- Department of Internal Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Danny M Tam
- NYU Comprehensive Epilepsy Center, New York, NY, USA
| | - Eiran Z Gorodeski
- Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
- Center for Connected Care, Cleveland Clinic, Desk J3-4, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
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Lander BS, Patel K, Blackstone EH, Nordseth T, Starling RC, Gorodeski EZ. Abstract 287: Trajectories of Post-acute Care in the Initial 365 Days Following Hospital Discharge After Left Ventricular Assist Device Implantation. Circ Cardiovasc Qual Outcomes 2015. [DOI: 10.1161/circoutcomes.8.suppl_2.287] [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:
Frequency and types of care transitions (CTs) experienced by patients within 365-days following discharge from index hospitalization for LVAD implantation are unknown.
Methods:
We conducted a retrospective study of consecutive adults who were discharged after LVAD implantation at our institution. We recorded numbers and types of CTs following discharge.
Results:
Between 1/2008 and 12/2012, 227 patients were discharged. Of these, 162 (71%) were discharged home, and 65 (29%) were discharged to facility. These included long term acute care hospitals (n=50), inpatient rehabilitation (n=11), and skilled nursing facilities (n=4). In the first 365-days post-discharge, those patients initially discharged home spent a mean 265 days at home, 0.5 days in facility, and 13 days in hospital as result of readmission. Those initially discharged to facility spent mean 37 days in facility, 241 days at home, and 19 days in hospital as result of readmission. Clinical state prevalence stratified by initial discharge destination is shown in the figure. In the first 90 days, patients discharged to facility had an increased burden of hospital days as compared to those discharged home (9.1 days versus 4 days).
Conclusion:
Patients discharged to facility following index hospitalization for LVAD implantation have an increased burden of CTs, especially within the initial 90 days, as compared to those initially discharged home. Specialized models of care are needed in facilities caring for patients with LVADs.
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Affiliation(s)
| | | | | | - Trond Nordseth
- Norwegian Univ of Science and Technology, Trondheim, Norway
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Abstract
BACKGROUND Heart failure (HF) guidelines recommend screening for cognitive impairment (CI) but do not identify how. The Mini-Cog is an ultrashort cognitive "vital signs" measure that has not been studied in patients hospitalized for HF. The purpose of this study was to evaluate whether CI as assessed by the Mini-Cog is associated with increased readmission or mortality risk after hospitalization for HF. METHODS AND RESULTS We analyzed 720 consecutive patients who completed the Mini-Cog as a part of routine clinical care during hospitalization for HF. Our primary outcome was time between hospital discharge and first occurrence of readmission or mortality. There was a high prevalence of CI as quantified by Mini-Cog performance (23% of cohort). During a mean follow-up time of 6 months, 342 (48%) patients were readmitted, and 24 (3%) died. Poor Mini-Cog performance was an independent predictor of composite outcome (adjusted hazard ratio, 1.90; 95% confidence interval, 1.47-2.44; P<0.0001) and was identified as the most important predictor among 55 variables by random survival forest analysis. Inclusion of Mini-Cog performance in risk models improved accuracy (bootstrapped c-index, 0.602 versus 0.624) and risk reclassification (category-free net reclassification improvement, 27%; 95% confidence interval, 14%-40%; P<0.001). Secondary analysis of initial 30 days post discharge showed effect modification by venue of discharge, whereby patients with CI discharged to a facility had longer time to outcome as compared with those discharged home. CONCLUSIONS Mini-Cog performance is a novel marker of posthospitalization risk. Discharge to facility rather than home may be protective for those patients with HF and CI. It is unknown whether structured in-home support would yield similar outcomes.
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Affiliation(s)
- Apurva Patel
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.)
| | - Roosha Parikh
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.)
| | - Erik H Howell
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.)
| | - Eileen Hsich
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.)
| | - Steven H Landers
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.)
| | - Eiran Z Gorodeski
- From the Department of Internal Medicine, Medicine Institute (A.P., R.P., E.H.H.), Section of Heart Failure and Cardiac Transplantation, Tomsich Family Department of Cardiovascular Medicine, Heart and Vascular Institute (E.H., E.Z.G.), and Center for Connected Care (E.Z.G.), Cleveland Clinic, Cleveland, OH; Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (S.H.L.); and Visiting Nurse Association Health Group, Red Bank, NJ (S.H.L.).
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Donneyong MM, Hornung CA, Taylor KC, Baumgartner RN, Myers JA, Eaton CB, Gorodeski EZ, Klein L, Martin LW, Shikany JM, Song Y, Li W, Manson JE. Risk of heart failure among postmenopausal women: a secondary analysis of the randomized trial of vitamin D plus calcium of the women's health initiative. Circ Heart Fail 2014; 8:49-56. [PMID: 25398967 DOI: 10.1161/circheartfailure.114.001738] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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] [Indexed: 12/18/2022]
Abstract
BACKGROUND Vitamin D supplementation may be an inexpensive intervention to reduce heart failure (HF) incidence. However, there are insufficient data to support this hypothesis. This study evaluates whether vitamin D plus calcium (CaD) supplementation is associated with lower rates of HF in postmenopausal women and whether the effects differ between those at high versus low risk for HF. METHODS AND RESULTS Analyses were restricted to 35 983 (of original 36 282) women aged 50 to 79 years old in the Women's Health Initiative randomized trial of CaD supplementation who were randomized 1:1 in a double-blinded fashion to receive 1000 mg/d of calcium plus 400 IU/d of vitamin D3 or placebo. Overall, 744 adjudicated incident HF cases (intervention, 363; control, 381) occurred during a median follow-up of 7.1 (interquartile range, 1.6) years. CaD supplementation, compared with placebo, was not associated with reduced HF risk in the overall population, hazard ratio, 0.95; P=0.46. However, CaD supplementation had differential effects (P interaction=0.005) in subgroups stratified by baseline risk status of HF defined by the presence (high risk=17 449) or absence (low risk=18 534) of pre-existing HF precursors including coronary heart diseases, diabetes mellitus, or hypertension: 37% (hazard ratio, 0.63 [95% confidence interval, 0.46-0.87]) lower risk of HF in the low-risk versus hazard ratio, 1.06; P=0.51, in the high-risk subgroups. CONCLUSIONS CaD supplementation did not significantly reduce HF incidence in the overall cohort, however, it was beneficial among postmenopausal women without major HF precursors while of little value in high-risk subgroups. Additional studies are warranted to confirm these findings and investigate the underlying mechanism. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00000611.
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Affiliation(s)
- Macarius M Donneyong
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.).
| | - Carlton A Hornung
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
| | - Kira C Taylor
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
| | - Richard N Baumgartner
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
| | - John A Myers
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
| | - Charles B Eaton
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
| | - Eiran Z Gorodeski
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
| | - Liviu Klein
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
| | - Lisa W Martin
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
| | - James M Shikany
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
| | - Yiqing Song
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
| | - Wenjun Li
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
| | - JoAnn E Manson
- From the Division of Pharmacoepidemiology and Pharmacoeconomics (M.M.D.) and Department of Medicine (J.E.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, School of Public Health and Information Sciences, University of Louisville, KY (M.M.D., C.A.H., K.C.T., R.N.B.); Department of Family Medicine, Brown University School of Medicine, Providence, RI (C.B.E.); Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, OH (E.Z.G.); Division of Cardiology, University of California, San Francisco (L.K.); Heart and Vascular Institute, George Washington University, Washington DC (L.W.M.); Division of Preventive Medicine, University of Alabama, Birmingham (J.M.S.); Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis (Y.S.); and Department of Medicine, University of Massachusetts Medical School, Worcester (W.L.)
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Reynard AK, Butler RS, McKee MG, Starling RC, Gorodeski EZ. Frequency of depression and anxiety before and after insertion of a continuous flow left ventricular assist device. Am J Cardiol 2014; 114:433-40. [PMID: 24931289 DOI: 10.1016/j.amjcard.2014.05.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/01/2014] [Accepted: 05/01/2014] [Indexed: 12/20/2022]
Abstract
Our objective was to investigate the course of depression and anxiety symptoms in patients treated with continuous flow (CF) left ventricular assist devices (LVADs). Depression and anxiety are associated with poor outcomes in patients with heart failure, yet few studies have examined such symptoms in patients with CF-LVADs. Depression and anxiety were measured as part of routine clinical care in patients who received a CF-LVAD at our institution from October 2009 to April 2012. Sixty-six patients completed the Patient Health Questionnaire-9, and 48 of 66 patients also completed the Generalized Anxiety Disorder Questionnaire-7. Nineteen of 66 patients completed measures before implantation. Patients who completed measures before and after implantation demonstrated significant improvements in depression and anxiety scores. All patients showed significant improvements in depression and anxiety scores from implantation to the first time point after implantation. Pairwise mean comparisons between time intervals after implantation were not significant. In conclusion, depression and anxiety scores improve after CF-LVAD implantation and remain stable up to 1 year. The improvement does not depend on baseline psychotropic medication use and may be related to improved physical health.
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