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Ozonoff A, Schaenman J, Jayavelu ND, Milliren CE, Calfee CS, Cairns CB, Kraft M, Baden LR, Shaw AC, Krammer F, van Bakel H, Esserman DA, Liu S, Sesma AF, Simon V, Hafler DA, Montgomery RR, Kleinstein SH, Levy O, Bime C, Haddad EK, Erle DJ, Pulendran B, Nadeau KC, Davis MM, Hough CL, Messer WB, Higuita NIA, Metcalf JP, Atkinson MA, Brakenridge SC, Corry D, Kheradmand F, Ehrlich LI, Melamed E, McComsey GA, Sekaly R, Diray-Arce J, Peters B, Augustine AD, Reed EF, Altman MC, Becker PM, Rouphael N, Ozonoff A, Schaenman J, Jayavelu ND, Milliren CE, Calfee CS, Cairns CB, Kraft M, Baden LR, Shaw AC, Krammer F, van Bakel H, Esserman DA, Liu S, Sesma AF, Simon V, Hafler DA, Montgomery RR, Kleinstein SH, Levy O, Bime C, Haddad EK, Erle DJ, Pulendran B, Nadeau KC, Davis MM, Hough CL, Messer WB, Higuita NIA, Metcalf JP, Atkinson MA, Brakenridge SC, Corry D, Kheradmand F, Ehrlich LI, Melamed E, McComsey GA, Sekaly R, Diray-Arce J, Peters B, Augustine AD, Reed EF, McEnaney K, Barton B, Lentucci C, Saluvan M, Chang AC, Hoch A, Albert M, Shaheen T, Kho AT, Thomas S, Chen J, Murphy MD, Cooney M, Presnell S, Fragiadakis GK, Patel R, Guan L, Gygi J, Pawar S, Brito A, Khalil Z, Maguire C, Fourati S, Overton JA, Vita R, Westendorf K, Salehi-Rad R, Leligdowicz A, Matthay MA, Singer JP, Kangelaris KN, Hendrickson CM, Krummel MF, Langelier CR, Woodruff PG, Powell DL, Kim JN, Simmons B, Goonewardene IM, Smith CM, Martens M, Mosier J, Kimura H, Sherman AC, Walsh SR, Issa NC, Dela Cruz C, Farhadian S, Iwasaki A, Ko AI, Chinthrajah S, Ahuja N, Rogers AJ, Artandi M, Siegel SA, Lu Z, Drevets DA, Brown BR, Anderson ML, Guirgis FW, Thyagarajan RV, Rousseau JF, Wylie D, Busch J, Gandhi S, Triplett TA, Yendewa G, Giddings O, Anderson EJ, Mehta AK, Sevransky JE, Khor B, Rahman A, Stadlbauer D, Dutta J, Xie H, Kim-Schulze S, Gonzalez-Reiche AS, van de Guchte A, Farrugia K, Khan Z, Maecker HT, Elashoff D, Brook J, Ramires-Sanchez E, Llamas M, Rivera A, Perdomo C, Ward DC, Magyar CE, Fulcher JA, Abe-Jones Y, Asthana S, Beagle A, Bhide S, Carrillo SA, Chak S, Fragiadakis GK, Ghale R, Gonzalez A, Jauregui A, Jones N, Lea T, Lee D, Lota R, Milush J, Nguyen V, Pierce L, Prasad PA, Rao A, Samad B, Shaw C, Sigman A, Sinha P, Ward A, Willmore A, Zhan J, Rashid S, Rodriguez N, Tang K, Altamirano LT, Betancourt L, Curiel C, Sutter N, Paz MT, Tietje-Ulrich G, Leroux C, Connors J, Bernui M, Kutzler MA, Edwards C, Lee E, Lin E, Croen B, Semenza NC, Rogowski B, Melnyk N, Woloszczuk K, Cusimano G, Bell MR, Furukawa S, McLin R, Marrero P, Sheidy J, Tegos GP, Nagle C, Mege N, Ulring K, Seyfert-Margolis V, Conway M, Francisco D, Molzahn A, Erickson H, Wilson CC, Schunk R, Sierra B, Hughes T, Smolen K, Desjardins M, van Haren S, Mitre X, Cauley J, Li X, Tong A, Evans B, Montesano C, Licona JH, Krauss J, Chang JBP, Izaguirre N, Chaudhary O, Coppi A, Fournier J, Mohanty S, Muenker MC, Nelson A, Raddassi K, Rainone M, Ruff WE, Salahuddin S, Schulz WL, Vijayakumar P, Wang H, Wunder Jr. E, Young HP, Zhao Y, Saksena M, Altman D, Kojic E, Srivastava K, Eaker LQ, Bermúdez-González MC, Beach KF, Sominsky LA, Azad AR, Carreño JM, Singh G, Raskin A, Tcheou J, Bielak D, Kawabata H, Mulder LCF, Kleiner G, Lee AS, Do ED, Fernandes A, Manohar M, Hagan T, Blish CA, Din HN, Roque J, Yang S, Brunton A, Sullivan PE, Strnad M, Lyski ZL, Coulter FJ, Booth JL, Sinko LA, Moldawer LL, Borresen B, Roth-Manning B, Song LZ, Nelson E, Lewis-Smith M, Smith J, Tipan PG, Siles N, Bazzi S, Geltman J, Hurley K, Gabriele G, Sieg S, Vaysman T, Bristow L, Hussaini L, Hellmeister K, Samaha H, Cheng A, Spainhour C, Scherer EM, Johnson B, Bechnak A, Ciric CR, Hewitt L, Carter E, Mcnair N, Panganiban B, Huerta C, Usher J, Ribeiro SP, Altman MC, Becker PM, Rouphael N. Phenotypes of disease severity in a cohort of hospitalized COVID-19 patients: Results from the IMPACC study. EBioMedicine 2022; 83:104208. [PMID: 35952496 PMCID: PMC9359694 DOI: 10.1016/j.ebiom.2022.104208] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/11/2022] [Accepted: 07/25/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Better understanding of the association between characteristics of patients hospitalized with coronavirus disease 2019 (COVID-19) and outcome is needed to further improve upon patient management. METHODS Immunophenotyping Assessment in a COVID-19 Cohort (IMPACC) is a prospective, observational study of 1164 patients from 20 hospitals across the United States. Disease severity was assessed using a 7-point ordinal scale based on degree of respiratory illness. Patients were prospectively surveyed for 1 year after discharge for post-acute sequalae of COVID-19 (PASC) through quarterly surveys. Demographics, comorbidities, radiographic findings, clinical laboratory values, SARS-CoV-2 PCR and serology were captured over a 28-day period. Multivariable logistic regression was performed. FINDINGS The median age was 59 years (interquartile range [IQR] 20); 711 (61%) were men; overall mortality was 14%, and 228 (20%) required invasive mechanical ventilation. Unsupervised clustering of ordinal score over time revealed distinct disease course trajectories. Risk factors associated with prolonged hospitalization or death by day 28 included age ≥ 65 years (odds ratio [OR], 2.01; 95% CI 1.28-3.17), Hispanic ethnicity (OR, 1.71; 95% CI 1.13-2.57), elevated baseline creatinine (OR 2.80; 95% CI 1.63- 4.80) or troponin (OR 1.89; 95% 1.03-3.47), baseline lymphopenia (OR 2.19; 95% CI 1.61-2.97), presence of infiltrate by chest imaging (OR 3.16; 95% CI 1.96-5.10), and high SARS-CoV2 viral load (OR 1.53; 95% CI 1.17-2.00). Fatal cases had the lowest ratio of SARS-CoV-2 antibody to viral load levels compared to other trajectories over time (p=0.001). 589 survivors (51%) completed at least one survey at follow-up with 305 (52%) having at least one symptom consistent with PASC, most commonly dyspnea (56% among symptomatic patients). Female sex was the only associated risk factor for PASC. INTERPRETATION Integration of PCR cycle threshold, and antibody values with demographics, comorbidities, and laboratory/radiographic findings identified risk factors for 28-day outcome severity, though only female sex was associated with PASC. Longitudinal clinical phenotyping offers important insights, and provides a framework for immunophenotyping for acute and long COVID-19. FUNDING NIH.
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Affiliation(s)
- Al Ozonoff
- Clinical & Data Coordinating Center (CDCC); Precision Vaccines Program, Boston Children's Hospital, Boston, MA, United States
| | - Joanna Schaenman
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
| | | | - Carly E. Milliren
- Clinical & Data Coordinating Center (CDCC); Precision Vaccines Program, Boston Children's Hospital, Boston, MA, United States
| | - Carolyn S. Calfee
- University of California San Francisco School of Medicine, San Francisco, CA, United States
| | - Charles B. Cairns
- Drexel University/Tower Health Hospital, Philadelphia, PA, United States
| | - Monica Kraft
- University of Arizona, Tucson, AZ, United States
| | - Lindsey R. Baden
- Boston Clinical Site: Precision Vaccines Program, Boston Children's Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States
| | - Albert C. Shaw
- Yale School of Medicine, and Yale School of Public Health, New Haven, CT, United States
| | - Florian Krammer
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Harm van Bakel
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Denise A. Esserman
- Yale School of Medicine, and Yale School of Public Health, New Haven, CT, United States
| | - Shanshan Liu
- Clinical & Data Coordinating Center (CDCC); Precision Vaccines Program, Boston Children's Hospital, Boston, MA, United States
| | | | - Viviana Simon
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - David A. Hafler
- Yale School of Medicine, and Yale School of Public Health, New Haven, CT, United States
| | - Ruth R. Montgomery
- Yale School of Medicine, and Yale School of Public Health, New Haven, CT, United States
| | - Steven H. Kleinstein
- Yale School of Medicine, and Yale School of Public Health, New Haven, CT, United States
| | - Ofer Levy
- Boston Clinical Site: Precision Vaccines Program, Boston Children's Hospital, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, United States
| | | | - Elias K. Haddad
- Drexel University/Tower Health Hospital, Philadelphia, PA, United States
| | - David J. Erle
- University of California San Francisco School of Medicine, San Francisco, CA, United States
| | | | | | | | | | | | | | - Jordan P. Metcalf
- Oklahoma University Health Sciences Center, Oklahoma, OK, United States
| | - Mark A. Atkinson
- University of Florida, Gainesville and University of South Florida, Tampa, FL, United States
| | - Scott C. Brakenridge
- University of Florida, Gainesville and University of South Florida, Tampa, FL, United States
| | - David Corry
- Baylor College of Medicine, and the Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey, Houston, TX, United States
| | - Farrah Kheradmand
- Baylor College of Medicine, and the Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey, Houston, TX, United States
| | | | - Esther Melamed
- The University of Texas at Austin, Austin, TX, United States
| | | | - Rafick Sekaly
- Case Western Reserve University, Cleveland, OH, United States
| | - Joann Diray-Arce
- Clinical & Data Coordinating Center (CDCC); Precision Vaccines Program, Boston Children's Hospital, Boston, MA, United States
| | - Bjoern Peters
- La Jolla Institute for Immunology, La Jolla, CA, United States
| | - Alison D. Augustine
- National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, MD, United States
| | - Elaine F. Reed
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, United States
| | | | - Patrice M. Becker
- National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, MD, United States
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Neuman MD, Feng R, Ellenberg SS, Sieber F, Sessler DI, Magaziner J, Elkassabany N, Schwenk ES, Dillane D, Marcantonio ER, Menio D, Ayad S, Hassan M, Stone T, Papp S, Donegan D, Marshall M, Jaffe JD, Luke C, Sharma B, Azim S, Hymes R, Chin KJ, Sheppard R, Perlman B, Sappenfield J, Hauck E, Hoeft MA, Tierney A, Gaskins LJ, Horan AD, Brown T, Dattilo J, Carson JL, Looke T, Bent S, Franco-Mora A, Hedrick P, Newbern M, Tadros R, Pealer K, Vlassakov K, Buckley C, Gavin L, Gorbatov S, Gosnell J, Steen T, Vafai A, Zeballos J, Hruslinski J, Cardenas L, Berry A, Getchell J, Quercetti N, Bajracharya G, Billow D, Bloomfield M, Cuko E, Elyaderani MK, Hampton R, Honar H, Khoshknabi D, Kim D, Krahe D, Lew MM, Maheshwer CB, Niazi A, Saha P, Salih A, de Swart RJ, Volio A, Bolkus K, DeAngelis M, Dodson G, Gerritsen J, McEniry B, Mitrev L, Kwofie MK, Belliveau A, Bonazza F, Lloyd V, Panek I, Dabiri J, Chavez C, Craig J, Davidson T, Dietrichs C, Fleetwood C, Foley M, Getto C, Hailes S, Hermes S, Hooper A, Koener G, Kohls K, Law L, Lipp A, Losey A, Nelson W, Nieto M, Rogers P, Rutman S, Scales G, Sebastian B, Stanciu T, Lobel G, Giampiccolo M, Herman D, Kaufman M, Murphy B, Pau C, Puzio T, Veselsky M, Apostle K, Boyer D, Fan BC, Lee S, Lemke M, Merchant R, Moola F, Payne K, Perey B, Viskontas D, Poler M, D'Antonio P, O'Neill G, Abdullah A, Fish-Fuhrmann J, Giska M, Fidkowski C, Guthrie ST, Hakeos W, Hayes L, Hoegler J, Nowak K, Beck J, Cuff J, Gaski G, Haaser S, Holzman M, Malekzadeh AS, Ramsey L, Schulman J, Schwartzbach C, Azefor T, Davani A, Jaberi M, Masear C, Haider SB, Chungu C, Ebrahimi A, Fikry K, Marcantonio A, Shelvan A, Sanders D, Clarke C, Lawendy A, Schwartz G, Garg M, Kim J, Caruci J, Commeh E, Cuevas R, Cuff G, Franco L, Furgiuele D, Giuca M, Allman M, Barzideh O, Cossaro J, D'Arduini A, Farhi A, Gould J, Kafel J, Patel A, Peller A, Reshef H, Safur M, Toscano F, Tedore T, Akerman M, Brumberger E, Clark S, Friedlander R, Jegarl A, Lane J, Lyden JP, Mehta N, Murrell MT, Painter N, Ricci W, Sbrollini K, Sharma R, Steel PAD, Steinkamp M, Weinberg R, Wellman DS, Nader A, Fitzgerald P, Ritz M, Bryson G, Craig A, Farhat C, Gammon B, Gofton W, Harris N, Lalonde K, Liew A, Meulenkamp B, Sonnenburg K, Wai E, Wilkin G, Troxell K, Alderfer ME, Brannen J, Cupitt C, Gerhart S, McLin R, Sheidy J, Yurick K, Chen F, Dragert K, Kiss G, Malveaux H, McCloskey D, Mellender S, Mungekar SS, Noveck H, Sagebien C, Biby L, McKelvy G, Richards A, Abola R, Ayala B, Halper D, Mavarez A, Rizwan S, Choi S, Awad I, Flynn B, Henry P, Jenkinson R, Kaustov L, Lappin E, McHardy P, Singh A, Donnelly J, Gonzalez M, Haydel C, Livelsberger J, Pazionis T, Slattery B, Vazquez-Trejo M, Baratta J, Cirullo M, Deiling B, Deschamps L, Glick M, Katz D, Krieg J, Lessin J, Mojica J, Torjman M, Jin R, Salpeter MJ, Powell M, Simmons J, Lawson P, Kukreja P, Graves S, Sturdivant A, Bryant A, Crump SJ, Verrier M, Green J, Menon M, Applegate R, Arias A, Pineiro N, Uppington J, Wolinsky P, Gunnett A, Hagen J, Harris S, Hollen K, Holloway B, Horodyski MB, Pogue T, Ramani R, Smith C, Woods A, Warrick M, Flynn K, Mongan P, Ranganath Y, Fernholz S, Ingersoll-Weng E, Marian A, Seering M, Sibenaller Z, Stout L, Wagner A, Walter A, Wong C, Orwig D, Goud M, Helker C, Mezenghie L, Montgomery B, Preston P, Schwartz JS, Weber R, Fleisher LA, Mehta S, Stephens-Shields AJ, Dinh C, Chelly JE, Goel S, Goncz W, Kawabe T, Khetarpal S, Monroe A, Shick V, Breidenstein M, Dominick T, Friend A, Mathews D, Lennertz R, Sanders R, Akere H, Balweg T, Bo A, Doro C, Goodspeed D, Lang G, Parker M, Rettammel A, Roth M, White M, Whiting P, Allen BFS, Baker T, Craven D, McEvoy M, Turnbo T, Kates S, Morgan M, Willoughby T, Weigel W, Auyong D, Fox E, Welsh T, Cusson B, Dobson S, Edwards C, Harris L, Henshaw D, Johnson K, McKinney G, Miller S, Reynolds J, Segal BS, Turner J, VanEenenaam D, Weller R, Lei J, Treggiari M, Akhtar S, Blessing M, Johnson C, Kampp M, Kunze K, O'Connor M, Looke T, Tadros R, Vlassakov K, Cardenas L, Bolkus K, Mitrev L, Kwofie MK, Dabiri J, Lobel G, Poler M, Giska M, Sanders D, Schwartz G, Giuca M, Tedore T, Nader A, Bryson G, Troxell K, Kiss G, Choi S, Powell M, Applegate R, Warrick M, Ranganath Y, Chelly JE, Lennertz R, Sanders R, Allen BFS, Kates S, Weigel W, Li J, Wijeysundera DN, Kheterpal S, Moore RH, Smith AK, Tosi LL, Looke T, Mehta S, Fleisher L, Hruslinski J, Ramsey L, Langlois C, Mezenghie L, Montgomery B, Oduwole S, Rose T. Pain, Analgesic Use, and Patient Satisfaction With Spinal Versus General Anesthesia for Hip Fracture Surgery : A Randomized Clinical Trial. Ann Intern Med 2022; 175:952-960. [PMID: 35696684 DOI: 10.7326/m22-0320] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 02/02/2023] Open
Abstract
BACKGROUND The REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial found similar ambulation and survival at 60 days with spinal versus general anesthesia for hip fracture surgery. Trial outcomes evaluating pain, prescription analgesic use, and patient satisfaction have not yet been reported. OBJECTIVE To compare pain, analgesic use, and satisfaction after hip fracture surgery with spinal versus general anesthesia. DESIGN Preplanned secondary analysis of a pragmatic randomized trial. (ClinicalTrials.gov: NCT02507505). SETTING 46 U.S. and Canadian hospitals. PARTICIPANTS Patients aged 50 years or older undergoing hip fracture surgery. INTERVENTION Spinal or general anesthesia. MEASUREMENTS Pain on postoperative days 1 through 3; 60-, 180-, and 365-day pain and prescription analgesic use; and satisfaction with care. RESULTS A total of 1600 patients were enrolled. The average age was 78 years, and 77% were women. A total of 73.5% (1050 of 1428) of patients reported severe pain during the first 24 hours after surgery. Worst pain over the first 24 hours after surgery was greater with spinal anesthesia (rated from 0 [no pain] to 10 [worst pain imaginable]; mean difference, 0.40 [95% CI, 0.12 to 0.68]). Pain did not differ across groups at other time points. Prescription analgesic use at 60 days occurred in 25% (141 of 563) and 18.8% (108 of 574) of patients assigned to spinal and general anesthesia, respectively (relative risk, 1.33 [CI, 1.06 to 1.65]). Satisfaction was similar across groups. LIMITATION Missing outcome data and multiple outcomes assessed. CONCLUSION Severe pain is common after hip fracture. Spinal anesthesia was associated with more pain in the first 24 hours after surgery and more prescription analgesic use at 60 days compared with general anesthesia. PRIMARY FUNDING SOURCE Patient-Centered Outcomes Research Institute.
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Affiliation(s)
- Mark D Neuman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.N., N.E., L.J.G.)
| | - Rui Feng
- Department of Biostatistics, Epidemiology, and Informatics, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (R.F., S.S.E.)
| | - Susan S Ellenberg
- Department of Biostatistics, Epidemiology, and Informatics, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (R.F., S.S.E.)
| | - Frederick Sieber
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland (F.S.)
| | - Daniel I Sessler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S., S. Ayad, M.H.)
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland (J.M.)
| | - Nabil Elkassabany
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.N., N.E., L.J.G.)
| | - Eric S Schwenk
- Department of Anesthesiology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania (E.S.S.)
| | - Derek Dillane
- Department of Anesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada (D. Dillane)
| | - Edward R Marcantonio
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (E.R.M.)
| | - Diane Menio
- Center for Advocacy for the Rights and Interests of the Elderly, Philadelphia, Pennsylvania (D.M.)
| | - Sabry Ayad
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S., S. Ayad, M.H.)
| | - Manal Hassan
- Department of Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.I.S., S. Ayad, M.H.)
| | - Trevor Stone
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada (T.S.)
| | - Steven Papp
- Division of Orthopaedics, Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada (S.P.)
| | - Derek Donegan
- Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (D. Donegan)
| | - Mitchell Marshall
- Department of Anesthesiology, New York University Langone Medical Center, New York, New York (M.M.)
| | - J Douglas Jaffe
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina (J.D.J.)
| | - Charles Luke
- Department of Anesthesiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (C.L.)
| | - Balram Sharma
- Department of Anesthesiology, Lahey Hospital and Medical Center, Burlington, Massachusetts (B.S.)
| | - Syed Azim
- Department of Anesthesiology, Stony Brook University, Stony Brook, New York (S. Azim)
| | - Robert Hymes
- Department of Orthopedic Surgery, Inova Fairfax Medical Campus, Falls Church, Virginia (R.H.)
| | - Ki-Jinn Chin
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada (K.C.)
| | - Richard Sheppard
- Department of Anesthesiology, Hartford Hospital, Hartford, Connecticut (R.S.)
| | - Barry Perlman
- Oregon Health and Science University, Portland, Oregon (B.P.)
| | - Joshua Sappenfield
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida (J.S.)
| | - Ellen Hauck
- Department of Anesthesiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania (E.H.)
| | - Mark A Hoeft
- Department of Anesthesiology, University of Vermont Larner College of Medicine, Burlington, Vermont (M.A.H.)
| | - Ann Tierney
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (A.T., T.B., J.D.)
| | - Lakisha J Gaskins
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (M.D.N., N.E., L.J.G.)
| | - Annamarie D Horan
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, and Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (A.D.H.)
| | - Trina Brown
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (A.T., T.B., J.D.)
| | - James Dattilo
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (A.T., T.B., J.D.)
| | - Jeffrey L Carson
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (J.L.C.)
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Bhardwaj V, Spaulding EM, Marvel FA, LaFave S, Yu J, Mota D, Lorigiano TJ, Huynh PP, Shan R, Yesantharao PS, Lee MA, Yang WE, Demo R, Ding J, Wang J, Xun H, Shah L, Weng D, Wongvibulsin S, Carter J, Sheidy J, McLin R, Flowers J, Majmudar M, Elgin E, Vilarino V, Lumelsky D, Leung C, Allen JK, Martin SS, Padula WV. Cost-effectiveness of a Digital Health Intervention for Acute Myocardial Infarction Recovery. Med Care 2021; 59:1023-1030. [PMID: 34534188 PMCID: PMC8516712 DOI: 10.1097/mlr.0000000000001636] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) is a common cause of hospital admissions, readmissions, and mortality worldwide. Digital health interventions (DHIs) that promote self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction may improve health outcomes in this population. The "Corrie" DHI consists of a smartphone application, smartwatch, and wireless blood pressure monitor to support medication tracking, education, vital signs monitoring, and care coordination. We aimed to assess the cost-effectiveness of this DHI plus standard of care in reducing 30-day readmissions among AMI patients in comparison to standard of care alone. METHODS A Markov model was used to explore cost-effectiveness from the hospital perspective. The time horizon of the analysis was 1 year, with 30-day cycles, using inflation-adjusted cost data with no discount rate. Currencies were quantified in US dollars, and effectiveness was measured in quality-adjusted life-years (QALYs). The results were interpreted as an incremental cost-effectiveness ratio at a threshold of $100,000 per QALY. Univariate sensitivity and multivariate probabilistic sensitivity analyses tested model uncertainty. RESULTS The DHI reduced costs and increased QALYs on average, dominating standard of care in 99.7% of simulations in the probabilistic analysis. Based on the assumption that the DHI costs $2750 per patient, use of the DHI leads to a cost-savings of $7274 per patient compared with standard of care alone. CONCLUSIONS Our results demonstrate that this DHI is cost-saving through the reduction of risk for all-cause readmission following AMI. DHIs that promote improved adherence with guideline-based health care can reduce hospital readmissions and associated costs.
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Affiliation(s)
- Vinayak Bhardwaj
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
| | - Erin M. Spaulding
- Johns Hopkins University School of Nursing, Baltimore, MD, US
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Francoise A. Marvel
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Sarah LaFave
- Johns Hopkins University School of Nursing, Baltimore, MD, US
| | - Jeffrey Yu
- Johns Hopkins Health System, Baltimore, MD, US
- Dept. of Pharmaceutical & Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, US
| | - Daniel Mota
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Dimock Center, Baltimore, MD, US
| | | | - Pauline P. Huynh
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Rongzi Shan
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Pooja S. Yesantharao
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Matthias A. Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, US
| | - William E. Yang
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, US
| | - Jie Ding
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Jane Wang
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Helen Xun
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Lochan Shah
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Daniel Weng
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Shannon Wongvibulsin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | | | | | | | | | - Maulik Majmudar
- Massachusetts General Hospital, Boston, MA, US
- Harvard Medical School, Boston, MA, US
| | | | - Valerie Vilarino
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD, US
| | - David Lumelsky
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD, US
| | | | - Jerilyn K. Allen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Johns Hopkins University School of Nursing, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
| | - Seth S. Martin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, US
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University School of Medicine, Baltimore, MD, US
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD, US
| | - William V. Padula
- Dept. of Pharmaceutical & Health Economics, School of Pharmacy, University of Southern California, Los Angeles, CA, US
- Leonard D. Schaeffer Center for Health Economics & Policy, University of Southern California, Los Angeles, CA
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4
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Marvel FA, Spaulding EM, Lee MA, Yang WE, Demo R, Ding J, Wang J, Xun H, Shah LM, Weng D, Carter J, Majmudar M, Elgin E, Sheidy J, McLin R, Flowers J, Vilarino V, Lumelsky DN, Bhardwaj V, Padula WV, Shan R, Huynh PP, Wongvibulsin S, Leung C, Allen JK, Martin SS. Digital Health Intervention in Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2021; 14:e007741. [PMID: 34261332 PMCID: PMC8288197 DOI: 10.1161/circoutcomes.121.007741] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 05/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Thirty-day readmissions among patients with acute myocardial infarction (AMI) contribute to the US health care burden of preventable complications and costs. Digital health interventions (DHIs) may improve patient health care self-management and outcomes. We aimed to determine if patients with AMI using a DHI have lower 30-day unplanned all-cause readmissions than a historical control. METHODS This nonrandomized controlled trial with a historical control, conducted at 4 US hospitals from 2015 to 2019, included 1064 patients with AMI (DHI n=200, control n=864). The DHI integrated a smartphone application, smartwatch, and blood pressure monitor to support guideline-directed care during hospitalization and through 30-days post-discharge via (1) medication reminders, (2) vital sign and activity tracking, (3) education, and (4) outpatient care coordination. The Patient Activation Measure assessed patient knowledge, skills, and confidence for health care self-management. All-cause 30-day readmissions were measured through administrative databases. Propensity score-adjusted Cox proportional hazard models estimated hazard ratios of readmission for the DHI group relative to the control group. RESULTS Following propensity score adjustment, baseline characteristics were well-balanced between the DHI versus control patients (standardized differences <0.07), including a mean age of 59.3 versus 60.1 years, 30% versus 29% Women, 70% versus 70% White, 54% versus 54% with private insurance, 61% versus 60% patients with a non ST-elevation myocardial infarction, and 15% versus 15% with high comorbidity burden. DHI patients were predominantly in the highest levels of patient activation for health care self-management (mean score 71.7±16.6 at 30 days). The DHI group had fewer all-cause 30-day readmissions than the control group (6.5% versus 16.8%, respectively). Adjusting for hospital site and a propensity score inclusive of age, sex, race, AMI type, comorbidities, and 6 additional confounding factors, the DHI group had a 52% lower risk for all-cause 30-day readmissions (hazard ratio, 0.48 [95% CI, 0.26-0.88]). Similar results were obtained in a sensitivity analysis employing propensity matching. CONCLUSIONS Our results suggest that in patients with AMI, the DHI may be associated with high patient activation for health care self-management and lower risk of all-cause unplanned 30-day readmissions. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03760796.
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Affiliation(s)
- Francoise A. Marvel
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Erin M. Spaulding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., W.V.P., J.K.A.)
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (E.M.S., S.S.M.)
| | - Matthias A. Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD (M.A.L., R.Y., S.S.M.)
| | - William E. Yang
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD (M.A.L., R.Y., S.S.M.)
| | - Jie Ding
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.D., V.B., J.K.A., S.S.M.)
| | - Jane Wang
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
| | - Helen Xun
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Lochan M. Shah
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Daniel Weng
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | | | - Maulik Majmudar
- Massachusetts General Hospital, Boston (J.C., M.M.)
- Harvard Medical School, Boston, MA (M.M.)
| | - Eric Elgin
- Reading Hospital, West Reading, PA (E.E., J.S., R.M., J.F.)
| | - Julie Sheidy
- Reading Hospital, West Reading, PA (E.E., J.S., R.M., J.F.)
| | - Renee McLin
- Reading Hospital, West Reading, PA (E.E., J.S., R.M., J.F.)
| | | | - Valerie Vilarino
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.D., V.B., J.K.A., S.S.M.)
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.N.L.)
| | - David N. Lumelsky
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.N.L.)
| | - Vinayak Bhardwaj
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., W.V.P., J.K.A.)
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (E.M.S., S.S.M.)
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD (M.A.L., R.Y., S.S.M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.D., V.B., J.K.A., S.S.M.)
- Massachusetts General Hospital, Boston (J.C., M.M.)
- Harvard Medical School, Boston, MA (M.M.)
- Reading Hospital, West Reading, PA (E.E., J.S., R.M., J.F.)
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.N.L.)
- Department of Pharmaceutical and Health Economics, School of Pharmacy (W.V.P.)
- University of Southern California, Los Angeles, CA (W.V.P.)
- Leonard D. Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA (W.V.P.)
- Johns Hopkins Health System, Baltimore, MD (C.L.)
| | - William V. Padula
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., W.V.P., J.K.A.)
- Department of Pharmaceutical and Health Economics, School of Pharmacy (W.V.P.)
- University of Southern California, Los Angeles, CA (W.V.P.)
- Leonard D. Schaeffer Center for Health Economics and Policy, University of Southern California, Los Angeles, CA (W.V.P.)
| | - Rongzi Shan
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
| | - Pauline P. Huynh
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Shannon Wongvibulsin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
| | - Curtis Leung
- Johns Hopkins Health System, Baltimore, MD (C.L.)
| | - Jerilyn K. Allen
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., W.V.P., J.K.A.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.D., V.B., J.K.A., S.S.M.)
| | - Seth S. Martin
- Digital Health Innovation Laboratory, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., E.M.S., J.D., J.W., H.X., L.M.S., D.W., V.V., D.N.L., R.S., P.P.H., S.W., S.S.M.)
- Johns Hopkins University School of Medicine, Baltimore, MD (F.A.M., W.E.Y., J.D., J.W., H.X., L.M.S., D.W., P.P.H., S.W., J.K.A., S.S.M.)
- The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (E.M.S., S.S.M.)
- Johns Hopkins University Whiting School of Engineering, Baltimore, MD (M.A.L., R.Y., S.S.M.)
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.D., V.B., J.K.A., S.S.M.)
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5
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Spaulding EM, Marvel FA, Lee MA, Yang WE, Demo R, Wang J, Xun H, Shah L, Weng D, Fashanu OE, Carter J, Sheidy J, McLin R, Flowers J, Majmudar M, Elgin E, Vilarino V, Lumelsky D, Bhardwaj V, Padula W, Allen JK, Martin SS. Corrie Health Digital Platform for Self-Management in Secondary Prevention After Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2020; 12:e005509. [PMID: 31043065 DOI: 10.1161/circoutcomes.119.005509] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Unplanned readmissions after hospitalization for acute myocardial infarction are among the leading causes of preventable morbidity, mortality, and healthcare costs. Digital health interventions could be an effective tool in promoting self-management, adherence to guideline-directed therapy, and cardiovascular risk reduction. A digital health intervention developed at Johns Hopkins-the Corrie Health Digital Platform (Corrie)-includes the first cardiology Apple CareKit smartphone application, which is paired with an Apple Watch and iHealth Bluetooth-enabled blood pressure cuff. Corrie targets: (1) self-management of cardiac medications, (2) self-tracking of vital signs, (3) education about cardiovascular disease through articles and animated videos, and (4) care coordination that includes outpatient follow-up appointments. METHODS AND RESULTS The 3 phases of the MiCORE study (Myocardial infarction, Combined-device, Recovery Enhancement) include (1) the development of Corrie, (2) a pilot study to assess the usability and feasibility of Corrie, and (3) a prospective research study to primarily compare time to first readmission within 30 days postdischarge among patients with Corrie to patients in the historical standard of care comparison group. In Phase 2, the feasibility of deploying Corrie in an acute care setting was established among a sample of 60 patients with acute myocardial infarction. Phase 3 is ongoing and patients from 4 hospitals are being enrolled as early as possible during their hospital stay if they are 18 years or older, admitted with acute myocardial infarction (ST-segment-elevation myocardial infarction or type I non-ST-segment-elevation myocardial infarction), and own a smartphone. Patients are either being enrolled with their own personal devices or they are provided an iPhone and/or Apple Watch for the duration of the study. Phase 3 started in October 2017 and we aim to recruit 140 participants. CONCLUSIONS This article will provide an in-depth understanding of the feasibility associated with implementing a digital health intervention in an acute care setting and the potential of Corrie as a self-management tool for acute myocardial infarction recovery.
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Affiliation(s)
- Erin M Spaulding
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., J.K.A.)
| | - Francoise A Marvel
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.)
| | - Matthias A Lee
- Whiting School of Engineering, Johns Hopkins University, Baltimore, MD (M.A.L., R.D., S.S.M.)
| | - William E Yang
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Ryan Demo
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.)
| | - Jane Wang
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Helen Xun
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Lochan Shah
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Daniel Weng
- Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
| | - Oluwaseun E Fashanu
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.)
| | | | - Julie Sheidy
- Reading Hospital, West Reading, PA (J.S., R.M., J.F., E.E.)
| | - Renee McLin
- Reading Hospital, West Reading, PA (J.S., R.M., J.F., E.E.)
| | | | | | - Eric Elgin
- Reading Hospital, West Reading, PA (J.S., R.M., J.F., E.E.)
| | - Valerie Vilarino
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.L.)
| | - David Lumelsky
- Johns Hopkins University Krieger School of Arts and Sciences, Baltimore, MD (V.V., D.L.)
| | - Vinayak Bhardwaj
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (V.B., W.P., J.K.A.)
| | - William Padula
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (V.B., W.P., J.K.A.)
| | - Jerilyn K Allen
- Johns Hopkins University School of Nursing, Baltimore, MD (E.M.S., J.K.A.).,Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.).,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (V.B., W.P., J.K.A.)
| | - Seth S Martin
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD (F.A.M., O.E.F., S.S.M.).,Whiting School of Engineering, Johns Hopkins University, Baltimore, MD (M.A.L., R.D., S.S.M.).,Johns Hopkins University School of Medicine, Baltimore, MD (W.E.Y., J.W., H.X., L.S., D.W., J.K.A., S.S.M.)
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