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Zhang RS, Alviar CL, Yuriditsky E, Alam U, Zhang PS, Elbaum L, Grossman K, Singh A, Maqsood MH, Greco AA, Postelnicu R, Mukherjee V, Horowitz J, Keller N, Bangalore S. Percutaneous mechanical thrombectomy in acute pulmonary embolism: Outcomes from a safety-net hospital. Catheter Cardiovasc Interv 2024. [PMID: 38577945 DOI: 10.1002/ccd.31024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/23/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Our study aims to present clinical outcomes of mechanical thrombectomy (MT) in a safety-net hospital. METHODS This is a retrospective study of intermediate or high-risk pulmonary embolism (PE) patients who underwent MT between October 2020 and May 2023. The primary outcome was 30-day mortality. RESULTS Among 61 patients (mean age 57.6 years, 47% women, 57% Black) analyzed, 12 (19.7%) were classified as high-risk PE, and 49 (80.3%) were intermediate-risk PE. Of these patients, 62.3% had Medicaid or were uninsured, 50.8% lived in a high poverty zip code. The prevalence of normotensive shock in intermediate-risk PE patients was 62%. Immediate hemodynamic improvements included 7.4 mmHg mean drop in mean pulmonary artery pressure (-21.7%, p < 0.001) and 93% had normalization of their cardiac index postprocedure. Thirty-day mortality for the entire cohort was 5% (3 patients) and 0% when restricted to the intermediate-risk group. All 3 patients who died at 30 days presented with cardiac arrest. There were no differences in short-term mortality based on race, insurance type, citizenship status, or socioeconomic status. All-cause mortality at most recent follow up was 13.1% (mean follow up time of 13.4 ± 8.5 months). CONCLUSION We extend the findings from prior studies that MT demonstrates a favorable safety profile with immediate improvement in hemodynamics and a low 30-day mortality in patients with acute PE, holding true even with relatively higher risk and more vulnerable population within a safety-net hospital.
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Affiliation(s)
- Robert S Zhang
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Carlos L Alviar
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Eugene Yuriditsky
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Usman Alam
- Department of Medicine, New York University, New York City, New York, USA
| | - Peter S Zhang
- Department of Medicine, New York University, New York City, New York, USA
| | - Lindsay Elbaum
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Kelsey Grossman
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Arushi Singh
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Muhammad H Maqsood
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Allison A Greco
- Division of Pulmonary Critical Care, and Sleep Medicine, New York University, New York City, New York, USA
| | - Radu Postelnicu
- Division of Pulmonary Critical Care, and Sleep Medicine, New York University, New York City, New York, USA
| | - Vikramjit Mukherjee
- Division of Pulmonary Critical Care, and Sleep Medicine, New York University, New York City, New York, USA
| | - James Horowitz
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Norma Keller
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
| | - Sripal Bangalore
- Division of Cardiovascular Medicine, New York University, New York City, New York, USA
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Leiva O, Alviar C, Khandhar S, Parikh SA, Toma C, Postelnicu R, Horowitz J, Mukherjee V, Greco A, Bangalore S. Catheter-based therapy for high-risk or intermediate-risk pulmonary embolism: death and re-hospitalization. Eur Heart J 2024:ehae184. [PMID: 38573048 DOI: 10.1093/eurheartj/ehae184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/18/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND AND AIMS Catheter-based therapies (CBTs) have been developed as a treatment option in patients with pulmonary embolism (PE). There remains a paucity of data to inform decision-making in patients with intermediate-risk or high-risk PE. The aim of this study was to characterize in-hospital and readmission outcomes in patients with intermediate-risk or high-risk PE treated with vs. without CBT in a large retrospective registry. METHODS Patients hospitalized with intermediate-risk or high-risk PE were identified using the 2017-20 National Readmission Database. In-hospital outcomes included death and bleeding and 30- and 90-day readmission outcomes including all-cause, venous thromboembolism (VTE)-related and bleeding-related readmissions. Inverse probability of treatment weighting (IPTW) was utilized to compare outcomes between CBT and no CBT. RESULTS A total of 14 903 [2076 (13.9%) with CBT] and 42 829 [8824 (20.6%) with CBT] patients with high-risk and intermediate-risk PE were included, respectively. Prior to IPTW, patients with CBT were younger and less likely to have cancer and cardiac arrest, receive systemic thrombolysis, or be on mechanical ventilation. In the IPTW logistic regression model, CBT was associated with lower odds of in-hospital death in high-risk [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.80-0.87] and intermediate-risk PE (OR 0.76, 95% CI 0.70-0.83). Patients with high-risk PE treated with CBT were associated with lower risk of 90-day all-cause [hazard ratio (HR) 0.77, 95% CI 0.71-0.83] and VTE (HR 0.46, 95% CI 0.34-0.63) readmission. Patients with intermediate-risk PE treated with CBT were associated with lower risk of 90-day all-cause (HR 0.75, 95% CI 0.72-0.79) and VTE (HR 0.66, 95% CI 0.57-0.76) readmission. CONCLUSIONS Among patients with high-risk or intermediate-risk PE, CBT was associated with lower in-hospital death and 90-day readmission. Prospective, randomized trials are needed to confirm these findings.
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Affiliation(s)
- Orly Leiva
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY 10016, USA
| | - Carlos Alviar
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY 10016, USA
| | - Sameer Khandhar
- Division of Cardiology, Penn Presbyterian Medical Center, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sahil A Parikh
- Division of Cardiology, Columbia University Irving Medical School, New York-Presbyterian Hospital, New York, NY, USA
| | - Catalin Toma
- Department of Medicine, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Radu Postelnicu
- Department of Medicine, Division of Pulmonology and Critical Care, New York University Grossman School of Medicine, New York, NY, USA
| | - James Horowitz
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY 10016, USA
| | - Vikramjit Mukherjee
- Department of Medicine, Division of Pulmonology and Critical Care, New York University Grossman School of Medicine, New York, NY, USA
| | - Allison Greco
- Department of Medicine, Division of Pulmonology and Critical Care, New York University Grossman School of Medicine, New York, NY, USA
| | - Sripal Bangalore
- Division of Cardiology, Department of Medicine, New York University Grossman School of Medicine, 550 First Ave, New York, NY 10016, USA
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3
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Nuti O, Merchan C, Papadopoulos J, Horowitz J, Rao SV, Ahuja T. Evaluating the Use of Unfractionated Heparin with Intra-Aortic Balloon Counterpulsation. Heart Lung Circ 2024:S1443-9506(24)00067-2. [PMID: 38575436 DOI: 10.1016/j.hlc.2024.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/07/2023] [Accepted: 01/28/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Evidence supporting anticoagulation with unfractionated heparin (UFH) in patients with an intra-aortic balloon pump (IABP) to prevent limb ischaemia remains limited, while bleeding risks remain high. Monitoring heparin in this setting with anti-factor Xa (anti-Xa) is not previously described. OBJECTIVES The study objective is to describe the incidence of thromboembolic and bleeding events with the use of UFH in patients with an IABP utilising monitoring with both anti-Xa and activated partial thromboplastin time (aPTT). METHODS This is a retrospective study of adults who received an IABP and UFH for ≥24 hours. Electronic medical records were reviewed for pertinent data. The primary outcome was the incidence of limb ischaemia during IABP. Secondary outcomes included myocardial infarction, thrombus on IABP, or stroke. Exploratory outcomes included any venous thromboembolism and bleeding events. RESULTS Of 159 patients, 88% received an IABP for cardiogenic shock and median duration of IABP support was 118 hours (interquartile range, 67-196). Limb ischaemia occurred in four of 159 patients (2.5%). Strokes occurred in 3.8% of the cohort, and bleeding events occurred in 33%. Despite anticoagulation use in all patients, 11% experienced a venous thromboembolism, with most identified upon asymptomatic screening with concern for heparin-induced thrombocytopenia. We found no differences in outcomes that occurred with a hybrid anti-Xa and aPTT versus aPTT monitoring alone. CONCLUSIONS We observed a high rate of thrombotic and bleeding complications with the use of UFH in patients with an IABP. Use of anti-Xa versus aPTT for monitoring was not associated with complications. These data suggest safer anticoagulation strategies are needed in this setting.
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Affiliation(s)
- Olivia Nuti
- Department of Pharmacy, NYU Langone Hospital, Brooklyn, NY, USA. https://www.twitter.com/olivia_nuti
| | - Cristian Merchan
- Department of Pharmacy, NYU Langone Health, New York, NY, USA. https://www.twitter.com/ColombianpharmD
| | - John Papadopoulos
- Department of Pharmacy, NYU Langone Health, New York, NY, USA. https://www.twitter.com/JPCritCarePharm
| | - James Horowitz
- Department of Medicine - Cardiology at NYU Grossman School of Medicine, New York, NY, USA. https://www.twitter.com/jameshorowitmd
| | - Sunil V Rao
- Department of Medicine - Interventional Cardiology, NYU Grossman School of Medicine, New York, NY, USA. https://www.twitter.com/SVRaoMD
| | - Tania Ahuja
- Department of Pharmacy, NYU Langone Health, New York, NY, USA; Department of Medicine - Cardiology at NYU Grossman School of Medicine, New York, NY, USA.
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4
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Zhu E, Yuriditsky E, Raco V, Katz A, Papadopoulos J, Horowitz J, Maldonado T, Ahuja T. Anti-factor Xa as the preferred assay to monitor heparin for the treatment of pulmonary embolism. Int J Lab Hematol 2024; 46:354-361. [PMID: 37989523 DOI: 10.1111/ijlh.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION The mainstay of acute pulmonary embolism (PE) treatment is anticoagulation. Timely anticoagulation correlates with decreased PE-associated mortality, but the ability to achieve a therapeutic activated partial thromboplastin time (aPTT) with unfractionated heparin (UFH) remains limited. Although some institutions have switched to a more accurate and reproducible test to assess for heparin's effectiveness, the anti-factor Xa (antiXa) assay, data correlating a timely therapeutic antiXa to PE-associated clinical outcomes remains scarce. We evaluated time to a therapeutic antiXa using intravenous heparin after PE response team (PERT) activation and assessed clinical outcomes including bleeding and recurrent thromboembolic events. METHODS This was a retrospective cohort study at NYU Langone Health. All adult patients ≥18 years with a confirmed PE started on IV UFH with >2 antiXa levels were included. Patients were excluded if they received thrombolysis or alternative anticoagulation. The primary endpoint was the time to a therapeutic antiXa level of 0.3-0.7 units/mL. Secondary outcomes included recurrent thromboembolism, bleeding and PE-associated mortality within 3 months. RESULTS A total of 330 patients with a PERT consult were identified with 192 patients included. The majority of PEs were classified as sub massive (64.6%) with 87% of patients receiving a bolus of 80 units/kg of UFH prior to starting an infusion at 18 units/kg/hour. The median time to the first therapeutic antiXa was 9.13 hours with 93% of the cohort sustaining therapeutic anticoagulation at 48 hours. Recurrent thromboembolism, bleeding and mortality occurred in 1%, 5% and 6.2%, respectively. Upon univariate analysis, a first antiXa <0.3 units/ml was associated with an increased risk of mortality [27.78% (5/18) vs 8.05% (14/174), p = 0.021]. CONCLUSION We observed a low incidence of recurrent thromboembolism or PE-associated mortality utilizing an antiXa titrated UFH protocol. The use of an antiXa based heparin assay to guide heparin dosing and monitoring allows for timely and sustained therapeutic anticoagulation for treatment of PE.
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Affiliation(s)
- Eric Zhu
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Eugene Yuriditsky
- Department of Medicine, Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Veronica Raco
- Department of Pharmacy, NYU Langone Brooklyn, Brooklyn, New York, USA
| | - Alyson Katz
- Department of Pharmacy, NYU Langone Health, New York, New York, USA
| | | | - James Horowitz
- Department of Medicine, Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Thomas Maldonado
- Department of Surgery, Vascular, NYU Grossman School of Medicine, New York, New York, USA
| | - Tania Ahuja
- Department of Medicine, Division of Cardiology, NYU Grossman School of Medicine, New York, New York, USA
- Department of Pharmacy, NYU Langone Health, New York, New York, USA
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5
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Alviar CL, Li BK, Keller NM, Bohula-May E, Barnett C, Berg DD, Burke JA, Chaudhry SP, Daniels LB, DeFilippis AP, Gerber D, Horowitz J, Jentzer JC, Katrapati P, Keeley E, Lawler PR, Park JG, Sinha SS, Snell J, Solomon MA, Teuteberg J, Katz JN, van Diepen S, Morrow DA. Prognostic performance of the IABP-SHOCK II Risk Score among cardiogenic shock subtypes in the critical care cardiology trials network registry. Am Heart J 2024; 270:1-12. [PMID: 38190931 PMCID: PMC11032171 DOI: 10.1016/j.ahj.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Risk stratification has potential to guide triage and decision-making in cardiogenic shock (CS). We assessed the prognostic performance of the IABP-SHOCK II score, derived in Europe for acute myocardial infarct-related CS (AMI-CS), in a contemporary North American cohort, including different CS phenotypes. METHODS The critical care cardiology trials network (CCCTN) coordinated by the TIMI study group is a multicenter network of cardiac intensive care units (CICU). Participating centers annually contribute ≥2 months of consecutive medical CICU admissions. The IABP-SHOCK II risk score includes age > 73 years, prior stroke, admission glucose > 191 mg/dl, creatinine > 1.5 mg/dl, lactate > 5 mmol/l, and post-PCI TIMI flow grade < 3. We assessed the risk score across various CS etiologies. RESULTS Of 17,852 medical CICU admissions 5,340 patients across 35 sites were admitted with CS. In patients with AMI-CS (n = 912), the IABP-SHOCK II score predicted a >3-fold gradient in in-hospital mortality (low risk = 26.5%, intermediate risk = 52.2%, high risk = 77.5%, P < .0001; c-statistic = 0.67; Hosmer-Lemeshow P = .79). The score showed a similar gradient of in-hospital mortality in patients with non-AMI-related CS (n = 2,517, P < .0001) and mixed shock (n = 923, P < .001), as well as in left ventricular (<0.0001), right ventricular (P = .0163) or biventricular (<0.0001) CS. The correlation between the IABP-SHOCK II score and SOFA was moderate (r2 = 0.17) and the IABP-SHOCK II score revealed a significant risk gradient within each SCAI stage. CONCLUSIONS In an unselected international multicenter registry of patients admitted with CS, the IABP- SHOCK II score only moderately predicted in-hospital mortality in a broad population of CS regardless of etiology or irrespective of right, left, or bi-ventricular involvement.
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Affiliation(s)
- Carlos L Alviar
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY;.
| | - Boyangzi K Li
- Division of Cardiology, University of Miami, Miami, FL
| | - Norma M Keller
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | - Erin Bohula-May
- Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Boston, MA
| | - Christopher Barnett
- Division of Cardiology, University of California San Francisco, San Francisco, CA
| | - David D Berg
- Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Boston, MA
| | - James A Burke
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | | | - Lori B Daniels
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA
| | | | - Daniel Gerber
- Division of Cardiology, Stanford University, Stanford, CA
| | - James Horowitz
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | - Jacob C Jentzer
- Division of Cardiovascular Medicine, Mayo Clinic, Minnesota, CA
| | | | - Ellen Keeley
- Division of Cardiology, University of Florida, Gainesville, FL
| | - Patrick R Lawler
- McGill University Health Centre, Montreal, Quebec, Canada;; Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada
| | - Jeong-Gun Park
- Levine Cardiac Intensive Care Unit, Brigham and Women's Hospital, Boston, MA
| | - Shashank S Sinha
- Inova Fairfax Medical Campus, Inova Heart and Vascular Institute, Falls Church, VA
| | - Jeffrey Snell
- Division of Cardiology, Rush University, Chicago, IL
| | - Michael A Solomon
- Critical Care Medicine Department, National Institutes of Health Clinical Center and Cardiovascular Branch, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, MD
| | | | - Jason N Katz
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, NY
| | - Sean van Diepen
- Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - David A Morrow
- Levine Cardiac Intensive Care Unit, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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6
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Hu Y, Lui A, Goldstein M, Sudarshan M, Tinsay A, Tsui C, Maidman SD, Medamana J, Jethani N, Puli A, Nguy V, Aphinyanaphongs Y, Kiefer N, Smilowitz NR, Horowitz J, Ahuja T, Fishman GI, Hochman J, Katz S, Bernard S, Ranganath R. Development and external validation of a dynamic risk score for early prediction of cardiogenic shock in cardiac intensive care units using machine learning. Eur Heart J Acute Cardiovasc Care 2024:zuae037. [PMID: 38518758 DOI: 10.1093/ehjacc/zuae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Myocardial infarction and heart failure are major cardiovascular diseases that affect millions of people in the US with the morbidity and mortality being highest among patients who develop cardiogenic shock. Early recognition of cardiogenic shock allows prompt implementation of treatment measures. Our objective is to develop a new dynamic risk score, called CShock, to improve early detection of cardiogenic shock in cardiac intensive care unit (ICU). METHODS We developed and externally validated a deep learning-based risk stratification tool, called CShock, for patients admitted into the cardiac ICU with acute decompensated heart failure and/or myocardial infarction to predict onset of cardiogenic shock. We prepared a cardiac ICU dataset using MIMIC-III database by annotating with physician adjudicated outcomes. This dataset that consisted of 1500 patients with 204 having cardiogenic/mixed shock was then used to train CShock. The features used to train the model for CShock included patient demographics, cardiac ICU admission diagnoses, routinely measured laboratory values and vital signs, and relevant features manually extracted from echocardiogram and left heart catheterization reports. We externally validated the risk model on the New York University (NYU) Langone Health cardiac ICU database that was also annotated with physician adjudicated outcomes. The external validation cohort consisted of 131 patients with 25 patients experiencing cardiogenic/mixed shock. RESULTS CShock achieved an area under the receiver operator characteristic curve (AUROC) of 0.821 (95% CI 0.792-0.850). CShock was externally validated in the more contemporary NYU cohort and achieved an AUROC of 0.800 (95% CI 0.717-0.884), demonstrating its generalizability in other cardiac ICUs. Having an elevated heart rate is most predictive of cardiogenic shock development based on Shapley values. The other top ten predictors are having an admission diagnosis of myocardial infarction with ST-segment elevation, having an admission diagnosis of acute decompensated heart failure, Braden Scale, Glasgow Coma Scale, Blood urea nitrogen, Systolic blood pressure, Serum chloride, Serum sodium, and Arterial blood pH. CONCLUSIONS The novel CShock score has the potential to provide automated detection and early warning for cardiogenic shock and improve the outcomes for the millions of patients who suffer from myocardial infarction and heart failure.
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Affiliation(s)
- Yuxuan Hu
- Leon. H. Charney Division of Cardiology, NYU Langone Health
| | | | | | | | | | - Cindy Tsui
- Department of Medicine, NYU Langone Health
| | | | | | - Neil Jethani
- NYU Grossman School of Medicine
- Courant Institute of Mathematics, New York University
| | - Aahlad Puli
- Courant Institute of Mathematics, New York University
| | - Vuthy Nguy
- Department of Population Health, NYU Langone Health
| | | | | | | | - James Horowitz
- Leon. H. Charney Division of Cardiology, NYU Langone Health
| | | | | | - Judith Hochman
- Leon. H. Charney Division of Cardiology, NYU Langone Health
| | - Stuart Katz
- Leon. H. Charney Division of Cardiology, NYU Langone Health
| | - Samuel Bernard
- Leon. H. Charney Division of Cardiology, NYU Langone Health
| | - Rajesh Ranganath
- Courant Institute of Mathematics, New York University
- Department of Population Health, NYU Langone Health
- Center for Data Science, New York University
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7
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Leiva O, Yuriditsky E, Postelnicu R, Yang EH, Mukherjee V, Greco A, Horowitz J, Alviar C, Bangalore S. Catheter-based therapy for intermediate or high-risk pulmonary embolism is associated with lower in-hospital mortality in patients with cancer: Insights from the National Inpatient Sample. Catheter Cardiovasc Interv 2024; 103:348-358. [PMID: 37997287 DOI: 10.1002/ccd.30917] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/17/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Pulmonary embolism (PE) is a common complication among patients with cancer and is a significant contributor to morbidity and mortality. Catheter-based therapies (CBT), including catheter-directed thrombolysis (CDT) and mechanical thrombectomy, have been developed and are used in patients with intermediate or high-risk PE. However, there is a paucity of data on outcomes in patients with cancer as most clinical studies exclude this group of patients. AIMS To characterize outcomes of patients with cancer admitted with intermediate or high-risk PE treated with CBT compared with no CBT. METHODS Patients with an admission diagnosis of intermediate or high-risk PE and a history of cancer from October 2015 to December 2018 were identified using the National Inpatient Sample. Outcomes of interest were in-hospital death or cardiac arrest (CA) and major bleeding. Inverse probability treatment weighting (IPTW) was utilized to compare outcomes between patients treated with and without CBT. Variables that remained unbalanced after IPTW were adjusted using multivariable logistic regression. RESULTS A total of 2084 unweighted admissions (10,420 weighted) for intermediate or high-risk PE and cancer were included, of which 136 (6.5%) were treated with CBT. After IPTW, CBT was associated with lower death or CA (aOR 0.54, 95% CI 0.46-0.64) but higher major bleeding (aOR 1.41, 95% CI 1.21-1.65). After stratifying by PE risk type, patients treated with CBT had lower risk of death or CA in both intermediate (aOR 0.52, 95% CI 0.36-0.75) and high-risk PE (aOR 0.48, 95% CI 0.33-0.53). However, patients with CBT were associated with increased risk of major bleeding in intermediate-risk PE (aOR 2.12, 95% CI 1.67-2.69) but not in those with high-risk PE (aOR 0.84, 95% CI 0.66-1.07). CONCLUSIONS Among patients with cancer hospitalized with intermediate or high-risk PE, treatment with CBT was associated with lower risk of in-hospital death or CA but higher risk of bleeding. Prospective studies and inclusion of patients with cancer in randomized trials are warranted to confirm our findings.
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Affiliation(s)
- Orly Leiva
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Eugene Yuriditsky
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Radu Postelnicu
- Department of Medicine, Division of Pulmonology and Critical Care, New York University Grossman School of Medicine, New York, New York, USA
| | - Eric H Yang
- Department of Medicine, Division of Cardiology, UCLA Cardio-Oncology Program, University of California Los Angeles, Los Angeles, California, USA
| | - Vikramjit Mukherjee
- Department of Medicine, Division of Pulmonology and Critical Care, New York University Grossman School of Medicine, New York, New York, USA
| | - Allison Greco
- Department of Medicine, Division of Pulmonology and Critical Care, New York University Grossman School of Medicine, New York, New York, USA
| | - James Horowitz
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Carlos Alviar
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
| | - Sripal Bangalore
- Department of Medicine, Division of Cardiology, New York University Grossman School of Medicine, New York, New York, USA
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8
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Raza HA, Horowitz J, Yuriditsky E. Indigo ® Aspiration System for thrombectomy in pulmonary embolism. Future Cardiol 2023; 19:469-475. [PMID: 37746827 DOI: 10.2217/fca-2022-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Anticoagulation is mainstay therapy for patients with acute pulmonary embolism while systemic thrombolysis is reserved for those with hemodynamic instability. Over the last decade, percutaneous interventional options have entered the landscape aimed to achieve rapid pharmacomechanical pulmonary artery recanalization. The Penumbra Indigo® Aspiration System (Penumbra Inc., CA, USA) is a US FDA-approved large-bore aspiration thrombectomy device for the treatment of pulmonary embolism. Recent data has demonstrated improved radiographic end points with low rates of major adverse events in cases of intermediate-risk pulmonary embolism. In this review article, we outline device technology, applications, evidence and future directions.
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Affiliation(s)
- Hassan A Raza
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, NYU Langone Health, Mineola, NY 11501, USA
| | - James Horowitz
- Department of Medicine, Division of Cardiology, NYU Langone Health, NY 10016, USA
| | - Eugene Yuriditsky
- Department of Medicine, Division of Cardiology, NYU Langone Health, NY 10016, USA
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Horowitz J. Outcomes of Percutaneous Mechanical Embolectomy for High-Risk Pulmonary Embolism: Insights from the Full US Cohort of the FLASH Registry. J Vasc Surg Venous Lymphat Disord 2023. [DOI: 10.1016/j.jvsv.2022.12.021] [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: 02/25/2023]
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10
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Mukhopadhyay A, Talmor N, Xia Y, Berger JS, Iturrate E, Adhikari S, Pulgarin C, Quinones-Camacho A, Yuriditsky E, Horowitz J, Jung AS, Massera D, Keller NM, Fishman GI, Horwitz L, Troxel AB, Hochman JS, Reynolds HR. Sex differences in the prognostic value of troponin and D-dimer in COVID-19 illness. Heart Lung 2023; 58:1-5. [PMID: 36334466 PMCID: PMC9597518 DOI: 10.1016/j.hrtlng.2022.10.012] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Male sex, elevated troponin levels, and elevated D-dimer levels are associated with more complicated COVID-19 illness and greater mortality; however, while there are known sex differences in the prognostic value of troponin and D-dimer in other disease states, it is unknown whether they exist in the setting of COVID-19. OBJECTIVE We assessed whether sex modified the relationship between troponin, D-dimer, and severe COVID-19 illness (defined as mechanical ventilation, ICU admission or transfer, discharge to hospice, or death). METHODS We conducted a retrospective cohort study of patients hospitalized with COVID-19 at a large, academic health system. We used multivariable regression to assess associations between sex, troponin, D-dimer, and severe COVID-19 illness, adjusting for demographic, clinical, and laboratory covariates. To test whether sex modified the relationship between severe COVID-19 illness and troponin or D-dimer, models with interaction terms were utilized. RESULTS Among 4,574 patients hospitalized with COVID-19, male sex was associated with higher levels of troponin and greater odds of severe COVID-19 illness, but lower levels of initial D-dimer when compared with female sex. While sex did not modify the relationship between troponin level and severe COVID-19 illness, peak D-dimer level was more strongly associated with severe COVID-19 illness in male patients compared to female patients (males: OR=2.91, 95%CI=2.63-2.34, p<0.001; females: OR=2.31, 95%CI=2.04-2.63, p<0.001; p-interaction=0.005). CONCLUSION Sex did not modify the association between troponin level and severe COVID-19 illness, but did modify the association between peak D-dimer and severe COVID-19 illness, suggesting greater prognostic value for D-dimer in males with COVID-19.
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Affiliation(s)
- Amrita Mukhopadhyay
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Nina Talmor
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Yuhe Xia
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Eduardo Iturrate
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Samrachana Adhikari
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Claudia Pulgarin
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Adriana Quinones-Camacho
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Eugene Yuriditsky
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - James Horowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Albert S Jung
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Daniele Massera
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Norma M Keller
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Glenn I Fishman
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Leora Horwitz
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Andrea B Troxel
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Judith S Hochman
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
| | - Harmony R Reynolds
- Leon H. Charney Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States.
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11
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Kelly C, Chu M, Untaru R, Assadi-Khansari B, Chen D, Croft A, Horowitz J, Sverdlov AL, Ngo DTM. Heart failure is associated with low circulating levels of secreted frizzled receptor protein 5 (Sfrp5). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.918] [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: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Obesity and metabolic dysregulation are closely associated with the pathophysiology of multiple cardiovascular diseases (CVD). To date, the pathophysiological mechanism(s) of obesity and its link with cardiovascular systems remain largely unknown. Adipose tissue inflammation as a result of excessive fat expansion in obesity, leading to increased systemic production of growth factors and recruitment of inflammatory cells have been postulated to be a major factor. Secreted frizzled-related protein 5 (SFRP5) is an anti-inflammatory adipokine that is linked with obesity and metabolic regulation and has been indicated to affect cardiovascular functions. Currently, the role of circulating SFRP5 levels as a biomarker for cardiovascular diseases are poorly understood, with studies yielding discordant results.
Purpose
This study aims to evaluate the relationship between circulating SFRP5 and cardiovascular functions in a cohort of patients with established CVD.
Methods
Patients (n=262, 148 male (56.5%), age (68±11 yrs)) presenting to the cardiology unit for cardiovascular investigations were recruited into the study. Plasma SFRP5 levels were measured via enzyme-linked immunosorbent assay (ELISA). Associations between plasma SFRP5 levels, cardiovascular functions, and patients' co-morbidities were analysed using univariate and multivariate analyses.
Results
Plasma SFRP5 levels were significantly lower in patients presenting with: heart failure (HF) vs non-HF (median; (10.7 vs 31.0; p<0.001); coronary artery disease (CAD) vs non-CAD; (11.0 vs 33.8; p<0.001); and atrial fibrillation (AF) vs non-AF; (11.2 vs 23.2; p=0.001). On univariate analyses, SFRP5 levels also significantly positively correlated with left ventricular ejection fraction (LVEF) (r=0.52, p<0.001), estimated glomerular filtration rate (eGFR) (r=0.16, p=0.02), total cholesterol levels and triglycerides (r=0.29, p<0.001; r=0.17, p<0.01 respectively). Low SFRP5 levels were correlated with high C-reactive protein (CRP) and E/E' (r=−0.29, p<0.001, r=−0.30, p<0.001, respectively). Patients with HF, CAD, statin use, low LVEF, low triglycerides, high CRP and high eGFR were associated with lower SFRP5 levels independent of age, BMI or diabetes on multivariate analysis (overall model r=0.729, SE=0.638).
Conclusion
Our results show that low plasma SFRP5 levels are independently associated with HF, CAD, and impaired systolic and diastolic functions. These results suggest that SFRP5 may regulate cardiovascular functions independent of obesity and metabolic regulations.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Heart Foundation of Australia Future Leader FellowshipsNSW Ministry of Health EMC FellowshipHeart Foundation of Australia Future Leader Fellowship
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Affiliation(s)
- C Kelly
- University of Newcastle , Newcastle , Australia
| | - M Chu
- University of Adelaide , Adelaide , Australia
| | - R Untaru
- University of Newcastle , Newcastle , Australia
| | | | - D Chen
- University of Newcastle , Newcastle , Australia
| | - A Croft
- University of Newcastle , Newcastle , Australia
| | - J Horowitz
- University of Adelaide , Adelaide , Australia
| | | | - D T M Ngo
- University of Newcastle , Newcastle , Australia
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12
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Fleitas Sosa D, Lehr AL, Zhao H, Roth S, Lakhther V, Bashir R, Cohen G, Panaro J, Maldonado TS, Horowitz J, Amoroso NE, Criner GJ, Brosnahan SB, Rali P. Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis. Eur Respir Rev 2022; 31:31/165/220023. [PMID: 35831010 DOI: 10.1183/16000617.0023-2022] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/16/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The impact of pulmonary embolism response teams (PERTs) on treatment choice and outcomes of patients with acute pulmonary embolism (PE) is still uncertain. OBJECTIVE To determine the effect of PERTs in the management and outcomes of patients with PE. METHODS PubMed, Embase, Web of Science, CINAHL, WorldWideScience and MedRxiv were searched for original articles reporting PERT patient outcomes from 2009. Data were analysed using a random effects model. RESULTS 16 studies comprising 3827 PERT patients and 3967 controls met inclusion criteria. The PERT group had more patients with intermediate and high-risk PE (66.2%) compared to the control group (48.5%). Meta-analysis demonstrated an increased risk of catheter-directed interventions, systemic thrombolysis and surgical embolectomy (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.74-2.53; p<0.01), similar bleeding complications (OR 1.10, 95% CI 0.88-1.37) and decreased utilisation of inferior vena cava (IVC) filters (OR 0.71, 95% CI 0.58-0.88; p<0.01) in the PERT group. Furthermore, there was a nonsignificant trend towards decreased mortality (OR 0.87, 95% CI 0.71-1.07; p=0.19) with PERTs. CONCLUSIONS The PERT group showed an increased use of advanced therapies and a decreased utilisation of IVC filters. This was not associated with increased bleeding. Despite comprising more severe PE patients, there was a trend towards lower mortality in the PERT group.
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Affiliation(s)
- Derlis Fleitas Sosa
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA .,Both authors contributed equally
| | - Andrew L Lehr
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA.,Both authors contributed equally
| | - Huaqing Zhao
- Dept of Clinical Sciences, Temple University School of Medicine, Philadelphia, PA, USA
| | - Stephanie Roth
- Biomedical and Research Services Librarian, Simmy and Harry Ginsburg Library, Temple University, Philadelphia, PA, USA
| | - Vlad Lakhther
- Dept of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Riyaz Bashir
- Dept of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Gary Cohen
- Dept of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Joseph Panaro
- Dept of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Thomas S Maldonado
- Division of Vascular Surgery, New York University Langone Health, New York, NY, USA
| | - James Horowitz
- Division of Cardiology, New York University Langone Health, New York, NY, USA
| | - Nancy E Amoroso
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Gerard J Criner
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Shari B Brosnahan
- Division of Pulmonary, Critical Care and Sleep Medicine, New York University Langone Health, New York, NY, USA
| | - Parth Rali
- Dept of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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13
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Pannu J, Venious G, Gallagher R, Shaver A, Cloyes R, Josan E, Donnelly E, King M, Knopp M, Merritt R, Kneuertz P, D'souza D, Ghattas C, Revelo A, Pastis N, Sowers T, Eastep C, Ottersbach M, Malinky M, Reinbolt R, Wert M, Horowitz J, Carbone D. P1.03-01 Do We Follow Incidental Lung Nodules Appropriately? A Retrospective Study. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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14
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Ong G, Sellers A, Mahadavan G, Nguyen T, Worthley M, Chew D, Horowitz J. “Bushfire Season” in Australia: Impacts of Variability in Ambient Temperature, Air Pollution and Bushfires on Incidence of Acute Coronary Syndromes and Takotsubo Syndrome. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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15
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Rokosh RS, Grazi JH, Ruohoniemi D, Yuriditsky E, Horowitz J, Sista AK, Jacobowitz GR, Rockman C, Maldonado TS. High incidence of patients lost to follow-up after venous thromboembolism diagnosis - Identifying an unmet need for targeted transition of care. Vascular 2021; 30:548-554. [PMID: 34080914 DOI: 10.1177/17085381211020969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Venous thromboembolism, including deep venous thrombosis and pulmonary embolism, is a major source of morbidity, mortality, and healthcare utilization. Given the prevalence of venous thromboembolism and its associated mortality, our study sought to identify factors associated with loss to follow-up in venous thromboembolism patients. METHODS This is a single-center retrospective study of all consecutive admitted (inpatient) and emergency department patients diagnosed with acute venous thromboembolism via venous duplex examination and/or chest computed tomography from January 2018 to March 2019. Patients with chronic deep venous thrombosis and those diagnosed in the outpatient setting were excluded. Lost to venous thromboembolism-specific follow-up (LTFU) was defined as patients who did not follow up with vascular, cardiology, hematology, oncology, pulmonology, or primary care clinic for venous thromboembolism management at our institution within three months of initial discharge. Patients discharged to hospice or dead within 30 days of initial discharge were excluded from LTFU analysis. Statistical analysis was performed using STATA 16 (College Station, TX: StataCorp LLC) with a p-value of <0.05 set for significance. RESULTS During the study period, 291 isolated deep venous thrombosis, 25 isolated pulmonary embolism, and 54 pulmonary embolism with associated deep venous thrombosis were identified in 370 patients. Of these patients, 129 (35%) were diagnosed in the emergency department and 241 (65%) in the inpatient setting. At discharge, 289 (78%) were on anticoagulation, 66 (18%) were not, and 15 (4%) were deceased. At the conclusion of the study, 120 patients (38%) had been LTFU, 85% of whom were discharged on anticoagulation. There was no statistically significant difference between those LTFU and those with follow-up with respect to age, gender, diagnosis time of day, venous thromboembolism anatomic location, discharge unit location, or anticoagulation choice at discharge. There was a non-significant trend toward longer inpatient length of stay among patients LTFU (16.2 days vs. 12.3 days, p = 0.07), and a significant increase in the proportion of LTFU patients discharged to a facility rather than home (p = 0.02). On multivariate analysis, we found a 95% increase in the odds of being lost to venous thromboembolism-specific follow-up if discharged to a facility (OR 1.95, CI 1.1-3.6, p = 0.03) as opposed to home. CONCLUSIONS Our study demonstrates that over one-third of patients diagnosed with venous thromboembolism at our institution are lost to venous thromboembolism-specific follow-up, particularly those discharged to a facility. Our work suggests that significant improvement could be achieved by establishing a pathway for the targeted transition of care to a venous thromboembolism-specific follow-up clinic.
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Affiliation(s)
- Rae S Rokosh
- Division of Vascular & Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY, USA.,Division of Vascular & Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jack H Grazi
- Division of Vascular & Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY, USA
| | - David Ruohoniemi
- Division of Vascular & Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY, USA
| | - Eugene Yuriditsky
- Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - James Horowitz
- Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY, USA
| | - Akhilesh K Sista
- Division of Vascular Interventional Radiology, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Glenn R Jacobowitz
- Division of Vascular & Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY, USA
| | - Caron Rockman
- Division of Vascular & Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY, USA
| | - Thomas S Maldonado
- Division of Vascular & Endovascular Surgery, Department of Surgery, NYU Langone Health, New York, NY, USA
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16
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Mitchell OJL, Doran O, Yuriditsky E, Root C, Teran F, Ma K, Shashaty M, Moskowitz A, Horowitz J, Abella BS. Rapid response system adaptations at 40 US hospitals during the COVID-19 pandemic. Resusc Plus 2021; 6:100121. [PMID: 33870236 PMCID: PMC8041183 DOI: 10.1016/j.resplu.2021.100121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 02/08/2023] Open
Abstract
Background Management of patients with acute deterioration from novel coronavirus disease of 2019 (COVID-19) has posed a particular challenge for rapid response systems (RRSs) due to increased hospital strain and direct risk of infection to RRS team members. Objective We sought to characterize RRS structure and protocols adaptions during the COVID-19 pandemic. Design, setting, and participants Internet-based cross-sectional survey of RRS leaders, physicians, and researchers across the United States. Results Clinicians from 46 hospitals were surveyed, 40 completed a baseline survey (87%), and 19 also completed a follow-up qualitative survey. Most reported an increase in emergency team resources during the COVID-19 pandemic. The number of sites performing simulation training sessions decreased from 88% before COVID-19 to 53% during the pandemic. Conclusions Most RRSs reported pandemic-related adjustments, most commonly through increasing resources and implementation of protocol changes. There was a reduction in the number of sites that performed simulation training.
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Affiliation(s)
- Oscar J L Mitchell
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, United States.,Center for Resuscitation Science, University of Pennsylvania, United States
| | - Olivia Doran
- Center for Resuscitation Science, University of Pennsylvania, United States.,Department of Emergency Medicine, University of Pennsylvania, United States
| | - Eugene Yuriditsky
- Division of Pulmonary and Critical Care Medicine, NYU Langone School of Medicine, United States
| | - Christopher Root
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, United States
| | - Felipe Teran
- Center for Resuscitation Science, University of Pennsylvania, United States.,Department of Emergency Medicine, University of Pennsylvania, United States
| | - Kevin Ma
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, United States
| | - Michael Shashaty
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania, United States.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, United States
| | - Ari Moskowitz
- Department of Medicine, Montefiore Medical Center, United States
| | - James Horowitz
- Department of Cardiology, NYU Langone School of Medicine, United States
| | - Benjamin S Abella
- Center for Resuscitation Science, University of Pennsylvania, United States.,Department of Emergency Medicine, University of Pennsylvania, United States
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17
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Chen D, Untaru R, Liu S, Assafi-Khansari B, Croft A, Kelly C, Ajaero C, Boyle A, Horowitz J, Ngo D, Sverdlov A. Follistatin-like 3 (FSTL3) Levels in Patients With Cardiovascular Disease. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Velagic A, Li J, Qin C, Li M, Deo M, Marshall S, Woodman O, Horowitz J, Kemp-Harper B, Ritchie R. Nitroxyl Exerts Positive Inotropic and Vasodilator Effects in the Type 2 Diabetic Heart. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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19
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Rosovsky RP, Grodzin C, Channick R, Davis GA, Giri JS, Horowitz J, Kabrhel C, Lookstein R, Merli G, Morris TA, Rivera-Lebron B, Tapson V, Todoran TM, Weinberg AS, Rosenfield K. Diagnosis and Treatment of Pulmonary Embolism During the Coronavirus Disease 2019 Pandemic: A Position Paper From the National PERT Consortium. Chest 2020; 158:2590-2601. [PMID: 32861692 PMCID: PMC7450258 DOI: 10.1016/j.chest.2020.08.2064] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 06/05/2020] [Revised: 08/06/2020] [Accepted: 08/16/2020] [Indexed: 12/22/2022] Open
Abstract
The coexistence of coronavirus disease 2019 (COVID-19) and pulmonary embolism (PE), two life-threatening illnesses, in the same patient presents a unique challenge. Guidelines have delineated how best to diagnose and manage patients with PE. However, the unique aspects of COVID-19 confound both the diagnosis and treatment of PE, and therefore require modification of established algorithms. Important considerations include adjustment of diagnostic modalities, incorporation of the prothrombotic contribution of COVID-19, management of two critical cardiorespiratory illnesses in the same patient, and protecting patients and health-care workers while providing optimal care. The benefits of a team-based approach for decision-making and coordination of care, such as that offered by pulmonary embolism response teams (PERTs), have become more evident in this crisis. The importance of careful follow-up care also is underscored for patients with these two diseases with long-term effects. This position paper from the PERT Consortium specifically addresses issues related to the diagnosis and management of PE in patients with COVID-19.
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Affiliation(s)
| | - Charles Grodzin
- Emory University Hospital Midtown, Emory University, Atlanta, GA
| | - Richard Channick
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | - Jay S Giri
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Geno Merli
- Thomas Jefferson University Hospitals, Philadelphia, PA
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20
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Berger JS, Kunichoff D, Adhikari S, Ahuja T, Amoroso N, Aphinyanaphongs Y, Cao M, Goldenberg R, Hindenburg A, Horowitz J, Parnia S, Petrilli C, Reynolds H, Simon E, Slater J, Yaghi S, Yuriditsky E, Hochman J, Horwitz LI. Prevalence and Outcomes of D-Dimer Elevation in Hospitalized Patients With COVID-19. Arterioscler Thromb Vasc Biol 2020; 40:2539-2547. [PMID: 32840379 PMCID: PMC7505147 DOI: 10.1161/atvbaha.120.314872] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Supplemental Digital Content is available in the text. Objective: To determine the prevalence of D-dimer elevation in coronavirus disease 2019 (COVID-19) hospitalization, trajectory of D-dimer levels during hospitalization, and its association with clinical outcomes. Approach and Results: Consecutive adults admitted to a large New York City hospital system with a positive polymerase chain reaction test for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) between March 1, 2020 and April 8, 2020 were identified. Elevated D-dimer was defined by the laboratory-specific upper limit of normal (>230 ng/mL). Outcomes included critical illness (intensive care, mechanical ventilation, discharge to hospice, or death), thrombotic events, acute kidney injury, and death during admission. Among 2377 adults hospitalized with COVID-19 and ≥1 D-dimer measurement, 1823 (76%) had elevated D-dimer at presentation. Patients with elevated presenting baseline D-dimer were more likely than those with normal D-dimer to have critical illness (43.9% versus 18.5%; adjusted odds ratio, 2.4 [95% CI, 1.9–3.1]; P<0.001), any thrombotic event (19.4% versus 10.2%; adjusted odds ratio, 1.9 [95% CI, 1.4–2.6]; P<0.001), acute kidney injury (42.4% versus 19.0%; adjusted odds ratio, 2.4 [95% CI, 1.9–3.1]; P<0.001), and death (29.9% versus 10.8%; adjusted odds ratio, 2.1 [95% CI, 1.6–2.9]; P<0.001). Rates of adverse events increased with the magnitude of D-dimer elevation; individuals with presenting D-dimer >2000 ng/mL had the highest risk of critical illness (66%), thrombotic event (37.8%), acute kidney injury (58.3%), and death (47%). Conclusions: Abnormal D-dimer was frequently observed at admission with COVID-19 and was associated with higher incidence of critical illness, thrombotic events, acute kidney injury, and death. The optimal management of patients with elevated D-dimer in COVID-19 requires further study.
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Affiliation(s)
- Jeffrey S Berger
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman).,Center for Prevention of Cardiovascular Disease (J.S.B.), NYU Langone Health, New York
| | - Dennis Kunichoff
- Division of Biostatistics, Department of Population Health, New York (D.K., S.A.)
| | - Samrachana Adhikari
- Division of Biostatistics, Department of Population Health, New York (D.K., S.A.)
| | - Tania Ahuja
- Department of Pharmacy (T.A.), NYU Langone Health, New York
| | - Nancy Amoroso
- Division of Pulmonary Critical Care, Department of Medicine, New York (N.A., S.P.)
| | | | - Meng Cao
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York (M.C., C.P., L.I.H.)
| | | | | | - James Horowitz
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman)
| | - Sam Parnia
- Division of Pulmonary Critical Care, Department of Medicine, New York (N.A., S.P.)
| | - Christopher Petrilli
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman).,Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York (M.C., C.P., L.I.H.)
| | - Harmony Reynolds
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman)
| | - Emma Simon
- Division of Healthcare Delivery Science, Department of Population Health, New York (E.S., L.I.H.)
| | - James Slater
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman)
| | - Shadi Yaghi
- Department of Neurology, NYU Grossman School of Medicine, Brooklyn, NY(S.Y.)
| | - Eugene Yuriditsky
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman)
| | - Judith Hochman
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York (J.S.B., J. Horowitz, C.P., H.R., J.S., E.Y., J. Hochman)
| | - Leora I Horwitz
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, New York (M.C., C.P., L.I.H.).,Division of Healthcare Delivery Science, Department of Population Health, New York (E.S., L.I.H.)
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21
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Wiske CP, Shen C, Amoroso N, Brosnahan SB, Goldenberg R, Horowitz J, Jamin C, Sista AK, Smith D, Maldonado TS. Evaluating time to treatment and in-hospital outcomes of pulmonary embolism response teams. J Vasc Surg Venous Lymphat Disord 2020; 8:717-724. [PMID: 32179041 DOI: 10.1016/j.jvsv.2019.12.077] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/29/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pulmonary embolism response teams (PERTs) have become increasingly popular at institutions around the country, although the evidence to support their efficacy is limited. PERTs are mechanisms for rapid involvement of a multidisciplinary team in the management of a time-sensitive condition with many treatment options. METHODS We retrospectively reviewed 201 patients with PERT activations since inception, collecting data on demographics, time to treatment, treatment modality, and in-hospital outcomes. RESULTS Massive pulmonary embolism accounted for 16 (8.7%) PERT activations. The majority of patients were treated without invasive intervention; 91.4% (95% confidence interval [CI], 87.1%-95.7%) of patients received anticoagulation alone, 4.5% (95% CI, 0%-18.6%) had catheter-directed therapy (CDT), and 3.0% (95% CI, 0%-16.9%) had systemic administration of tissue plasminogen activator (tPA). The average time to intervention was 665 minutes (95% CI, 249-1080 minutes) for CDT and 22 minutes (95% CI, 0-456 minutes) for systemic TPA. The average time to anticoagulation was 2.3 minutes (95% CI, 0-43 minutes). There was a trend toward higher rates of cardiac events (odds ratio [OR], 12.68; 95% CI, 0.62-65.74) and death (OR, 3.19; 95% CI, 0.28-5.18) among patients with massive PE. There was a higher rate of cardiac events (OR, 5.66; 95% CI, 1.34-23.83) among patients who received tPA or an invasive intervention. There was no difference in mortality rates of patients who underwent aggressive management compared with anticoagulation alone. CONCLUSIONS A dedicated PERT results in efficient delivery of care and excellent outcomes, in part owing to the rapid (on average, 8 minutes) time to initiation of a multidisciplinary discussion. Patients who ultimately underwent CDT had an interval of >10 hours on average between diagnosis and CDT. This provisional or delayed approach to CDT in selected patients who were not improving with anticoagulation alone (and therefore had potential for higher net benefit from a procedure with its own inherent risks) may have resulted in a lower rate of CDT.
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Affiliation(s)
- Clay P Wiske
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Chen Shen
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Nancy Amoroso
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Shari B Brosnahan
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Ronald Goldenberg
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - James Horowitz
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Catherine Jamin
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Akhilesh K Sista
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Deane Smith
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Thomas S Maldonado
- Division of Vascular Surgery, New York University Langone Health, New York, NY.
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22
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Rivera-Lebron B, McDaniel M, Ahrar K, Alrifai A, Dudzinski DM, Fanola C, Blais D, Janicke D, Melamed R, Mohrien K, Rozycki E, Ross CB, Klein AJ, Rali P, Teman NR, Yarboro L, Ichinose E, Sharma AM, Bartos JA, Elder M, Keeling B, Palevsky H, Naydenov S, Sen P, Amoroso N, Rodriguez-Lopez JM, Davis GA, Rosovsky R, Rosenfield K, Kabrhel C, Horowitz J, Giri JS, Tapson V, Channick R. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin Appl Thromb Hemost 2019; 25:1076029619853037. [PMID: 31185730 PMCID: PMC6714903 DOI: 10.1177/1076029619853037] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [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: 12/12/2022] Open
Abstract
Pulmonary embolism (PE) is a life-threatening condition and a leading cause of morbidity and mortality. There have been many advances in the field of PE in the last few years, requiring a careful assessment of their impact on patient care. However, variations in recommendations by different clinical guidelines, as well as lack of robust clinical trials, make clinical decisions challenging. The Pulmonary Embolism Response Team Consortium is an international association created to advance the diagnosis, treatment, and outcomes of patients with PE. In this consensus practice document, we provide a comprehensive review of the diagnosis, treatment, and follow-up of acute PE, including both clinical data and consensus opinion to provide guidance for clinicians caring for these patients.
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Affiliation(s)
| | | | - Kamran Ahrar
- 3 The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Abdulah Alrifai
- 4 University of Miami of Palm Beach Regional Campus/JFK Hospital, Atlantis, FL, USA
| | - David M Dudzinski
- 5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Danielle Blais
- 7 The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Roman Melamed
- 9 Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Elizabeth Rozycki
- 7 The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | | | - Parth Rali
- 10 Temple University, Philadelphia, PA, USA
| | | | | | | | | | | | - Mahir Elder
- 14 Wayne State University, Detroit, MI, USA.,15 Michigan State University, East Lansing, MI, USA
| | | | | | | | | | | | | | | | - Rachel Rosovsky
- 5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Kenneth Rosenfield
- 5 Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | - Jay S Giri
- 16 University of Pennsylvania, Philadelphia, PA, USA
| | - Victor Tapson
- 21 Cedars-Sinai Medical Center, Los Angeles, CA, USA
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23
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Sibley R, Yuriditsky E, Roellke E, Horowitz J, Mitchell O, Parnia S. ADHERENCE TO GUIDELINE-RECOMMENDED VENTILATION RATE DURING CARDIAC ARREST: A QUALITY IMPROVEMENT STUDY. Chest 2019. [DOI: 10.1016/j.chest.2019.08.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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24
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Wiske CP, Shen C, Amoroso N, Goldenberg R, Horowitz J, Sista A, Smith D, Maldonado T. PC192. Pulmonary Embolism Response Teams: Evaluating Time to Treatment and Outcomes. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.04.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Surikow S, Nguyen T, Stafford I, Horowitz J. Inhibition of Nitric Oxide Synthase: Impact on Cardiovascular Injury and Mortality in a Model of Takotsubo Syndrome. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Aulin J, Hijazi Z, Lindback J, Alexander JH, Gersh B, Granger CB, Hanna M, Horowitz J, Hylek E, Lopes RD, McMurray JJV, Siegbahn A, Wallentin L. P976Elevated biomarkers are associated with increased risk of death and heart failure hospitalization in patients with atrial fibrillation: insights from the ARISTOTLE trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p976] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Aulin
- Dept of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Z Hijazi
- Dept of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - J Lindback
- Uppsala Clinical Research Center, UCR, Uppsala, Sweden
| | - J H Alexander
- Duke Clinical Research Institute, Durham, United States of America
| | - B Gersh
- Mayo Clinic, College of Medicine, Rochester, United States of America
| | - C B Granger
- Duke Clinical Research Institute, Durham, United States of America
| | - M Hanna
- Bristol-Myers Squibb, former employee, Princeton, United States of America
| | - J Horowitz
- University of Adelaide, Adelaide, Australia
| | - E Hylek
- Boston University, Boston, United States of America
| | - R D Lopes
- Duke Clinical Research Institute, Durham, United States of America
| | - J J V McMurray
- University of Glasgow, BHF Cardiovascular Research Centre, Glasgow, United Kingdom
| | - A Siegbahn
- Uppsala University, Dept of Medical Sciences, Clinical Chemistry, Uppsala, Sweden
| | - L Wallentin
- Dept of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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27
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Imam H, Ha Nguyen T, Tu S, Tonnu O, Chirkov Y, Horowitz J. P1678Pathogenesis of coronary artery spasm: a critical role for impaired platelet nitric oxide signaling. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1678] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Imam
- BHI for Translational Research, TQEH, The University of Adelaide, Adelaide, Australia
| | - T Ha Nguyen
- BHI for Translational Research, TQEH, The University of Adelaide, Adelaide, Australia
| | - S Tu
- BHI for Translational Research, TQEH, The University of Adelaide, Adelaide, Australia
| | - O Tonnu
- BHI for Translational Research, TQEH, The University of Adelaide, Adelaide, Australia
| | - Y Chirkov
- BHI for Translational Research, TQEH, The University of Adelaide, Adelaide, Australia
| | - J Horowitz
- BHI for Translational Research, TQEH, The University of Adelaide, Adelaide, Australia
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28
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Chen D, Liu S, Horowitz J, Sverdlov A, Ngo D. Follistatin-like 3 Release Occurs Synchronously With Onset of Doxorubicin-Induced Cardiotoxicity in an Isolated Myocardial Cell Model. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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29
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Liu S, Chen D, Horowitz J. Myocardial Toxicity of Doxorubicin Compared with that of Hydrogen Peroxide and Peroxynitrite: Results from Flow Cytometric Analyses. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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30
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Worku B, de Biasi A, Horowitz J, Kampaktsis P, Elmously A, Minutello R, Wong SC, Salemi A. Electrocardiographic Correlates of Myocardial Injury After Transcatheter Aortic Valve Replacement. J Heart Valve Dis 2017; 26:624-631. [PMID: 30207111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is associated with several conduction abnormalities and a need for pacemaker placement. The study aim was to describe all electrocardiographic (ECG) changes seen after TAVR, to compare such changes between transapical (TA) and transfemoral (TF) patient cohorts, and to assess their impact on postoperative outcomes. METHODS Between March 2009 and July 2014, a total of 286 consecutive patients underwent TAVR at the present authors' institution. Perioperative data were collected prospectively, while preoperative and predischarge electrocardiograms were reviewed retrospectively by an independent cardiologist. RESULTS A greater proportion of TA patients experienced ECG changes than TF patients at the time of discharge (78% versus 42%; p <0.0001), with more intraventricular conduction abnormalities (29% versus 15%; p = 0.006), and a trend towards more frequent atrioventricular block and pacemaker placement. Troponin levels were higher in patients with new ECG changes (4.61ng/ml versus 2.12 ng/ml; p = 0.0009). New intraventricular conduction abnormalities were associated with increased one-year mortality only in the TF subgroup (65% versus 84%; p = 0.028). Six TA patients demonstrated new ECG findings of myocardial infarction, and this was associated with greater 30-day mortality (67% versus 98%; p = 0.012), although none met the clinical criteria for myocardial infarction. CONCLUSIONS New ECG changes after TAVR, including new conduction abnormalities, were seen more frequently in TA patients. When seen in TF patients, they were associated with decreased survival. ECG findings of new myocardial infarction, seen only in TA patients, were also associated with decreased survival.
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Affiliation(s)
- Berhane Worku
- Weill Cornell Medical Center-New York Presbyterian Hospital Department of Cardiothoracic Surgery, New York, USA
- Brooklyn Methodist Hospital-New York Presbyterian Hospital Department of Cardiothoracic Surgery, New York, USA. Electronic correspondence:
| | - Andreas de Biasi
- Weill Cornell Medical Center-New York Presbyterian Hospital Department of Cardiothoracic Surgery, New York, USA
| | - James Horowitz
- Weill Cornell Medical Center-New York Presbyterian Hospital Division of Cardiology, New York, USA
| | - Polydoros Kampaktsis
- Weill Cornell Medical Center-New York Presbyterian Hospital Division of Cardiology, New York, USA
| | - Adham Elmously
- Weill Cornell Medical Center-New York Presbyterian Hospital Department of Cardiothoracic Surgery, New York, USA
| | - Robert Minutello
- Weill Cornell Medical Center-New York Presbyterian Hospital Division of Cardiology, New York, USA
| | - Shing-Chu Wong
- Weill Cornell Medical Center-New York Presbyterian Hospital Division of Cardiology, New York, USA
| | - Arash Salemi
- Weill Cornell Medical Center-New York Presbyterian Hospital Department of Cardiothoracic Surgery, New York, USA
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31
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Nguyen T, Ong G, Stansborough J, Surikow S, Chong C, Horowitz J. P604Hypotension at admission and extent of release of NT-proBNP and catecholamines are associated with increased medium-term mortality rate in Takotsubo cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p604] [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: 11/14/2022] Open
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32
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Aulin J, Hijazi Z, Andersson U, Alexander J, Gersh B, Granger C, Hanna M, Horowitz J, Hylek E, Lopes R, Siegbahn A, Wallentin L. P3626Serial IL-6 levels and risk of death in anticoagulated patients with atrial fibrillation: Insights from the ARISTOTLE trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3626] [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: 11/14/2022] Open
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33
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Chu M, Chua S, Assadi-Khansari B, Amarasekera A, Horowitz J, Sverdlov A, Ngo D. Circulating Secreted Frizzled-Related Protein 5 (Sfrp5) is Decreased in Patients with Diabetes and is Associated with Diabetic Control. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.165] [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: 11/17/2022]
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34
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Chua S, Goh V, Assadi-Khansari B, Chen D, Hii J, Horowitz J, Sverdlov A, Ngo D. Follistatin-like 3 is Elevated in Patients with Atrial Fibrillation but is Unchanged Following Ablative Therapy. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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35
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Assadi-Khansari B, Chua S, Chapman M, Ali O, Nguyen H, Horowitz J, Sverdlov A, Ngo D. Follistatin-like 3 Predicts Aortic Root Enlargement in Patients with Bicuspid Aortic Valve. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Assadi-Khansari B, Chua S, Horowitz J, Sverdlov A, Ngo D. Follistatin-like 3 Is Associated with Increased Left Ventricular Mass in an Ageing Population. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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37
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Ajaero C, Chan A, Arstall M, Hersztyn T, McGavigan A, Horowitz J. Implications of Cardiac Resynchronisation Therapy (Crt) on the Pathophysiology of Congestive Heart Failure: Focus on Endothelial Function and Inflammatory Activation. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.273] [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: 11/24/2022]
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38
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Chen D, Procter N, Goh V, Liu S, Chua S, Assadi-Khansari B, Horowitz J, Sverdlov A, Ngo D. New Onset Atrial Fibrillation Is Associated with Elevated Galactic-3 Levels. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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39
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Chua S, Ajaero C, Assadi-Khansari B, Horowitz J, Sverdlov A, Ngo D. Galectin 3 Predicts Functional Capacity in Patients with Severe Congestive Heart Failure (CHF). Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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40
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Chong C, Liu S, Sallustio B, Chirkov Y, Horowitz J. Effects of Perhexiline on Insulin and Nitric Oxide Signalling in Diabetics. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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41
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Chua S, Assadi-Khansari B, Horowitz J, Sverdlov A, Ngo D. Galectin-3 Levels Is not a Predictor of Increased Left Ventricular Mass in a Healthy Ageing Population. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.180] [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: 11/24/2022]
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42
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Horowitz J. Occupation times and other accumulation processes. ADV APPL PROBAB 2016. [DOI: 10.2307/1426345] [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: 11/10/2022]
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43
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Kim LK, Looser P, Swaminathan RV, Horowitz J, Friedman O, Shin JH, Minutello RM, Bergman G, Singh H, Wong SC, Feldman DN. Sex-Based Disparities in Incidence, Treatment, and Outcomes of Cardiac Arrest in the United States, 2003-2012. J Am Heart Assoc 2016; 5:JAHA.116.003704. [PMID: 27333880 PMCID: PMC4937290 DOI: 10.1161/jaha.116.003704] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent studies have shown improving survival after cardiac arrest. However, data regarding sex-based disparities in treatment and outcomes after cardiac arrest are limited. METHODS AND RESULTS We performed a retrospective analysis of all patients suffering cardiac arrest between 2003 and 2012 using the Nationwide Inpatient Sample database. Annual rates of cardiac arrest, rates of utilization of coronary angiography/percutaneous coronary interventions/targeted temperature management, and sex-based outcomes after cardiac arrest were examined. Among a total of 1 436 052 discharge records analyzed for cardiac arrest patients, 45.4% (n=651 745) were females. Women were less likely to present with ventricular tachycardia/ventricular fibrillation arrests compared with men throughout the study period. The annual rates of cardiac arrests have increased from 2003 to 2012 by 14.0% (Ptrend<0.001) and ventricular tachycardia/ventricular fibrillation arrests have increased by 25.9% (Ptrend<0.001). Women were less likely to undergo coronary angiography, percutaneous coronary interventions, or targeted temperature management in both ventricular tachycardia/ventricular fibrillation and pulseless electrical activity/asystole arrests. Over a 10-year study period, there was a significant decrease in in-hospital mortality in women (from 69.1% to 60.9%, Ptrend<0.001) and men (from 67.2% to 58.6%, Ptrend<0.001) after cardiac arrest. In-hospital mortality was significantly higher in women compared with men (64.0% versus 61.4%; adjusted odds ratio 1.02, P<0.001), particularly in the ventricular tachycardia/ventricular fibrillation arrest cohort (49.4% versus 45.6%; adjusted odds ratio 1.11, P<0.001). CONCLUSIONS Women presenting with cardiac arrests are less likely to undergo therapeutic procedures, including coronary angiography, percutaneous coronary interventions, and targeted temperature management. Despite trends in improving survival after cardiac arrest over 10 years, women continue to have higher in-hospital mortality when compared with men.
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Affiliation(s)
- Luke K Kim
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Patrick Looser
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Rajesh V Swaminathan
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - James Horowitz
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Oren Friedman
- Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Ji Hae Shin
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Robert M Minutello
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Geoffrey Bergman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Harsimran Singh
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - S Chiu Wong
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
| | - Dmitriy N Feldman
- Division of Cardiology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY
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44
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Tully PJ, Turnbull DA, Beltrame J, Horowitz J, Cosh S, Baumeister H, Wittert GA. Panic disorder and incident coronary heart disease: a systematic review and meta-regression in 1131612 persons and 58111 cardiac events. Psychol Med 2015; 45:2909-2920. [PMID: 26027689 DOI: 10.1017/s0033291715000963] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [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] [Indexed: 12/16/2022]
Abstract
BACKGROUND Substantial healthcare resources are devoted to panic disorder (PD) and coronary heart disease (CHD); however, the association between these conditions remains controversial. Our objective was to conduct a systematic review of studies assessing the association between PD, related syndromes, and incident CHD. METHOD Relevant studies were retrieved from Medline, EMBASE, SCOPUS and PsycINFO without restrictions from inception to January 2015 supplemented with hand-searching. We included studies that reported hazard ratios (HR) or sufficient data to calculate the risk ratio and 95% confidence interval (CI) which were pooled using a random-effects model. Studies utilizing self-reported CHD were ineligible. Twelve studies were included comprising 1 131 612 persons and 58 111 incident CHD cases. RESULTS PD was associated with the primary incident CHD endpoint [adjusted HR (aHR) 1.47, 95% CI 1.24-1.74, p < 0.00001] even after excluding angina (aHR 1.49, 95% CI 1.22-1.81, p < 0.00001). High to moderate quality evidence suggested an association with incident major adverse cardiac events (MACE; aHR 1.40, 95% CI 1.16-1.69, p = 0.0004) and myocardial infarction (aHR 1.36, 95% CI 1.12-1.66, p = 0.002). The risk for CHD was significant after excluding depression (aHR 1.64, 95% CI 1.45-1.85) and after depression adjustment (aHR 1.38, 95% CI 1.03-1.87). Age, sex, length of follow-up, socioeconomic status and diabetes were sources of heterogeneity in the primary endpoint. CONCLUSIONS Meta-analysis showed that PD was independently associated with incident CHD, myocardial infarction and MACE; however, reverse causality cannot be ruled out and there was evidence of heterogeneity.
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Affiliation(s)
- P J Tully
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
| | - D A Turnbull
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
| | - J Beltrame
- School of Medicine,Discipline of Medicine,The University of Adelaide,Australia
| | - J Horowitz
- School of Medicine,Discipline of Medicine,The University of Adelaide,Australia
| | - S Cosh
- Clinic of Psychiatry and Psychotherapy II,University of Ulm,Gunzburg,Germany
| | - H Baumeister
- Department of Rehabilitation Psychology and Psychotherapy,Institute of Psychology,University of Freiburg,Germany
| | - G A Wittert
- Freemasons Foundation Centre for Men's Health,Discipline of Medicine,School of Medicine,The University of Adelaide,Australia
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Pick J, Berlin D, Horowitz J, Winokur R, Sista AK, Lichtman AD. Massive Pulmonary Embolism in Pregnancy Treated with Catheter-Directed Tissue Plasminogen Activator. ACTA ACUST UNITED AC 2015; 4:91-4. [DOI: 10.1213/xaa.0000000000000128] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Haider MA, Karas M, Horn E, Horowitz J, Garrett F, Magro C, DeSancho M, Singh H. TCTAP C-172 Fibrinous Pleuritis and Necrotizing Pericarditis: Unique and Serious Complications of Degos Disease. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.02.447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Goto S, Zhu J, Lisheng L, Oh BH, Wojdyla D, Hanna M, Horowitz J, Wallentin L, Xavier D, Alexander JH. Efficacy and safety of apixaban compared with warfarin for stroke prevention in atrial fibrillation in East Asia. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5613] [Citation(s) in RCA: 2] [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: 11/15/2022] Open
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Nguyen TH, Neil C, Singh K, Heresztyn T, Chirkov Y, Horowitz J. Determinants of prolonged impairment of global longitudinal strain post Takotsubo cardiomyopathy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4247] [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: 11/12/2022] Open
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Procter N, Ball J, Ngo D, Chirkov Y, Isenberg J, Hylek E, Stewart S, Horowitz J. Impact of Female Gender and Admission Heart Rate on Platelet Aggregation and Nitric Oxide Signalling in Atrial Fibrillation. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nguyen T, Neil C, Chong C, Singh K, Heresztyn T, Chirkov Y, Horowitz J. Can Recurrence of Takotsubo Cardiomyopathy be Predicted? Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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