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IsHak WW, Hamilton MA, Korouri S, Diniz MA, Mirocha J, Hedrick R, Chernoff R, Black JT, Aronow H, Vanle B, Dang J, Edwards G, Darwish T, Messineo G, Collier S, Pasini M, Tessema KK, Harold JG, Ong MK, Spiegel B, Wells K, Danovitch I. Comparative Effectiveness of Psychotherapy vs Antidepressants for Depression in Heart Failure: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2352094. [PMID: 38231511 PMCID: PMC10794938 DOI: 10.1001/jamanetworkopen.2023.52094] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/28/2023] [Indexed: 01/18/2024] Open
Abstract
Importance Heart failure (HF) affects more than 6 million adults in the US and more than 64 million adults worldwide, with 50% prevalence of depression. Patients and clinicians lack information on which interventions are more effective for depression in HF. Objective To compare the effectiveness of behavioral activation psychotherapy (BA) vs antidepressant medication management (MEDS) on patient-centered outcomes inpatients with HF and depression. Design, Setting, and Participants This pragmatic randomized comparative effectiveness trial was conducted from 2018 to 2022, including 1-year follow-up, at a not-for-profit academic health system serving more than 2 million people from diverse demographic, socioeconomic, cultural, and geographic backgrounds. Participant included inpatients and outpatients diagnosed with HF and depression, and data were analyzed as intention-to-treat. Data were analyzed from 2022 to 2023. Interventions BA is an evidence-based manualized treatment for depression, promoting engagement in personalized pleasurable activities selected by patients. MEDS involves the use of an evidence-based collaborative care model with care managers providing coordination with patients, psychiatrists, and primary care physicians to only administer medications. Main Outcomes and Measures The primary outcome was depressive symptom severity at 6 months, measured using the Patient Health Questionnaire 9-Item (PHQ-9). Secondary outcomes included physical and mental health-related quality of life (HRQOL), measured using the Short-Form 12-Item version 2 (SF-12); heart failure-specific HRQOL, measured using the Kansas City Cardiomyopathy Questionnaire; caregiver burden, measured with the Caregiver Burden Questionnaire for Heart Failure; emergency department visits; readmissions; days hospitalized; and mortality at 3, 6, and 12 months. Results A total of 416 patients (mean [SD] age, 60.71 [15.61] years; 243 [58.41%] male) were enrolled, with 208 patients randomized to BA and 208 patients randomized to MEDS. At baseline, mean (SD) PHQ-9 scores were 14.54 (3.45) in the BA group and 14.31 (3.60) in the MEDS group; both BA and MEDS recipients experienced nearly 50% reduction in depressive symptoms at 3, 6, and 12 months (eg, mean [SD] score at 12 months: BA, 7.62 (5.73); P < .001; MEDS, 7.98 (6.06); P < .001; between-group P = .55). There was no statistically significant difference between BA and MEDS in the primary outcome of PHQ-9 at 6 months (mean [SD] score, 7.53 [5.74] vs 8.09 [6.06]; P = .88). BA recipients, compared with MEDS recipients, experienced small improvement in physical HRQOL at 6 months (mean [SD] SF-12 physical score: 38.82 [11.09] vs 37.12 [10.99]; P = .04), had fewer ED visits (3 months: 38% [95% CI, 14%-55%] reduction; P = .005; 6 months: 30% [95% CI, 14%-40%] reduction; P = .008; 12 months: 27% [95% CI, 15%-38%] reduction; P = .001), and spent fewer days hospitalized (3 months: 17% [95% CI, 8%-25%] reduction; P = .002; 6 months: 19% [95% CI, 13%-25%] reduction; P = .005; 12 months: 36% [95% CI, 32%-40%] reduction; P = .001). Conclusions and Relevance In this comparative effectiveness trial of BA and MEDS in patients with HF experiencing depression, both treatments significantly reduced depressive symptoms by nearly 50% with no statistically significant differences between treatments. BA recipients experienced better physical HRQOL, fewer ED visits, and fewer days hospitalized. The study findings suggested that patients with HF could be given the choice between BA or MEDS to ameliorate depression. Trial Registration ClinicalTrials.gov Identifier: NCT03688100.
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Affiliation(s)
- Waguih William IsHak
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Michele A. Hamilton
- Smidt Heart Institute, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Samuel Korouri
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Marcio A. Diniz
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - James Mirocha
- Biostatistics Research Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Rebecca Hedrick
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robert Chernoff
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Harriet Aronow
- Department of Nursing Research, Cedars-Sinai Medical Center, Los Angeles, California
| | - Brigitte Vanle
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jonathan Dang
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gabriel Edwards
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tarneem Darwish
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Gabrielle Messineo
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Stacy Collier
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mia Pasini
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - John G. Harold
- Smidt Heart Institute, Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael K. Ong
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Brennan Spiegel
- Division of Health Services Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, California
| | - Kenneth Wells
- David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Itai Danovitch
- Department of Psychiatry and Behavioral Neurosciences, Cedars-Sinai Medical Center, Los Angeles, California
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O'Brien CG, Barnett CF, Dudzinski DM, Sanchez PA, Katz JN, Harold JG, Hennessey EK, Mohabir PK. Training in Critical Care Cardiology Within Critical Care Medicine Fellowship: A Novel Pathway. J Am Coll Cardiol 2022; 79:609-613. [PMID: 35144752 DOI: 10.1016/j.jacc.2021.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Connor G O'Brien
- Department of Medicine, Division of Cardiology, University of California-San Francisco School of Medicine, San Francisco, California, USA.
| | - Christopher F Barnett
- Department of Medicine, Division of Cardiology, University of California-San Francisco School of Medicine, San Francisco, California, USA
| | - David M Dudzinski
- Department of Medicine, Division of Cardiology and Heart Center Intensive Care Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Pablo A Sanchez
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jason N Katz
- Department of Medicine, Division of Cardiovascular Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - John G Harold
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Erin K Hennessey
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Paul K Mohabir
- Department of Medicine, Division of Allergy, Critical Care, and Pulmonary Medicine, Stanford University School of Medicine, Stanford, California, USA
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Schultz WM, Kelli HM, Lisko JC, Varghese T, Shen J, Sandesara P, Quyyumi AA, Taylor HA, Gulati M, Harold JG, Mieres JH, Ferdinand KC, Mensah GA, Sperling LS. Socioeconomic Status and Cardiovascular Outcomes: Challenges and Interventions. Circulation 2018; 137:2166-2178. [PMID: 29760227 PMCID: PMC5958918 DOI: 10.1161/circulationaha.117.029652] [Citation(s) in RCA: 661] [Impact Index Per Article: 110.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Socioeconomic status (SES) has a measurable and significant effect on cardiovascular health. Biological, behavioral, and psychosocial risk factors prevalent in disadvantaged individuals accentuate the link between SES and cardiovascular disease (CVD). Four measures have been consistently associated with CVD in high-income countries: income level, educational attainment, employment status, and neighborhood socioeconomic factors. In addition, disparities based on sex have been shown in several studies. Interventions targeting patients with low SES have predominantly focused on modification of traditional CVD risk factors. Promising approaches are emerging that can be implemented on an individual, community, or population basis to reduce disparities in outcomes. Structured physical activity has demonstrated effectiveness in low-SES populations, and geomapping may be used to identify targets for large-scale programs. Task shifting, the redistribution of healthcare management from physician to nonphysician providers in an effort to improve access to health care, may have a role in select areas. Integration of SES into the traditional CVD risk prediction models may allow improved management of individuals with high risk, but cultural and regional differences in SES make generalized implementation challenging. Future research is required to better understand the underlying mechanisms of CVD risk that affect individuals of low SES and to determine effective interventions for patients with high risk. We review the current state of knowledge on the impact of SES on the incidence, treatment, and outcomes of CVD in high-income societies and suggest future research directions aimed at the elimination of these adverse factors, and the integration of measures of SES into the customization of cardiovascular treatment.
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Affiliation(s)
| | - Heval M Kelli
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | | | | | - Jia Shen
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | - Pratik Sandesara
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | - Arshed A Quyyumi
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
| | | | - Martha Gulati
- University of Arizona-Phoenix College of Medicine (M.G.)
| | - John G Harold
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (J.G.H.)
| | | | | | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.)
| | - Laurence S Sperling
- Emory Clinical Cardiovascular Research Institute (H.M.K., J.S., P.S., A.A.Q., L.S.S.), Emory University School of Medicine, Atlanta, GA
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Zoghbi WA, Duncan T, Antman E, Barbosa M, Champagne B, Chen D, Gamra H, Harold JG, Josephson S, Komajda M, Logstrup S, Jur C, Mayosi BM, Mwangi J, Ralston J, Sacco RL, Sim KH, Smith SC, Vardas PE, Wood DA. Sustainable Development Goals and the future of cardiovascular health. A statement from the Global Cardiovascular Disease Taskforce. Eur Heart J 2014; 35:3238-3239. [PMID: 25629099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
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Anderson JL, Antman EM, Harold JG, Jessup M, O’Gara PT, Pinto FJ, Vardas PE, Zamorano JL. Clinical Practice Guidelines on Perioperative Cardiovascular Evaluation. J Am Coll Cardiol 2014; 64:2371-2. [DOI: 10.1016/j.jacc.2014.07.938] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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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Zoghbi WA, Duncan T, Antman E, Barbosa M, Champagne B, Chen D, Gamra H, Harold JG, Josephson S, Komajda M, Logstrup S, Mayosi BM, Mwangi J, Ralston J, Sacco RL, Sim KH, Smith SC, Vardas PE, Wood DA. Sustainable development goals and the future of cardiovascular health: a statement from the Global Cardiovascular Disease Taskforce. Glob Heart 2014; 9:273-4. [PMID: 25667177 DOI: 10.1016/j.gheart.2014.09.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - K H Sim
- Asian Pacific Society of Cardiology
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7
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Zoghbi WA, Duncan T, Antman E, Barbosa M, Champagne B, Chen D, Gamra H, Harold JG, Josephson S, Komajda M, Logstrup S, Mayosi BM, Mwangi J, Ralston J, Sacco RL, Sim KH, Smith SC, Vardas PE, Wood DA. Sustainable Development Goals and the future of cardiovascular health: a statement from the Global Cardiovascular Disease Taskforce. J Am Heart Assoc 2014; 3:e000504. [PMID: 25246447 PMCID: PMC4323800 DOI: 10.1161/jaha.114.000504] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - K H Sim
- Asian Pacific Society of Cardiology
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8
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Anderson JL, Antman EM, Harold JG, Jessup M, O'Gara PT, Pinto FJ, Vardas PE, Zamorano JL. Clinical Practice Guidelines on Perioperative Cardiovascular Evaluation: collaborative efforts among the American College of Cardiology, the American Heart Association, and the European Society of Cardiology. Eur Heart J 2014; 35:2342-3. [DOI: 10.1093/eurheartj/ehu295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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9
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Taylor J, Smith SC, Collins A, Chen D, Harold JG, Jessup M, Josephson S, Jur C, Logstrup S, Sacco RL, Vardas PE, Wood DA, Zoghbi WA, Bordon WB, Nallamothu BK. Cardiologists urged to reduce inappropriate radiation exposure. Eur Heart J 2013; 34:3525-30. [PMID: 24316977 DOI: 10.1093/eurheartj/eht455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Smith SC, Chen D, Collins A, Harold JG, Jessup M, Josephson S, Logstrup S, Jur C, Sacco RL, Vardas PE, Wood DA, Zoghbi WA. Moving from political declaration to action on reducing the global burden of cardiovascular diseases: a statement from the global cardiovascular disease taskforce. Circulation 2013; 128:2546-8. [PMID: 24045045 DOI: 10.1161/cir.0b013e3182a93504] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Smith SC, Chen D, Collins A, Harold JG, Jessup M, Josephson S, Logstrup S, Sacco RL, Vardas PE, Wood DA, Zoghbi WA. Moving from political declaration to action on reducing the global burden of cardiovascular diseases: a statement from the Global Cardiovascular Disease Taskforce. J Am Coll Cardiol 2013; 62:2151-3. [PMID: 24054821 DOI: 10.1016/j.jacc.2013.08.722] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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12
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Harold JG, Bass TA, Bashore TM, Brindiss RG, Brush JE, Burke JA, Dehmers GJ, Deychak YA, Jneids H, Jolliss JG, Landzberg JS, Levine GN, McClurken JB, Messengers JC, Moussas ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, Whites CJ, Williamss ES, Halperin JL, Beckman JA, Bolger A, Byrne JG, Lester SJ, Merli GJ, Muhlestein JB, Pina IL, Wang A, Weitz HH. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. Catheter Cardiovasc Interv 2013; 82:E69-111. [DOI: 10.1002/ccd.24985] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 11/11/2022]
Affiliation(s)
| | - John G. Harold
- American College of Cardiology Foundation representative
| | - Theodore A. Bass
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | | | | | | | | | | | - Issam D. Moussas
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | - Joshua A. Beckman
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
| | | | | | | | | | | | - Ileana L. Pina
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
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Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE, Burke JA, Dehmer GJ, Deychak YA, Jneid H, Jollis JG, Landzberg JS, Levine GN, McClurken JB, Messenger JC, Moussa ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, White CJ, Williams ES. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (writing committee to revise the 2007 clinical competence statement on cardiac interventional procedures). Circulation 2013; 128:436-72. [PMID: 23658439 DOI: 10.1161/cir.0b013e318299cd8a] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Oetgen WJ, Parikh PD, Cacchione JG, Casale PN, Dove JT, Harold JG, Hindle BL, Maglaras M, Rodgers GP, Wright JS. Characteristics of medical professional liability claims in patients with cardiovascular diseases. Am J Cardiol 2010; 105:745-52. [PMID: 20185027 DOI: 10.1016/j.amjcard.2009.10.072] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 10/25/2009] [Accepted: 10/25/2009] [Indexed: 10/19/2022]
Abstract
This report presents data describing a large cohort of closed cardiovascular medical professional liability (MPL) claims. The Physician Insurers Association of America established a registry of closed MPL claims in 1985. This registry contains data describing 230,624 closed claims for 28 medical specialties through 2007. The registry is maintained to support educational programs designed to improve the quality of care and to reduce patient injury and MPL claims. In this report, descriptive techniques are used to present summary information for the medical cardiovascular claims in the registry. Of 230,624 closed claims, 4,248 (1.8%) involved cardiovascular medical physicians. Of the 4,248 closed cardiovascular medical claims, 770 (18%) resulted in indemnity payments, and the average indemnity payment was $248,291. In the entire database, 30% of closed claims were paid, and the average indemnity payment was $204,268. The most common allegation among cardiovascular closed claims was diagnostic error, and the most prevalent diagnosis was coronary atherosclerosis. Claims involving cardiac catheterization and coronary angioplasty represented 12% and 7% of the cardiovascular closed claims. Aortic aneurysms and dissections, although relatively infrequent as clinical events, represent a substantial MPL risk because of the high percentage of paid claims (30%) and the very high average indemnity payment of $417,298. In conclusion, MPL issues are common and are important to all practicing cardiologists. Detailed knowledge of risks associated with liability claims should assist practicing cardiologists in improving the quality of care, reducing patient injury, and reducing the incidence of claims.
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Abstract
Penetrating aortic ulcers and intramural hematomas cannot always be differentiated by transesophageal echocardiography. We suggest that color and pulsed-wave Doppler flow can be used for identifying penetrating aortic ulcers.
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Affiliation(s)
- S Atar
- Cardiac Non-Invasive Laboratory, Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA
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Carroll BJ, Chandra M, Phillips EH, Harold JG. Laparoscopic cholecystectomy in the heart transplant candidate with acute cholecystitis. J Heart Lung Transplant 1992; 11:831-3. [PMID: 1386754] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We report the first successful laparoscopic cholecystectomy for treatment of acute cholecystitis in a heart transplant candidate with end-stage heart disease. Eight successful cases of conventional cholecystectomy in heart transplant candidates have been reported, but convalescence after the conventional procedure is prolonged, and morbidity often interferes with a timely heart transplantation. Laparoscopic cholecystectomy is a less-invasive method for treatment of symptomatic cholelithiasis and cholecystitis and may be better tolerated in this patient population. Although further study is needed, we believe laparoscopic cholecystectomy will have applications in patients with end-stage heart disease.
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Affiliation(s)
- B J Carroll
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, Calif. 90048
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Harold JG, Siegel RJ, FitzGerald GA, Satoh P, Fishbein MC. Differential prostacyclin production by human umbilical vasculature. Arch Pathol Lab Med 1988; 112:43-6. [PMID: 3276285] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Using the avidin-biotin immunohistochemical technique with rabbit antihuman 6-keto-prostaglandin (PG)-F1 alpha (6KPGF), we studied the distribution of the stable prostacyclin metabolite, 6KPGF, in 14 formaldehyde-fixed human umbilical cords. All umbilical veins demonstrated intense endothelial cell staining. None of the arteries stained. To corroborate the immunohistochemical findings, three fresh umbilical cords were dissected to separate arteries from veins and then were incubated in oxygenated tissue baths containing Ringer's lactate (37 degrees C) for 30 minutes. Cumulative 6KPGF production as measured by radioimmunoassay of tissue effluents was markedly different between arteries and veins with the umbilical vein producing the largest quantity of 6KPGF. Thus, immunohistochemistry and ex vivo capacitance studies suggest that there is a differential distribution of 6KPGF in human umbilical arteries and veins.
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Affiliation(s)
- J G Harold
- Division of Cardiology, Cedars-Sinai Medical Center, UCLA School of Medicine 90048
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Harold JG, Bateman TM, Czer LS, Chaux A, Matloff JM, Gray RJ. Mitral valve replacement early after myocardial infarction: attendant high risk of left ventricular rupture. J Am Coll Cardiol 1987; 9:277-82. [PMID: 3492523 DOI: 10.1016/s0735-1097(87)80375-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Between 1969 and 1983, 608 patients underwent mitral valve replacement surgery at Cedars-Sinai Medical Center. Perioperative rupture of the left ventricular myocardium complicated seven operations (1.2%), five of them in the 247 patients with concomitant ischemic heart disease. Six ruptures were fatal. Relative incidences of seven previously hypothesized predisposing factors were determined for patients with and without myocardial rupture. In addition, because of the apparent frequency of association with ischemic heart disease and because all ruptures were posterior or posterolateral, patients were also categorized by prior history of posterior myocardial infarction: 177 patients had none, whereas 49 patients had a remote and 21 patients a recent (less than or equal to 1 month) posterior wall infarct. Four ruptures (accounting for 57% of all ruptures) occurred in the 21 patients (19% incidence) with a recent posterior infarct, compared with only three ruptures in the 587 patients (0.5%) without a recent posterior wall infarct (p = 0.000). None of the factors of age, sex, valve pathology, etiology of valve lesion, concomitant coronary disease, valve substitute or intraoperative myocardial preservation were associated with perioperative rupture. These data establish a low overall incidence of ventricular rupture after mitral valve replacement, high fatality and possible etiologic association with recent posterior wall infarction.
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Lopez JA, Harold JG, Rosenthal MC, Oseran DS, Schapira JN, Peter T. QT prolongation and torsades de pointes after administration of trimethoprim-sulfamethoxazole. Am J Cardiol 1987; 59:376-7. [PMID: 3492908 DOI: 10.1016/0002-9149(87)90824-1] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Harold JG, Siegel RJ, Edwalds GM, Satoh P, Fishbein MC. Immunohistochemical localization of 6-keto-PGF1-alpha in canine coronary vasculature. Prostaglandins 1985; 29:19-23. [PMID: 3883429 DOI: 10.1016/0090-6980(85)90147-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The localization of the prostacyclin metabolite, 6-keto-PGF1-alpha, in canine coronary vasculature was accomplished using immunohistochemical techniques (avidin-biotin method of immunoperoxidase staining). Six-keto-PGF1-alpha was localized to the intimal endothelial cell layer of epicardial and intramyocardial arteries and veins. No specific staining was seen in the the media or adventitia of canine coronary vasculature, or in capillaries, or myocardial fibers. To our knowledge these studies represent the first immunohistochemical demonstration of the endothelial cell localization of the prostacyclin metabolite, 6-keto-PGF1-alpha. The described technique allows the cellular localization of prostaglandin metabolites in histologic sections.
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