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Reddy KP, Faggioni M, Eberly LA, Halaby R, Sanghavi M, Lewey J, Mehran R, Coylewright M, Herrmann HC, Giri J, Fanaroff AC, Nathan AS. Enrollment of Older Patients, Women, and Racial and Ethnic Minority Individuals in Valvular Heart Disease Clinical Trials: A Systematic Review. JAMA Cardiol 2023; 8:871-878. [PMID: 37494015 DOI: 10.1001/jamacardio.2023.2098] [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] [Indexed: 07/27/2023]
Abstract
Importance Inadequate representation of older patients, women, and racial minority individuals in cardiovascular clinical trials limits both the generalizability of trial findings and inclusivity in access to novel therapies and therapeutic strategies. Objective To report on temporal trends in the representation of older patients, women, and racial and ethnic minority individuals in clinical trials studying treatments for valvular heart disease. Evidence Review All published clinical trials enrolling more than 100 adults with any valvular heart disease published between 2005 and 2020 were included after searches with PubMed and ClinicalTrials.gov. Data on age, sex, race, and ethnicity reported in the included studies were collected. Trials were assigned to 4 time periods based on the publication date, and temporal trends were analyzed in the representation of older patients, women, and racial and ethnic minority individuals. Findings A total of 139 clinical trials with 51 527 participants were identified. Of these trials, 103 (74%) investigated aortic valve disease and the remainder mitral valve disease. Overall, 63 trials (45.3%) enrolled patients only in Europe, 24 (17.3%) only in North America, and 19 (13.7%) in multiple geographical regions. The weighted mean (SD) age of enrolled patients was 68.4 (11.4) years, increasing nonsignificantly from 61.9 (5.9) years in 2005-2008 to 72.8 (9.6) years in 2017-2020 (P = .09 for trend). The overall proportion of women enrolled in valvular heart disease trials was 41.1%, with no significant changes over time. Data on race and ethnicity of trial participants were reported in 13 trials (9.4%), in which trial-level representation of American Indian/Alaska Native, Asian, Black/African American, Hispanic, and Native Hawaiian/Pacific Islander patients ranged from 0.27% to 43.9%. There were no significant temporal trends noted in the enrollment of racial and ethnic minority populations. The representation of women in clinical trials was positively associated with enrollment rates of older patients and underrepresented racial and ethnic groups. Conclusions and Relevance This review found that over the past 2 decades, women and racial and ethnic minority individuals have remained underrepresented in North American valvular heart disease clinical trials. Further work is needed to improve the reporting of race and ethnicity data and address barriers to trial enrollment for older patients, women, and racial and ethnic minority individuals.
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Affiliation(s)
- Kriyana P Reddy
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
| | - Michela Faggioni
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Lauren A Eberly
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Rim Halaby
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Monika Sanghavi
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Jennifer Lewey
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
- Associate Editor, JAMA Cardiology
| | | | - Howard C Herrmann
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander C Fanaroff
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ashwin S Nathan
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Fanaroff AC, Coratti S, Halaby R, Sanghavi M, O'Quinn RP, Krishnan S, Glassberg H, Bajaj A, Adusumalli S, Chokshi N, Patel MS. Feasibility and outcomes from using a commitment device and text message reminders to increase adherence to time-restricted eating: A randomized trial. Am Heart J 2023; 258:85-95. [PMID: 36640862 PMCID: PMC11010633 DOI: 10.1016/j.ahj.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Obesity is strongly associated with cardiovascular disease, particularly through its effects on blood pressure. Though maintaining a negative caloric balance leads to weight loss, many patients struggle to adhere to low calorie diets over the long term. Time-restricted eating, a subtype of intermittent fasting (IF), may be an easier dietary pattern for patients to initiate and maintain. We tested the feasibility of a bidirectional texting strategy to help patients with obesity and hypertension initiate and maintain time-restricted eating, and whether a commitment device, a pledge to behave in a certain way in the future while making nonadherence costlier, would increase adherence beyond bidirectional texting. METHODS Patients with obesity and hypertension seen in cardiology clinics were provided education on time-restricted eating and randomized to a commitment device versus attention control. Attention control consisted of daily bidirectional text messages asking whether patients adhered to IF and weekly text messages asking participants to send their weight and blood pressure. The commitment device involved the same text messages as attention control, plus a commitment contract, setting of implementation intentions with respect to details of time-restricted eating, and involvement of a support partner who received weekly updates on the participant's adherence to time-restricted eating. The intervention lasted 12 weeks, followed by a 6-week follow-up period. The primary outcome was days per week adherent to time-restricted eating over the 18-week study period, measured by daily self-report. We also compared change from baseline weight and blood pressure between randomized groups. RESULTS A total of 37 patients were randomized and started the study-20 to attention control and 17 to the commitment device. Mean age was 60 years old, and mean BMI was 38.4 kg/m2. Over the 18-week study period, the mean ± standard deviation (SD) number of days per week adherent to time-restricted eating was 4.7 ± 1.9 in the control arm and 5.4 ± 1.7 in the intervention arm (P = .23). Mean systolic blood pressure declined from 135 to 128 mm Hg among all participants (P = .006) with no difference between groups in change from baseline blood pressure (P = .74). Weight decreased from 229 to 223 pounds among all participants (P = .25) with no significant difference between groups in change from baseline weight (P = .84). CONCLUSIONS A bidirectional texting strategy was feasible for helping patients with obesity and hypertension initiate and adhere to time-restricted eating. Adding a commitment device to bidirectional texting did not increase adherence to time-restricted eating compared with attention control, nor were there significant between group changes in blood pressure or weight, but these comparisons were underpowered. A larger randomized trial of the effect of this scalable intervention, compared with usual care, on blood pressure and weight among patients with obesity and hypertension is warranted. CLINICAL TRIALS REGISTRATION clinicaltrials.gov; unique identifier: NCT04836312.
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Affiliation(s)
- Alexander C Fanaroff
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA; Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, PA; Center for Health Economics and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Penn Center for Digital Cardiology, University of Pennsylvania, Philadelphia, PA.
| | - Samantha Coratti
- Center for Health Economics and Behavioral Economics, University of Pennsylvania, Philadelphia, PA
| | - Rim Halaby
- National Institutes of Health, Bethesda, MD
| | - Monika Sanghavi
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rupal P O'Quinn
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA; Penn Center for Digital Cardiology, University of Pennsylvania, Philadelphia, PA
| | - Sheela Krishnan
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA
| | - Helene Glassberg
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA
| | - Archna Bajaj
- Division of Translational Medicine & Human Genetics, University of Pennsylvania, Philadelphia, PA
| | - Srinath Adusumalli
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Penn Center for Digital Cardiology, University of Pennsylvania, Philadelphia, PA; CVS Health, Woonsocket, RI
| | - Neel Chokshi
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA; Penn Center for Digital Cardiology, University of Pennsylvania, Philadelphia, PA
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Reddy KP, Eberly LA, Halaby R, Julien H, Khatana SAM, Dayoub EJ, Coylewright M, Alkhouli M, Fiorilli PN, Kobayashi TJ, Goldberg DM, Santangeli P, Herrmann HC, Giri J, Groeneveld PW, Fanaroff AC, Nathan AS. Racial, Ethnic, and Socioeconomic Inequities in Access to Left Atrial Appendage Occlusion. J Am Heart Assoc 2023; 12:e028032. [PMID: 36802837 PMCID: PMC10111439 DOI: 10.1161/jaha.122.028032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Background Inequitable access to high-technology therapeutics may perpetuate inequities in care. We examined the characteristics of US hospitals that did and did not establish left atrial appendage occlusion (LAAO) programs, the patient populations those hospitals served, and the associations between zip code-level racial, ethnic, and socioeconomic composition and rates of LAAO among Medicare beneficiaries living within large metropolitan areas with LAAO programs. Methods and Results We conducted cross-sectional analyses of Medicare fee-for-service claims for beneficiaries aged 66 years or older between 2016 and 2019. We identified hospitals establishing LAAO programs during the study period. We used generalized linear mixed models to measure the association between zip code-level racial, ethnic, and socioeconomic composition and age-adjusted rates of LAAO in the most populous 25 metropolitan areas with LAAO sites. During the study period, 507 candidate hospitals started LAAO programs, and 745 candidate hospitals did not. Most new LAAO programs opened in metropolitan areas (97.4%). Compared with non-LAAO centers, LAAO centers treated patients with higher median household incomes (difference of $913 [95% CI, $197-$1629], P=0.01). Zip code-level rates of LAAO procedures per 100 000 Medicare beneficiaries in large metropolitan areas were 0.34% (95% CI, 0.33%-0.35%) lower for each $1000 zip code-level decrease in median household income. After adjustment for socioeconomic markers, age, and clinical comorbidities, LAAO rates were lower in zip codes with higher proportions of Black or Hispanic patients. Conclusions Growth in LAAO programs in the United States had been concentrated in metropolitan areas. LAAO centers treated wealthier patient populations in hospitals without LAAO programs. Within major metropolitan areas with LAAO programs, zip codes with higher proportions of Black and Hispanic patients and more patients experiencing socioeconomic disadvantage had lower age-adjusted rates of LAAO. Thus, geographic proximity alone may not ensure equitable access to LAAO. Unequal access to LAAO may reflect disparities in referral patterns, rates of diagnosis, and preferences for using novel therapies experienced by racial and ethnic minority groups and patients experiencing socioeconomic disadvantage.
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Affiliation(s)
- Kriyana P Reddy
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA
| | - Lauren A Eberly
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Rim Halaby
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA
| | - Howard Julien
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Sameed Ahmed M Khatana
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Elias J Dayoub
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | | | | | - Paul N Fiorilli
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Taisei J Kobayashi
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | | | - Pasquale Santangeli
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA
| | - Howard C Herrmann
- Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
| | - Peter W Groeneveld
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA.,Division of General Internal Medicine, Perelman School of Medicine University of Pennsylvania Philadelphia PA
| | - Alexander C Fanaroff
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA
| | - Ashwin S Nathan
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center University of Pennsylvania Philadelphia PA.,Division of Cardiology Hospital of the University of Pennsylvania Philadelphia PA.,Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia PA.,Corporal Michael J. Crescenz VA Medical Center Philadelphia PA
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Halaby R, Vidula MK, Gillespie MJ, Herrmann HC, Chen T. Multimodality Imaging for Procedural Planning and Guidance of Percutaneous Sinus Venosus Defect Closure. JACC Cardiovasc Interv 2022; 15:e187-e188. [PMID: 35907748 DOI: 10.1016/j.jcin.2022.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/05/2022] [Accepted: 06/14/2022] [Indexed: 10/16/2022]
Affiliation(s)
- Rim Halaby
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mahesh K Vidula
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew J Gillespie
- Division of Cardiovascular Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Howard C Herrmann
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tiffany Chen
- Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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Fiorilli PN, Halaby R. Self-expanding TAVR in large annuli: Challenges and implications. Cardiovasc Revasc Med 2021; 35:27-28. [PMID: 34893446 DOI: 10.1016/j.carrev.2021.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Paul N Fiorilli
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
| | - Rim Halaby
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
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Halaby R, Hirji S, Han J. Different Paths for Careers in Structural Heart Disease: Trainees Perspective. J Am Coll Cardiol 2021; 78:532-536. [PMID: 34325841 DOI: 10.1016/j.jacc.2021.04.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/01/2021] [Accepted: 04/07/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Rim Halaby
- Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Sameer Hirji
- Division of Cardiothoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA. https://twitter.com/hirji1987
| | - Jason Han
- Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA. https://twitter.com/jasonhanmd
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Halaby R, Giri J, Herrmann HC, Kobayashi TJ, Fiorilli P, Fanaroff AC, Nathan AS. Lack of Association Between Percutaneous Coronary Intervention and Transcatheter Aortic Valve Replacement Outcomes in New York Hospitals. Circ Cardiovasc Interv 2021; 14:e010750. [PMID: 34320840 DOI: 10.1161/circinterventions.121.010750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Rim Halaby
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Jay Giri
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Howard C Herrmann
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Taisei J Kobayashi
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Paul Fiorilli
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Alexander C Fanaroff
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
| | - Ashwin S Nathan
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia
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Halaby R, Cuker A, Yui J, Matthews A, Ishaaya E, Traxler E, Domenico C, Cooper T, Tierney A, Niami P, van der Rijst N, Adusumalli S, Gutsche J, Giri J, Pugliese S, Hecht TEH, Pishko AM. Bleeding risk by intensity of anticoagulation in critically ill patients with COVID-19: A retrospective cohort study. J Thromb Haemost 2021; 19:1533-1545. [PMID: 33774903 PMCID: PMC8250316 DOI: 10.1111/jth.15310] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/23/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Studies report hypercoagulability in coronavirus disease 2019 (COVID-19), leading many institutions to escalate anticoagulation intensity for thrombosis prophylaxis. OBJECTIVE To determine the bleeding risk with various intensities of anticoagulation in critically ill patients with COVID-19 compared with other respiratory viral illnesses (ORVI). PATIENTS/METHODS This retrospective cohort study compared the incidence of major bleeding in patients admitted to an intensive care unit (ICU) within a single health system with COVID-19 versus ORVI. In the COVID-19 cohort, we assessed the effect of anticoagulation intensity received on ICU admission on bleeding risk. We performed a secondary analysis with anticoagulation intensity as a time-varying covariate to reflect dose changes after ICU admission. RESULTS Four hundred and forty-three and 387 patients were included in the COVID-19 and ORVI cohorts, respectively. The hazard ratio of major bleeding for the COVID-19 cohort relative to the ORVI cohort was 1.26 (95% confidence interval [CI]: 0.86-1.86). In COVID-19 patients, an inverse-probability treatment weighted model found therapeutic-intensity anticoagulation on ICU admission had an adjusted hazard ratio of bleeding of 1.55 (95% CI: 0.88-2.73) compared with standard prophylactic-intensity anticoagulation. However, when anticoagulation was assessed as a time-varying covariate and adjusted for other risk factors for bleeding, the adjusted hazard ratio for bleeding on therapeutic-intensity anticoagulation compared with standard thromboprophylaxis was 2.59 (95% CI: 1.20-5.57). CONCLUSIONS Critically ill patients with COVID-19 had a similar bleeding risk as ORVI patients. When accounting for changes in anticoagulation that occurred in COVID-19 patients, therapeutic-intensity anticoagulation was associated with a greater risk of major bleeding compared with standard thromboprophylaxis.
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Affiliation(s)
- Rim Halaby
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Adam Cuker
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer Yui
- Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Andrew Matthews
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ella Ishaaya
- Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Elizabeth Traxler
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher Domenico
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Tara Cooper
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Ann Tierney
- Department of Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Pardis Niami
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Nathalie van der Rijst
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Srinath Adusumalli
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jacob Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jay Giri
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Pugliese
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Todd E H Hecht
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Allyson M Pishko
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Halaby R, Herrmann HC, Gertz ZM, Lim S, Kar S, Lindenfeld J, Abraham WT, Grayburn PA, Naidu S, Asch FM, Weissman NJ, Zhang Y, Mack MJ, Stone GW. Effect of Mitral Valve Gradient After MitraClip on Outcomes in Secondary Mitral Regurgitation: Results From the COAPT Trial. JACC Cardiovasc Interv 2021; 14:879-889. [PMID: 33888233 DOI: 10.1016/j.jcin.2021.01.049] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/24/2020] [Accepted: 01/19/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The authors sought to evaluate the association between mean mitral valve gradient (MVG) and clinical outcomes among patients who underwent MitraClip treatment for secondary mitral regurgitation (SMR) in the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial. BACKGROUND In the COAPT trial, patients with heart failure (HF) and severe SMR who remained symptomatic despite guideline-directed medical therapy had marked 2-year reductions in mortality and HF hospitalizations after treatment with MitraClip. METHODS MitraClip-treated patients were divided into quartiles (Q) based on discharge echocardiographic MVG (n = 250). Endpoints including all-cause mortality, HF hospitalization, and health status measures at 2 years were compared between quartiles. RESULTS Mean MVG after MitraClip was 2.1 ± 0.4 mm Hg, 3.0 ± 0.2 mm Hg, 4.2 ± 0.5 mm Hg, and 7.2 ± 2.0 mm Hg in Q1 (n = 63), Q2 (n = 61), Q3 (n = 62), and Q4 (n = 64), respectively. There was no difference across quartiles in the 2-year composite endpoint of all-cause mortality or HF hospitalization (43.2%, 49.2%, 40.6%, and 40.9%, respectively; p = 0.80), nor in improvements in New York Heart Association functional class, Kansas City Cardiomyopathy Questionnaire score, or 6-min walk time. Results were similar after adjustment for baseline clinical and echocardiographic characteristics, post-procedure MR grade, and number of clips (all-cause mortality or HF hospitalization Q4 [44.6%] vs. Q1 to Q3 [40.3%]; adjusted hazard ratio: 1.23, 95% confidence interval: 0.60 to 2.51; p = 0.57). CONCLUSIONS Among HF patients with severe SMR, higher MVGs on discharge did not adversely affect clinical outcomes following MitraClip. These findings suggest that in select patients with HF and SMR otherwise meeting the COAPT inclusion criteria, the benefits of MR reduction may outweigh the effects of mild-to-moderate mitral stenosis after MitraClip.
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Affiliation(s)
- Rim Halaby
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA. https://twitter.com/rimhalabymd
| | - Howard C Herrmann
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Zachary M Gertz
- Division of Cardiology, Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA
| | - Scott Lim
- Division of Cardiovascular Medicine, University of Virginia Health System Hospital, University of Virginia, Charlottesville, Virginia, USA
| | - Saibal Kar
- Interventional Cardiology, Los Robles Regional Medical Center, Thousand Oaks, California, USA
| | - JoAnn Lindenfeld
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
| | - Paul A Grayburn
- Division of Cardiology, Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA
| | - Suveeksha Naidu
- Cardiovascular Division, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Yiran Zhang
- Cardiovascular Research Foundation, New York, New York, USA
| | - Michael J Mack
- Division of Cardiology, Baylor Scott & White Heart and Vascular Hospital, Dallas, Texas, USA
| | - Gregg W Stone
- Cardiovascular Research Foundation, New York, New York, USA; Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA. https://twitter.com/GreggWStone
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Pothineni NVK, Starkey S, Conn K, Evans C, Shah R, Hyman MC, Frankel DS, Halaby R, Johnston-Cox HA, Kunkel K, Nathan AS, Seigerman ME, Herrmann HC, Giri J, Marchlinski FE, Santangeli P, Fanaroff AC. Patient and Staff Perceptions of Universal Severe Acute Respiratory Syndrome Coronavirus 2 Screening Prior to Cardiac Catheterization and Electrophysiology Laboratory Procedures. Circ Cardiovasc Interv 2020; 13:e009975. [PMID: 33272035 PMCID: PMC7732150 DOI: 10.1161/circinterventions.120.009975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Naga Venkata K. Pothineni
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Samantha Starkey
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Kristine Conn
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Christina Evans
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Ronak Shah
- Department of Anesthesiology and Critical Care (R.S., M.C.H., D.S.F., R.H., H.A.J.-C.), University of Pennsylvania, Philadelphia
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Matthew C. Hyman
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Department of Anesthesiology and Critical Care (R.S., M.C.H., D.S.F., R.H., H.A.J.-C.), University of Pennsylvania, Philadelphia
| | - David S. Frankel
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Department of Anesthesiology and Critical Care (R.S., M.C.H., D.S.F., R.H., H.A.J.-C.), University of Pennsylvania, Philadelphia
| | - Rim Halaby
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Department of Anesthesiology and Critical Care (R.S., M.C.H., D.S.F., R.H., H.A.J.-C.), University of Pennsylvania, Philadelphia
| | - Hillary A. Johnston-Cox
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Department of Anesthesiology and Critical Care (R.S., M.C.H., D.S.F., R.H., H.A.J.-C.), University of Pennsylvania, Philadelphia
| | - Katherine Kunkel
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Ashwin S. Nathan
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Cardiovascular Outcomes Quality and Evaluative Research Center and Leonard Davis Institute (A.S.N., J.G., A.C.F.), University of Pennsylvania, Philadelphia
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Matthew E. Seigerman
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Howard C. Herrmann
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Jay Giri
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Cardiovascular Outcomes Quality and Evaluative Research Center and Leonard Davis Institute (A.S.N., J.G., A.C.F.), University of Pennsylvania, Philadelphia
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Francis E. Marchlinski
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Pasquale Santangeli
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
| | - Alexander C. Fanaroff
- Division of Cardiovascular Medicine (N.V.K.P., M.C.H., D.S.F., R.H., H.A.J.-C., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.), University of Pennsylvania, Philadelphia
- Cardiovascular Outcomes Quality and Evaluative Research Center and Leonard Davis Institute (A.S.N., J.G., A.C.F.), University of Pennsylvania, Philadelphia
- Penn Heart and Vascular Center, Philadelphia, PA (N.V.K.P., S.S., K.C., C.E., R.S., K.K., A.S.N., M.E.S., H.C.H., J.G., F.E.M., P.S., A.C.F.)
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Halaby R, Herrmann H, Lim S, Kar S, Kar, Lindenfeld J, Abraham W, Grayburn PA, Asch FM, Weissman NJ, Zhang Y, Mack M, Stone G. LACK OF ASSOCIATION OF MITRAL VALVE GRADIENT AFTER MITRACLIP WITH OUTCOMES IN FUNCTIONAL MITRAL REGURGITATION: RESULTS FROM THE COAPT TRIAL. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31936-7] [Citation(s) in RCA: 2] [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: 10/24/2022]
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Affiliation(s)
- Rim Halaby
- 1 Cardiovascular Medicine Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jay Giri
- 1 Cardiovascular Medicine Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,2 Penn Cardiovascular Outcomes Quality & Evaluative Research Center, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Gibson CM, Jennings LK, Chi G, Yee MK, Halaby R, Nafee T, AlKhalfan F, Kerneis M, Korjian S, Daaboul Y, Goldhaber SZ, Hull RD, Hernandez AF, Cohen AT, Harrington RA. Association of D-dimer Levels with Clinical Event Rates and the Efficacy of Betrixaban versus Enoxaparin in the APEX Trial. TH Open 2018; 2:e16-e24. [PMID: 31249924 PMCID: PMC6524856 DOI: 10.1055/s-0037-1615288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 09/05/2017] [Accepted: 11/20/2017] [Indexed: 11/12/2022] Open
Abstract
Background Elevated D-dimer concentrations are associated with an increased risk of venous thromboembolism (VTE). However, they may also provide prognostic value. The present analysis sought to study the association of D-dimer levels with VTE event rates and the efficacy of betrixaban versus enoxaparin in the APEX trial. Methods Hospitalized acutely medically ill subjects ( n = 7,513) were randomized in a double-dummy double-blind fashion to either extended-duration oral betrixaban (80 mg once daily for 35-42 days) or standard dose subcutaneous enoxaparin (40 mg once daily for 10 ± 4 days) for venous thromboprophylaxis. D-dimer was assessed using a central core laboratory measurement. Results For every 0.25 µg/mL increase in D-dimer concentration, there was a 2% increase in the relative risk of experiencing the primary efficacy endpoint (asymptomatic deep vein thrombosis [DVT], symptomatic DVT, nonfatal pulmonary embolism, or VTE-related death) in both the betrixaban ( p < 0.001) and enoxaparin ( p < 0.001) treatment arms. Among D-dimer-positive (≥ 2 × upper limit of normal; corresponding to ≥ 1.00 µg/mL) subjects, extended-duration betrixaban reduced the risk of experiencing the primary efficacy outcome (5.4% [ n = 124] vs. 7.6% [ n = 170]; odds ratio = 0.69; 95% confidence interval: 0.55-0.88; absolute risk reduction = 2.2%, number needed to treat = 46, p = 0.003). There was no interaction between D-dimer and the treatment effect ( p int = 0.53). Conclusion Extended-duration betrixaban was superior to standard-duration enoxaparin, irrespective of D-dimer level at baseline. To prevent one VTE event, 46 D-dimer-positive patients would need to be treated with betrixaban.
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Affiliation(s)
- C. Michael Gibson
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Lisa K. Jennings
- CirQuest Labs, The University of Tennessee Health Science Center, Memphis, Tennessee, United States
| | - Gerald Chi
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Megan K. Yee
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Rim Halaby
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Tarek Nafee
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Fahad AlKhalfan
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Mathieu Kerneis
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Serge Korjian
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Yazan Daaboul
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Samuel Z. Goldhaber
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Russel D. Hull
- Division of Cardiology, Faculty of Medicine, University of Calgary, Alberta, Canada
| | - Adrian F. Hernandez
- Division of Cardiology, Duke University and Duke Clinical Research Institute, Durham, North Carolina, United States
| | - Alexander T. Cohen
- Department of Haematological Medicine, Guy's and St. Thomas' Hospitals, King's College London, London, United Kingdom
| | - Robert A. Harrington
- Department of Medicine, Stanford University, Stanford, California, United States
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Gibson C, Arbetter D, Jain P, Halaby R, Chi G, Nafee T, Korjian S, Daaboul Y, Harrington R, Goldhaber S, Hull R, Gold A, Cohen A. P1551D-dimer concentration is associated with increased risk for VTE and greater absolute benefit of extended prophylaxis with betrixaban in acutely Ill medical patients: insights from the APEX trial. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1551] [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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Gibson C, Arbetter D, Jain P, Halaby R, Chi G, Nafee T, Korjian S, Daaboul Y, Goldhaber S, Hull R, Gold A, Hernandez A, Cohen A, Harrington R. P1732Extended duration betrixaban in acutely ill medical patients is associated with reduction in fatal or irreversible ischemic or bleeding events compared with standard dose enoxaparin: an APEX substudy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1732] [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: 11/13/2022] Open
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Gibson CM, Giugliano RP, Kloner RA, Bode C, Tendera M, Jánosi A, Merkely B, Godlewski J, Halaby R, Korjian S, Daaboul Y, Chakrabarti AK, Spielman K, Neal BJ, Weaver WD. EMBRACE STEMI study: a Phase 2a trial to evaluate the safety, tolerability, and efficacy of intravenous MTP-131 on reperfusion injury in patients undergoing primary percutaneous coronary intervention. Eur Heart J 2015; 37:1296-303. [DOI: 10.1093/eurheartj/ehv597] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/04/2015] [Indexed: 01/24/2023] Open
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Halaby R, Popma CJ, Cohen A, Chi G, Zacarkim MR, Romero G, Goldhaber SZ, Hull R, Hernandez A, Mentz R, Harrington R, Lip G, Peacock F, Welker J, Martin-Loeches I, Daaboul Y, Korjian S, Gibson CM. D-Dimer elevation and adverse outcomes. J Thromb Thrombolysis 2015; 39:55-9. [PMID: 25006010 PMCID: PMC4300425 DOI: 10.1007/s11239-014-1101-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
d-Dimer is a biomarker of fibrin formation and degradation. While a d-dimer within normal limits is used to rule out the diagnosis of deep venous thrombosis and pulmonary embolism among patients with a low clinical probability of venous thromboembolism (VTE), the prognostic association of an elevated d-dimer with adverse outcomes has received far less emphasis. An elevated d-dimer is independently associated with an increased risk for incident VTE, recurrent VTE, and mortality. An elevated d-dimer is an independent correlate of increased mortality and subsequent VTE across a broad variety of disease states. Therefore, medically ill subjects in whom the d-dimer is elevated constitute a high risk subgroup in which the prospective evaluation of the efficacy and safety of antithrombotic therapy is warranted.
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Affiliation(s)
- Rim Halaby
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, East Campus, RW 459, Boston, MA, 02215, USA
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Korjian S, Daaboul Y, Halaby R, Goldhaber SZ, Cohen AT, Singh K, Susheela AT, Harrington RA, Hull RD, Hernandez AF, Gibson CM. Extended-Duration Thromboprophylaxis Among Acute Medically Ill Patients. J Cardiovasc Pharmacol Ther 2015; 21:227-32. [DOI: 10.1177/1074248415601894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 07/02/2015] [Indexed: 01/08/2023]
Abstract
Acute medical illnesses are associated with a prolonged elevation in inflammatory markers that predisposes patients to thrombosis beyond the duration of their hospital stay. In parallel, both observational and randomized data have demonstrated a rate of postdischarge venous thromboembolic events that often exceeds that observed in the hospital setting. Despite this significant residual risk of venous thromboembolic events following discharge among acute medically ill patients, no therapeutic strategies have been recommended to address this unmet need. Available randomized trials have demonstrated the efficacy of extending the duration of thromboprophylaxis with available anticoagulants; however, the efficacy is offset, at least in part, by an increase in bleeding events. Identification of the optimal therapeutic strategies, treatment duration, and risk assessment tools that reconcile both efficacy and safety of extended-duration thromboprophylaxis among acute medically ill patients is an area of ongoing investigation.
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Affiliation(s)
- Serge Korjian
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Yazan Daaboul
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rim Halaby
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Samuel Z. Goldhaber
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander T. Cohen
- Department of Haematology, Guys and St Thomas’ NHS Trust, London, United Kingdom
| | - Kiran Singh
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ammu T. Susheela
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Robert A. Harrington
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Russell D. Hull
- Department of Medicine, Foothills Hospital, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adrian F. Hernandez
- Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - C. Michael Gibson
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Affiliation(s)
- Robert G Badgett
- Department of Internal Medicine, Kansas University School of Medicine, Wichita2Department of Preventive Medicine and Public Health, Kansas University School of Medicine, Wichita
| | - Mohinder Vindhyal
- Department of Internal Medicine, Kansas University School of Medicine, Wichita3Department of Pediatrics, Kansas University School of Medicine, Wichita
| | | | - C Michael Gibson
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rim Halaby
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Aragon JR, Korjian S, Halaby R, Daaboul Y, Shenoda M, Price S, Bacon J, Beckord B, Miller J, Florea A, Spielman K, Cochet M, Stepanchak M, Gibson CM. INTRACORONARY BIVALIRUDIN ADMINISTRATION IN STEMI IMPROVES CORONARY FLOW. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60121-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bahous SA, Khairallah M, Al Danaf J, Halaby R, Korjian S, Daaboul Y, Salameh P, Stephan A, Blacher J, Safar ME. Renal function decline in recipients and donors of kidney grafts: role of aortic stiffness. Am J Nephrol 2015; 41:57-65. [PMID: 25662778 DOI: 10.1159/000371858] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 12/28/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Renal function decreases over time as a result of reduction in the number of functioning nephrons with age. In recipients and donors of kidney grafts, renal function decline may be linked differently to various parameters, namely arterial stiffness. METHODS We conducted a prospective cohort study including 101 recipients of kidney grafts and their donors aiming at determining the factors correlated to the renal function decline over time. Aortic stiffness was evaluated by the non-invasive measurement of aortic pulse wave velocity. The glomerular filtration rate was estimated using the Modification of Diet in Renal Disease (MDRD) equation and the annualized change was determined. RESULTS Decline in renal function was estimated at 1-year post-transplantation and annually thereafter (median follow-up 8 years, range 3.6-18.3), as the mean of the annualized decrease in the glomerular filtration rate. In recipients, filtration rate decreased by 4.8 ± 19.7 ml/min/1.73 m(2) the first post-transplant year and at a yearly rate of 2.2 ± 3.8 ml/min/1.73 m(2) thereafter. The first-year decline was related to smoking and acute rejection. Later decline was significantly associated with donor age and aortic stiffness. In living donors, renal function decline after the first year corresponded to 0.7 ml/min/1.73 m(2), was significantly lower than that of recipients (p < 0.001), and was determined by donor age at nephrectomy. CONCLUSION Recipients of kidney grafts show a glomerular filtration rate decline over time that is significantly associated with donor age and aortic stiffness after the first post-transplant year, while donors demonstrate a lower decline that is mostly determined by age at nephrectomy.
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Affiliation(s)
- Sola Aoun Bahous
- Division of Nephrology and Renal Transplantation, University Medical Center-Rizk Hospital, Ashrafieh, Beirut, Lebanon
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Khoriaty E, Halaby R, Berro M, Sweid A, Abbas HA, Inati A. Incidence of sickle cell disease and other hemoglobin variants in 10,095 Lebanese neonates. PLoS One 2014; 9:e105109. [PMID: 25180595 PMCID: PMC4152148 DOI: 10.1371/journal.pone.0105109] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 07/21/2014] [Indexed: 12/02/2022] Open
Abstract
Hemoglobinopathies are highly prevalent diseases and impose a public health burden. Early diagnosis and treatment can ameliorate the course of these diseases and improve survival. Despite purported high incidence of hemoglobinopathies in Lebanon, there are no nationwide screening programs. In this study, newborn screening utilizing high pressure liquid chromatography was executed in all public hospitals across Lebanon between 2010 and 2013. All newborns with an abnormal hemoglobin (Hb) were offered genetic counseling and all those with disease were enrolled in comprehensive hemoglobinopathy clinics. Among newborns, 2.1% were found to have an abnormal Hb variant with sickle Hb being the most common while 0.1% were found to have sickle cell disease (SCD). The majority of those with SCD had non-Lebanese origins. The most common causes of hospitalizations in infants with SCD were acute splenic sequestration and pain crises. No bacteremia or other life threatening infections were noted. At a median follow up 14 months (follow up range 7 to 34 months), all children with disease are alive and compliant with treatment. Systematic screening for SCD and other Hb variants was shown to be feasible, cost effective, and of accurate predictive value. This program was also clinically effective because it led to the identification of babies with disease and to providing them with free early multidisciplinary care. Conclusively, a newborn screening program should be implemented across Lebanon to detect hemoglobinopathies and initiate early therapeutic and preventive strategies and genetic counseling.
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Affiliation(s)
- Evelyne Khoriaty
- Department of Pediatrics, State University of New York, Syracuse, New York, United States of America
| | - Rim Halaby
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Mohamad Berro
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Ahmad Sweid
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hussein A. Abbas
- School of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Adlette Inati
- School of Medicine, Lebanese American University, Byblos, Lebanon
- Lebanese American University and Division of Pediatric Hematology-Oncology, Rafic Hariri University Hospital, Beirut, Lebanon
- * E-mail:
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Kunadian V, Dunford JR, Swarbrick D, Halaby R, Ajari O, Cochet M, Feeney K, Larkin E, Gonzalez GR, Govindavarjhulla A, Nethala D, Patel H, Guddeti RR, Khan F, Kumar S, Patel S, Saddala P, Serla VV, Zacarkim M, Yadav D, Gibson CM. Triple Antiplatelet Therapy and Combinations with Oral Anticoagulants After Stent Implantation. Interv Cardiol Clin 2013; 2:595-606. [PMID: 28582186 DOI: 10.1016/j.iccl.2013.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Triple oral anticoagulation or triple antiplatelet therapies may be administered for various reasons. They reduce cardiac complications following percutaneous coronary intervention and stroke or other thromboembolic phenomenon in conditions such as atrial fibrillation. There is an elevated risk of severe bleeding, so it is necessary to balance risk and benefits. Newer oral anticoagulants and antiplatelet drugs may be considered; the number of options is increasing. This article examines triple therapies and the efficacy and safety of combinations of traditional anticoagulant and antiplatelet drugs, and reviews clinical trial data on novel agents. Guidelines to inform clinical decision-making are presented.
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Affiliation(s)
- Vijay Kunadian
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Joseph Robert Dunford
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Daniel Swarbrick
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Rim Halaby
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ogheneochuko Ajari
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Madeleine Cochet
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Kristin Feeney
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Emily Larkin
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Gonzalo Romero Gonzalez
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Aditya Govindavarjhulla
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Daniel Nethala
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Hardik Patel
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Raviteja Reddy Guddeti
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Farman Khan
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Shankar Kumar
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Sapan Patel
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Prashanth Saddala
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Vishnu Vardhan Serla
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Marcelo Zacarkim
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Divya Yadav
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - C Michael Gibson
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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Messina ME, Halaby R. Does triptolide induce lysosomal-mediated apoptosis in human breast cancer cells? Med Hypotheses 2011; 77:91-3. [PMID: 21486687 DOI: 10.1016/j.mehy.2011.03.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Accepted: 03/17/2011] [Indexed: 10/18/2022]
Abstract
With breast cancer plaguing the United States as the second leading cause of cancer related deaths amongst women, as well as the adverse effects of current treatment options there is a need to develop safer and noninvasive treatments. Triptolide is an extract from the herb Tripterygium wilfordii Hook F, and has been used in Chinese medicine for over two centuries and is now used to treat certain autoimmune diseases, such as rheumatoid arthritis. Based on the anti-proliferative, anti-inflammatory, and anti-cancer properties of triptolide we believe that it will stimulate apoptosis in human breast cancer cells. Triptolide is known to induce apoptosis in many cancer cells lines, but the exact mechanisms that regulate this are largely unknown. It has been suggested that triptolide activates the p53 pathway to trigger apoptosis in these cells. However, we believe that there are other mechanisms at work including the activation of lysosomal-mediated apoptosis.
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Affiliation(s)
- M E Messina
- Montclair State University, Department of Biology and Molecular Biology, 1 Normal Avenue, Montclair, NJ 07043, USA
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Abstract
The labial gland of Manduca sexta is a valuable system to study the mechanisms of programmed cell death since the death of the gland is nearly synchronous and, except for the anterior duct, involves all of the tissue. The gland degenerates in 5 days during pupation. Our previous work documents a drop in total protein synthesis as the gland degenerates. To evaluate potential causes of this altered protein synthesis, we monitored several parameters of metabolism in dying cells: levels of adenosine triphosphate to estimate the energy resources of the gland; reduction of 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide to assess mitochondrial respiration; levels of acid phosphatase to assay lysosomal enzyme activity; and concentrations of cyclic nucleotides and inositol triphosphate to monitor signaling. While protein synthesis fell precipitously on day 0, total adenosine triphosphate and mitochondrial respiration were unchanged until the cells underwent massive collapse on day 3. Lysosomal acid phosphatase increased during early metamorphosis, and ultimately the bulk of the cytoplasm was destroyed in autophagic vacuoles. Changes in the concentrations of second messengers were modest and late. The relationships between the metabolism and the collapse of the labial gland are under investigation.
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Affiliation(s)
- R Halaby
- Department of Biology, Queens College and Graduate Center of City University of New York, Flushing 11367, USA
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