1
|
Abdulhai F, Motairek I, Mirzai S, Bazarbachi B, Chamseddine F, Alamer M, Salerno PR, Makhlouf MHE, Deo SV, Al-Kindi S. Quantifying lead-attributable cardiovascular disease burden in the United States. Curr Probl Cardiol 2024; 49:102565. [PMID: 38599559 DOI: 10.1016/j.cpcardiol.2024.102565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/12/2024]
Abstract
Lead exposure has been linked to a myriad of cardiovascular diseases. Utilizing data from the 2019 Global Burden of Disease Study, we quantified age-standardized lead exposure-related mortality and disability-adjusted life years (DALYs) in the United States between 1990 and 2019. Our analysis revealed a substantial reduction in age-standardized cardiovascular disease (CVD) mortality attributable to lead exposure by 60 % (from 7.4 to 2.9 per 100,000), along with a concurrent decrease in age-standardized CVD DALYs by 66 % (from 143.2 to 48.7 per 100,000).
Collapse
Affiliation(s)
- Farah Abdulhai
- Internal medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Issam Motairek
- Internal medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Saeid Mirzai
- Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Basel Bazarbachi
- Internal medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Mohammad Alamer
- Internal medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Pedro Rvo Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mohamed H E Makhlouf
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Salil V Deo
- Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - Sadeer Al-Kindi
- Division of Cardiology, Houston Methodist Hospital, Houston, TX, USA.
| |
Collapse
|
2
|
Salerno PRVO, Motairek I, Dong W, Nasir K, Fotedar N, Omran SS, Ganatra S, Hahad O, Deo SV, Rajagopalan S, Al-Kindi SG. County-Level Socio-Environmental Factors Associated With Stroke Mortality in the United States: A Cross-Sectional Study. Angiology 2024:33197241244814. [PMID: 38569060 DOI: 10.1177/00033197241244814] [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: 04/05/2024]
Abstract
We used machine learning methods to explore sociodemographic and environmental determinants of health (SEDH) associated with county-level stroke mortality in the USA. We conducted a cross-sectional analysis of individuals aged ≥15 years who died from all stroke subtypes between 2016 and 2020. We analyzed 54 county-level SEDH possibly associated with age-adjusted stroke mortality rates/100,000 people. Classification and Regression Tree (CART) was used to identify specific county-level clusters associated with stroke mortality. Variable importance was assessed using Random Forest analysis. A total of 501,391 decedents from 2397 counties were included. CART identified 10 clusters, with 77.5% relative increase in stroke mortality rates across the spectrum (28.5 vs 50.7 per 100,000 persons). CART identified 8 SEDH to guide the classification of the county clusters. Including, annual Median Household Income ($), live births with Low Birthweight (%), current adult Smokers (%), adults reporting Severe Housing Problems (%), adequate Access to Exercise (%), adults reporting Physical Inactivity (%), adults with diagnosed Diabetes (%), and adults reporting Excessive Drinking (%). In conclusion, SEDH exposures have a complex relationship with stroke. Machine learning approaches can help deconstruct this relationship and demonstrate associations that allow improved understanding of the socio-environmental drivers of stroke and development of targeted interventions.
Collapse
Affiliation(s)
- Pedro R V O Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Weichuan Dong
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Khurram Nasir
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Neel Fotedar
- Neurological Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Setareh S Omran
- University of Colorado Health, Stroke and Brain Aneurysm Center, Anschutz Medical Campus, Aurora, CO, USA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Burlington, MA, USA
| | - Omar Hahad
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
| | - Salil V Deo
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Sadeer G Al-Kindi
- Center for Health and Nature and Department of Cardiology, Houston Methodist, Houston, TX, USA
| |
Collapse
|
3
|
Rajagopalan S, Brook RD, Salerno PRVO, Bourges-Sevenier B, Landrigan P, Nieuwenhuijsen MJ, Munzel T, Deo SV, Al-Kindi S. Air pollution exposure and cardiometabolic risk. Lancet Diabetes Endocrinol 2024; 12:196-208. [PMID: 38310921 DOI: 10.1016/s2213-8587(23)00361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 02/06/2024]
Abstract
The Global Burden of Disease assessment estimates that 20% of global type 2 diabetes cases are related to chronic exposure to particulate matter (PM) with a diameter of 2·5 μm or less (PM2·5). With 99% of the global population residing in areas where air pollution levels are above current WHO air quality guidelines, and increasing concern in regard to the common drivers of air pollution and climate change, there is a compelling need to understand the connection between air pollution and cardiometabolic disease, and pathways to address this preventable risk factor. This Review provides an up to date summary of the epidemiological evidence and mechanistic underpinnings linking air pollution with cardiometabolic risk. We also outline approaches to improve awareness, and discuss personal-level, community, governmental, and policy interventions to help mitigate the growing global public health risk of air pollution exposure.
Collapse
Affiliation(s)
- Sanjay Rajagopalan
- University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Robert D Brook
- Division of Cardiovascular Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Pedro R V O Salerno
- University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Philip Landrigan
- Program for Global Public Health and the Common Good, Boston College, Boston, MA, USA; Centre Scientifique de Monaco, Monaco
| | | | - Thomas Munzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; German Center of Cardiovascular Research, Partner-Site Rhine-Main, Germany
| | - Salil V Deo
- Louis Stokes Cleveland VA Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Sadeer Al-Kindi
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
| |
Collapse
|
4
|
Salerno PR, Chen Z, Wass S, Motairek I, Elamm C, Salerno LM, Hassani NS, Deo SV, Al-Kindi SG. Sex-specific heart failure burden across the United States: Global burden of disease 1990-2019. Am Heart J 2024; 269:35-44. [PMID: 38109986 DOI: 10.1016/j.ahj.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Heart failure (HF) has unique aspects that vary by biological sex. Thus, understanding sex-specific trends of HF in the US population is crucial to develop targeted interventions. We aimed to analyze the burden of HF in female and male patients across the US, from 1990 to 2019. METHODS Using the Global Burden of Disease (GBD) study data from 2019, we performed an analysis of the burden of HF from 1990-2019, across US states and regions. The GBD defined HF through studies that used symptom-based criteria and expressed the burden of HF as the age-adjusted prevalence and years lived with disability (YLDs) rates per 100,000 individuals. RESULTS The age-adjusted prevalence of HF for the US in 2019 was 926.2 (95% UI [799.6, 1,079.0]) for females and 1,291.2 (95% UI [1,104.1, 1,496.8]) for males. Notably, our findings also highlight cyclic fluctuations in HF prevalence over time, with peaks occurring in the mid-1990s and around 2010, while reaching their lowest points in around 2000 and 2018. Among individuals >70 years of age, the absolute number of individuals with HF was higher in females, and this age group doubled the absolute count between 1990 and 2019. Comparing 1990-1994 to 2015-2019, 10 states had increased female HF prevalence, while only 4 states increased male prevalence. Overall, Western states had the greatest relative decline in HF burden, in both sexes. CONCLUSION The burden of HF in the US is high, although the magnitude of this burden varies according to age, sex, state, and region. There is a significant increase in the absolute number of individuals with HF, especially among women >70 years, expected to continue due to the aging population.
Collapse
Affiliation(s)
- Pedro Rvo Salerno
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sojin Wass
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Chantal Elamm
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH; Section of Advanced Heart Failure and Transplantation, University Hospitals, Cleveland, OH
| | - Lúcia Mvo Salerno
- Hospital das Clínicas, Universidade Federal de Pernambuco, Recife, Brazil
| | - Neda Shafiabadi Hassani
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH
| | - Salil V Deo
- Surgical Services, Louis Stokes VA Hospital, Cleveland, OH
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University School of Medicine, Cleveland, OH; Section of Advanced Heart Failure and Transplantation, University Hospitals, Cleveland, OH.
| |
Collapse
|
5
|
Deo SV, Al-Kindi S, Motairek I, McAllister D, Shah ASV, Elgudin YE, Gorodeski EZ, Virani S, Petrie MC, Rajagopalan S, Sattar N. Impact of Residential Social Deprivation on Prediction of Heart Failure in Patients With Type 2 Diabetes: External Validation and Recalibration of the WATCH-DM Score Using Real World Data. Circ Cardiovasc Qual Outcomes 2024; 17:e010166. [PMID: 38328913 DOI: 10.1161/circoutcomes.123.010166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/20/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Patients with type 2 diabetes are at risk of heart failure hospitalization. As social determinants of health are rarely included in risk models, we validated and recalibrated the WATCH-DM score in a diverse patient-group using their social deprivation index (SDI). METHODS We identified US Veterans with type 2 diabetes without heart failure that received outpatient care during 2010 at Veterans Affairs medical centers nationwide, linked them to their SDI using residential ZIP codes and grouped them as SDI <20%, 21% to 40%, 41% to 60%, 61% to 80%, and >80% (higher values represent increased deprivation). Accounting for all-cause mortality, we obtained the incidence for heart failure hospitalization at 5 years follow-up; overall and in each SDI group. We evaluated the WATCH-DM score using the C statistic, the Greenwood Nam D'Agostino test χ2 test and calibration plots and further recalibrated the WATCH-DM score for each SDI group using a statistical correction factor. RESULTS In 1 065 691 studied patients (mean age 67 years, 25% Black and 6% Hispanic patients), the 5-year incidence of heart failure hospitalization was 5.39%. In SDI group 1 (least deprived) and 5 (most deprived), the 5-year heart failure hospitalization was 3.18% and 11%, respectively. The score C statistic was 0.62; WATCH-DM systematically overestimated heart failure risk in SDI groups 1 to 2 (expected/observed ratios, 1.38 and 1.36, respectively) and underestimated the heart failure risk in groups 4 to 5 (expected/observed ratios, 0.95 and 0.80, respectively). Graphical evaluation demonstrated that the recalibration of WATCH-DM using an SDI group-based correction factor improved predictive capabilities as supported by reduction in the χ2 test results (801-27 in SDI groups I; 623-23 in SDI group V). CONCLUSIONS Including social determinants of health to recalibrate the WATCH-DM score improved risk prediction highlighting the importance of including social determinants in future clinical risk prediction models.
Collapse
Affiliation(s)
- Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, OH (S.V.D., Y.E.E.)
- Case School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (S.V.D., Y.E.E., E.Z.G., S.R.)
- School of Health and Wellbeing (S.V.D., D.M.), University of Glasgow, United Kingdom
| | - Sadeer Al-Kindi
- Division of Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX (S.A.-K.)
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (I.M., E.Z.G., S.R.)
| | - David McAllister
- School of Health and Wellbeing (S.V.D., D.M.), University of Glasgow, United Kingdom
| | - Anoop S V Shah
- London School of Hygiene and Tropical Medicine, London, United Kingdom (A.S.V.S.)
| | - Yakov E Elgudin
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, OH (S.V.D., Y.E.E.)
- Case School of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH (S.V.D., Y.E.E., E.Z.G., S.R.)
| | - Eiran Z Gorodeski
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (I.M., E.Z.G., S.R.)
| | - Salim Virani
- The Aga Khan University, Karachi, Pakistan (S.V.)
- Division of Cardiology, Baylor School of Medicine, Houston, TX (S.V.)
| | - Mark C Petrie
- BHF Cardiovascular Research Center, School of Cardiovascular and Metabolic Health (M.C.P., N.S.), University of Glasgow, United Kingdom
- Robertson Center for Biostatistics (M.C.P.), University of Glasgow, United Kingdom
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (I.M., E.Z.G., S.R.)
| | - Naveed Sattar
- BHF Cardiovascular Research Center, School of Cardiovascular and Metabolic Health (M.C.P., N.S.), University of Glasgow, United Kingdom
| |
Collapse
|
6
|
Deo SV, Al-Kindi S, Virani SS, Fremes S. Novel therapies to achieve the recommended low-density lipoprotein cholesterol concentration (LDL-C) targets for patients after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2024; 167:723-730.e4. [PMID: 37286075 DOI: 10.1016/j.jtcvs.2023.05.028] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/21/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; School of Medicine, Case Western Reserve University, Cleveland, Ohio; School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.
| | - Sadeer Al-Kindi
- School of Medicine, Case Western Reserve University, Cleveland, Ohio; Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Salim S Virani
- The Aga Khan University, Karachi, Pakistan; Texas Heart Institute and Baylor College of Medicine, Houston, Tex
| | - Stephen Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
7
|
Deo SV, Althouse A, Al‐Kindi S, McAllister DA, Orkaby A, Elgudin YE, Fremes S, Chu D, Visseren FLJ, Pell JP, Sattar N. Validating the SMART2 Score in a Racially Diverse High-Risk Nationwide Cohort of Patients Receiving Coronary Artery Bypass Grafting. J Am Heart Assoc 2023; 12:e030757. [PMID: 37889195 PMCID: PMC10727407 DOI: 10.1161/jaha.123.030757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/03/2023] [Indexed: 10/28/2023]
Abstract
Background We tested the potential of the Secondary Manifestations of Arterial Disease (SMART2) risk score for use in patients undergoing coronary artery bypass grafting. Methods and Results We conducted an external validation of the SMART2 score in a racially diverse high-risk national cohort (2010-2019) that underwent isolated coronary artery bypass grafting. We calculated the preoperative SMART2 score and modeled the 5-year major adverse cardiovascular event (cardiovascular mortality+myocardial infarction+stroke) incidence. We evaluated SMART2 score discrimination at 5 years using c-statistic and calibration with observed/expected ratio and calibration plots. We analyzed the potential clinical benefit using decision curves. We repeated these analyses in clinical subgroups, diabetes, chronic kidney disease, and polyvascular disease, and separately in White and Black patients. In 27 443 (mean age, 65 years; 10% Black individuals) US veterans undergoing coronary artery bypass grafting (2010-2019) nationwide, the 5-year major adverse cardiovascular event rate was 25%; 27% patients were in high predicted risk (>30% 5-year major adverse cardiovascular events). SMART2 score discrimination (c-statistic: 64) was comparable to the original study (c-statistic: 67) and was best in patients with chronic kidney disease (c-statistic: 66). However, it underpredicted major adverse cardiovascular event rates in the whole cohort (observed/expected ratio, 1.45) as well as in all studied subgroups. The SMART2 score performed better in White than Black patients. On decision curve analysis, the SMART2 score provides a net benefit over a wide range of risk thresholds. Conclusions The SMART2 model performs well in a racially diverse coronary artery bypass grafting cohort, with better predictive capabilities at the upper range of baseline risk, and can therefore be used to guide secondary preventive pharmacotherapy.
Collapse
Affiliation(s)
- Salil V. Deo
- Louis Stokes Cleveland Veteran Affairs Medical CenterClevelandOH
- Case School of Medicine, Case Western Reserve UniversityClevelandOH
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Andrew Althouse
- Department of Internal MedicineUniversity of PittsburghPittsburghPA
- Medtronic CorporationMinneapolisMN
| | - Sadeer Al‐Kindi
- Case School of Medicine, Case Western Reserve UniversityClevelandOH
- Department of CardiologyUniversity Hospitals Cleveland Medical CenterClevelandOH
| | | | - Ariela Orkaby
- New England Geriatric Research, Education, and Clinical Center, VA Boston, Healthcare SystemBostonMA
- Division of Aging, Brigham and Women’s HospitalHarvard Medical SchoolBostonMA
| | - Yakov E. Elgudin
- Louis Stokes Cleveland Veteran Affairs Medical CenterClevelandOH
- Case School of Medicine, Case Western Reserve UniversityClevelandOH
| | - Stephen Fremes
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Danny Chu
- Department of Cardiac Surgery, Pittsburgh VA Medical CenterPittsburghPA
| | | | - Jill P. Pell
- School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic HealthUniversity of GlasgowGlasgowUK
| |
Collapse
|
8
|
Vieira de Oliveira Salerno PR, Briones-Valdivieso C, Motairek I, Palma Dallan LA, Rajagopalan S, Deo SV, Petermann-Rocha F, Al-Kindi S. The cardiovascular disease burden attributable to particulate matter pollution in South America: analysis of the 1990-2019 global burden of disease. Public Health 2023; 224:169-177. [PMID: 37797563 DOI: 10.1016/j.puhe.2023.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 07/22/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Fine particulate matter <2.5 microns (PM2.5) is the most studied air pollutant. Both short- and long-term exposure to PM2.5 have been linked to cardiovascular disease (CVD). Studies evaluating air pollution in South America are scarce. Therefore, the impact of exposure to PM2.5, household air pollution (HAP), and ambient air pollution (AAP) on CVD mortality and CVD disability-adjusted life years (DALYs) in South American countries from 1990 to 2019 was explored. STUDY DESIGN AND METHODS The Global Burden of Disease initiative exposure-response function was used to analyze the total PM2.5, ambient PM2.5, and household PM2.5-related CVD deaths and DALYs rates, per 100,000 individuals, in 12 South American countries between 1990 and 2019. The relative change in burden was also assessed by comparing the 1990-1994 to 2015-2019 periods. RESULTS In 2019, 70,668 deaths and 1,736,414 DALYs due to CVD were attributed to total PM2.5 exposure in South America. Substantial regional heterogeneity was observed concerning the absolute change in PM2.5 concentration levels comparing 1990 to 2019. All South American countries observed a relative decline in CVD deaths and DALYs comparing the 1990-1994 to 2015-2019 periods. No country was able to reach the current World Health Organization 5 μg/m3 recommended limit in 2019. Predominantly, AAP was the greatest contributor to the CVD burden. CONCLUSION Air pollution substantially impacted CVD in South America; however, this impact was heterogenous, and the relative reduction of HAP and AAP burden was also not uniform. Recognizing PM2.5 importance is key for developing target population and individual-level interventions, which could ultimately alleviate its burden.
Collapse
Affiliation(s)
| | - C Briones-Valdivieso
- Escuela de Medicina, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile
| | - I Motairek
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - L A Palma Dallan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - S Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - S V Deo
- Case Western Reserve University School of Medicine, Cleveland, OH, USA; Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, USA
| | - F Petermann-Rocha
- Centro de Investigación Biomédica, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile.
| | - S Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Escuela de Medicina, Facultad de Medicina, Universidad Diego Portales, Santiago, Chile.
| |
Collapse
|
9
|
Deo SV, Al-Kindi S, Motairek I, Elgudin YE, Gorodeski E, Nasir K, Rajagopalan S, Petrie MC, Sattar N. Neighbourhood-level social deprivation and the risk of recurrent heart failure hospitalizations in type 2 diabetes. Diabetes Obes Metab 2023; 25:2846-2852. [PMID: 37311730 PMCID: PMC10528514 DOI: 10.1111/dom.15174] [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: 05/04/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND The importance of type 2 diabetes mellitus (T2D) in heart failure hospitalizations (HFH) is acknowledged. As information on the prevalence and influence of social deprivation on HFH is limited, we studied this issue in a racially diverse cohort. METHODS Linking data from US Veterans with stable T2D (without prevalent HF) with a zip-code derived population-level social deprivation index (SDI), we grouped them according to increasing SDI as follows: SDI: group I: ≤20; II: 21-40; III: 41-60; IV: 61-80; and V (most deprived) 81-100. Over a 10-year follow-up period, we identified the total (first and recurrent) number of HFH episodes for each patient and calculated the age-adjusted HFH rate [per 1000 patient-years (PY)]. We analysed the incident rate ratio between SDI groups and HFH using adjusted analyses. RESULTS In 1 012 351 patients with T2D (mean age 67.5 years, 75.7% White), the cumulative incidence of first HFH was 9.4% and 14.2% in SDI groups I and V respectively. The 10-year total HFH rate was 54.8 (95% CI: 54.5, 55.2)/1000 PY. Total HFH increased incrementally from SDI group I [43.3 (95% CI: 42.4, 44.2)/1000 PY] to group V [68.6 (95% CI: 67.8, 69.9)/1000 PY]. Compared with group I, group V patients had a 53% higher relative risk of HFH. The negative association between SDI and HFH was stronger in Black patients (SDI × Race pinteraction < .001). CONCLUSIONS Social deprivation is associated with increased HFH in T2D with a disproportionate influence in Black patients. Strategies to reduce social disparity and equalize racial differences may help to bridge this gap.
Collapse
Affiliation(s)
- Salil V. Deo
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sadeer Al-Kindi
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Yakov E. Elgudin
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Eiran Gorodeski
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | | | - Sanjay Rajagopalan
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Mark C. Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
- Robertson Center for Biostatistics, University of Glasgow, Glasgow, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| |
Collapse
|
10
|
Kochar A, Deo SV, Charest B, Peterman-Rocha F, Elgudin Y, Chu D, Yeh RW, Rao SV, Kim DH, Driver JA, Hall DE, Orkaby AR. Preoperative frailty and adverse outcomes following coronary artery bypass grafting surgery in US veterans. J Am Geriatr Soc 2023; 71:2736-2747. [PMID: 37083188 PMCID: PMC10524307 DOI: 10.1111/jgs.18390] [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] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/20/2023] [Accepted: 03/24/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Contemporary guidelines emphasize the value of incorporating frailty into clinical decision-making regarding revascularization strategies for coronary artery disease. Yet, there are limited data describing the association between frailty and longer-term mortality among coronary artery bypass grafting (CABG) patients. METHODS We conducted a retrospective cohort study (2016-2020, 40 VA medical centers) of US veterans nationwide that underwent coronary artery bypass grafting (CABG). Frailty was quantified by the Veterans Administration Frailty Index (VA-FI), which applies the cumulative deficit method to render a proportion of 30 pertinent diagnosis codes. Patients were classified as non-frail (VA-FI ≤ 0.1), pre-frail (0.1 < VA-FI ≤ 0.2), or frail (VA-FI > 0.2). We used Cox proportional hazards models to ascertain the association of frailty with all-cause mortality. Our primary study outcome was 5-year all-cause mortality; the co-primary outcome was days alive and out of the hospital within the first postoperative year. RESULTS There were 13,554 CABG patients (median 69 years, 79% White, 1.5% women). The mean pre-operative VA-FI was 0.21 (SD: 0.11); 31% were pre-frail (VA-FI: 0.17) and 47% were frail (VA-FI: 0.31). Frail patients were older and had higher co-morbidity burdens than pre-frail and non-frail patients. Compared with non-frail patients (13.0% [11.4, 14.7]), there was a significant association between frail and pre-frail patients and increased cumulative 5-year all-cause mortality (frail: 24.8% [23.3, 26.1]; HR: 1.75 [95% CI 1.54, 2.00]; pre-frail 16.8% [95% CI 15.3, 18.4]; HR 1.2 [1.08,1.34]). Compared with non-frail patients (mean 362[SD 12]), pre-frail (mean 361 [SD 14]; p < 0.01) and frail patients (mean 358[SD 18]; p < 0.01) spent fewer days alive and out of the hospital in the first postoperative year. CONCLUSIONS Pre-frailty and frailty were prevalent among US veterans undergoing CABG and associated with worse mid-term outcomes. Given the high prevalence of frailty with attendant adverse outcomes, there may be an opportunity to improve outcomes by identifying and mitigating frailty before surgery.
Collapse
Affiliation(s)
- Ajar Kochar
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston USA
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston USA
| | - Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland USA
- Case School of Medicine, Case Western Reserve University, Cleveland USA
| | - Brian Charest
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston USA
| | | | - Yakov Elgudin
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland USA
- Case School of Medicine, Case Western Reserve University, Cleveland USA
| | - Danny Chu
- Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh USA
| | - Robert W Yeh
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston USA
| | - Sunil V Rao
- The Durham Veterans Affairs Healthcare System, Durham, NC, USA
| | - Dae H. Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston USA
| | - Jane A. Driver
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston USA
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare system, Boston USA
| | - Daniel E Hall
- Wolff Center, University of Pittsburgh Medical Center, Pittsburgh USA
- Center for Health Equity Research and Promotion, Veteran Affairs Pittsburgh Healthcare System, Pittsburgh USA
| | - Ariela R. Orkaby
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston USA
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare system, Boston USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston USA
| |
Collapse
|
11
|
Misfeld M, Marin-Cuartas M, Ramirez P, Wehrmann K, Renatus K, Deo SV, Gohmann RF, Haunschild J, Leontyev S, Borger MA, Etz CD. Early Intraluminal Frozen Elephant Trunk Stent Graft Thrombosis After Aortic Arch Surgery. Ann Thorac Surg 2023; 116:450-457. [PMID: 36608753 DOI: 10.1016/j.athoracsur.2022.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 11/15/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Partial intraluminal thrombosis of the frozen elephant trunk (FET) stent graft is a poorly described but not infrequent complication after aortic arch surgery. This study aims to describe and analyze the occurrence of early FET stent graft thrombosis. METHODS Retrospective single-center analysis including patients who underwent aortic arch replacement with FET technique between 2006 and 2020. Stent graft thrombosis was diagnosed through computed tomography scan. Several computed tomography scan parameters and clinical variables were analyzed as predictors of this event. RESULTS A total of 125 patients were included for analysis. Among these, 21 (16.8%) patients developed early postoperative FET stent graft thrombosis. Mean volumetric size of the aorta was 12.2 ± 2.0 mL in patients with FET stent graft thrombosis and 10.1 ± 2.8 mL in patients without thrombosis (P < .01). Thrombosis occurred more frequently among patients requiring thoracic endovascular aortic repair completion (15 of 21 [71.4%] patients) than in patients with completely excluded aneurysms (6 of 21 [28.6%] patients) (P = .01). Mean stent-to-aneurysm diameter ratio was 0.8 ± 0.2 among patients with thrombosis and 1.0 ± 0.2 among patients without thrombosis (P < .01). Thrombosis was more frequently observed among patients with conservative management of postoperative bleeding (P = .04). Patients with early FET thrombosis had a nonsignificantly higher in-hospital all-cause mortality than patients without thrombosis (19.0% vs 8.7%; P = .3). CONCLUSIONS Early postoperative intraluminal thrombosis is a frequent complication post FET surgery. Smaller stent graft sizes, larger or partially covered aneurysms, and major bleeding are associated with early thrombosis. Slight FET oversizing, prompt thoracic endovascular aortic repair completion, and early reintervention for major bleeding may prevent early thrombosis.
Collapse
Affiliation(s)
- Martin Misfeld
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Sydney Medical School, University of Sydney, Australia.
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Paulina Ramirez
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Katharina Wehrmann
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | - Salil V Deo
- Department of Veterans Affairs, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Robin F Gohmann
- Department of Radiology, Leipzig Heart Center, Leipzig, Germany
| | - Josephina Haunschild
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Sergey Leontyev
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Christian D Etz
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| |
Collapse
|
12
|
Deo SV. Monte Carlo simulations to meet the ESC recommended low-density lipoprotein cholesterol targets. Lancet Reg Health Eur 2023; 31:100670. [PMID: 37388944 PMCID: PMC10300384 DOI: 10.1016/j.lanepe.2023.100670] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023]
Affiliation(s)
- Salil V. Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, USA
- Case School of Medicine, Case Western Reserve University, Cleveland, USA
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
13
|
Ong KL, Stafford LK, McLaughlin SA, Boyko EJ, Vollset SE, Smith AE, Dalton BE, Duprey J, Cruz JA, Hagins H, Lindstedt PA, Aali A, Abate YH, Abate MD, Abbasian M, Abbasi-Kangevari Z, Abbasi-Kangevari M, Abd ElHafeez S, Abd-Rabu R, Abdulah DM, Abdullah AYM, Abedi V, Abidi H, Aboagye RG, Abolhassani H, Abu-Gharbieh E, Abu-Zaid A, Adane TD, Adane DE, Addo IY, Adegboye OA, Adekanmbi V, Adepoju AV, Adnani QES, Afolabi RF, Agarwal G, Aghdam ZB, Agudelo-Botero M, Aguilera Arriagada CE, Agyemang-Duah W, Ahinkorah BO, Ahmad D, Ahmad R, Ahmad S, Ahmad A, Ahmadi A, Ahmadi K, Ahmed A, Ahmed A, Ahmed LA, Ahmed SA, Ajami M, Akinyemi RO, Al Hamad H, Al Hasan SM, AL-Ahdal TMA, Alalwan TA, Al-Aly Z, AlBataineh MT, Alcalde-Rabanal JE, Alemi S, Ali H, Alinia T, Aljunid SM, Almustanyir S, Al-Raddadi RM, Alvis-Guzman N, Amare F, Ameyaw EK, Amiri S, Amusa GA, Andrei CL, Anjana RM, Ansar A, Ansari G, Ansari-Moghaddam A, Anyasodor AE, Arabloo J, Aravkin AY, Areda D, Arifin H, Arkew M, Armocida B, Ärnlöv J, Artamonov AA, Arulappan J, Aruleba RT, Arumugam A, Aryan Z, Asemu MT, Asghari-Jafarabadi M, Askari E, Asmelash D, Astell-Burt T, Athar M, Athari SS, Atout MMW, Avila-Burgos L, Awaisu A, Azadnajafabad S, B DB, Babamohamadi H, Badar M, Badawi A, Badiye AD, Baghcheghi N, Bagheri N, Bagherieh S, Bah S, Bahadory S, Bai R, Baig AA, Baltatu OC, Baradaran HR, Barchitta M, Bardhan M, Barengo NC, Bärnighausen TW, Barone MTU, Barone-Adesi F, Barrow A, Bashiri H, Basiru A, Basu S, Basu S, Batiha AMM, Batra K, Bayih MT, Bayileyegn NS, Behnoush AH, Bekele AB, Belete MA, Belgaumi UI, Belo L, Bennett DA, Bensenor IM, Berhe K, Berhie AY, Bhaskar S, Bhat AN, Bhatti JS, Bikbov B, Bilal F, Bintoro BS, Bitaraf S, Bitra VR, Bjegovic-Mikanovic V, Bodolica V, Boloor A, Brauer M, Brazo-Sayavera J, Brenner H, Butt ZA, Calina D, Campos LA, Campos-Nonato IR, Cao Y, Cao C, Car J, Carvalho M, Castañeda-Orjuela CA, Catalá-López F, Cerin E, Chadwick J, Chandrasekar EK, Chanie GS, Charan J, Chattu VK, Chauhan K, Cheema HA, Chekol Abebe E, Chen S, Cherbuin N, Chichagi F, Chidambaram SB, Cho WCS, Choudhari SG, Chowdhury R, Chowdhury EK, Chu DT, Chukwu IS, Chung SC, Coberly K, Columbus A, Contreras D, Cousin E, Criqui MH, Cruz-Martins N, Cuschieri S, Dabo B, Dadras O, Dai X, Damasceno AAM, Dandona R, Dandona L, Das S, Dascalu AM, Dash NR, Dashti M, Dávila-Cervantes CA, De la Cruz-Góngora V, Debele GR, Delpasand K, Demisse FW, Demissie GD, Deng X, Denova-Gutiérrez E, Deo SV, Dervišević E, Desai HD, Desale AT, Dessie AM, Desta F, Dewan SMR, Dey S, Dhama K, Dhimal M, Diao N, Diaz D, Dinu M, Diress M, Djalalinia S, Doan LP, Dongarwar D, dos Santos Figueiredo FW, Duncan BB, Dutta S, Dziedzic AM, Edinur HA, Ekholuenetale M, Ekundayo TC, Elgendy IY, Elhadi M, El-Huneidi W, Elmeligy OAA, Elmonem MA, Endeshaw D, Esayas HL, Eshetu HB, Etaee F, Fadhil I, Fagbamigbe AF, Fahim A, Falahi S, Faris MEM, Farrokhpour H, Farzadfar F, Fatehizadeh A, Fazli G, Feng X, Ferede TY, Fischer F, Flood D, Forouhari A, Foroumadi R, Foroutan Koudehi M, Gaidhane AM, Gaihre S, Gaipov A, Galali Y, Ganesan B, Garcia-Gordillo MA, Gautam RK, Gebrehiwot M, Gebrekidan KG, Gebremeskel TG, Getacher L, Ghadirian F, Ghamari SH, Ghasemi Nour M, Ghassemi F, Golechha M, Goleij P, Golinelli D, Gopalani SV, Guadie HA, Guan SY, Gudayu TW, Guimarães RA, Guled RA, Gupta R, Gupta K, Gupta VB, Gupta VK, Gyawali B, Haddadi R, Hadi NR, Haile TG, Hajibeygi R, Haj-Mirzaian A, Halwani R, Hamidi S, Hankey GJ, Hannan MA, Haque S, Harandi H, Harlianto NI, Hasan SMM, Hasan SS, Hasani H, Hassanipour S, Hassen MB, Haubold J, Hayat K, Heidari G, Heidari M, Hessami K, Hiraike Y, Holla R, Hossain S, Hossain MS, Hosseini MS, Hosseinzadeh M, Hosseinzadeh H, Huang J, Huda MN, Hussain S, Huynh HH, Hwang BF, Ibitoye SE, Ikeda N, Ilic IM, Ilic MD, Inbaraj LR, Iqbal A, Islam SMS, Islam RM, Ismail NE, Iso H, Isola G, Itumalla R, Iwagami M, Iwu CCD, Iyamu IO, Iyasu AN, Jacob L, Jafarzadeh A, Jahrami H, Jain R, Jaja C, Jamalpoor Z, Jamshidi E, Janakiraman B, Jayanna K, Jayapal SK, Jayaram S, Jayawardena R, Jebai R, Jeong W, Jin Y, Jokar M, Jonas JB, Joseph N, Joseph A, Joshua CE, Joukar F, Jozwiak JJ, Kaambwa B, Kabir A, Kabthymer RH, Kadashetti V, Kahe F, Kalhor R, Kandel H, Karanth SD, Karaye IM, Karkhah S, Katoto PDMC, Kaur N, Kazemian S, Kebede SA, Khader YS, Khajuria H, Khalaji A, Khan MAB, Khan M, Khan A, Khanal S, Khatatbeh MM, Khater AM, Khateri S, khorashadizadeh F, Khubchandani J, Kibret BG, Kim MS, Kimokoti RW, Kisa A, Kivimäki M, Kolahi AA, Komaki S, Kompani F, Koohestani HR, Korzh O, Kostev K, Kothari N, Koyanagi A, Krishan K, Krishnamoorthy Y, Kuate Defo B, Kuddus M, Kuddus MA, Kumar R, Kumar H, Kundu S, Kurniasari MD, Kuttikkattu A, La Vecchia C, Lallukka T, Larijani B, Larsson AO, Latief K, Lawal BK, Le TTT, Le TTB, Lee SWH, Lee M, Lee WC, Lee PH, Lee SW, Lee SW, Legesse SM, Lenzi J, Li Y, Li MC, Lim SS, Lim LL, Liu X, Liu C, Lo CH, Lopes G, Lorkowski S, Lozano R, Lucchetti G, Maghazachi AA, Mahasha PW, Mahjoub S, Mahmoud MA, Mahmoudi R, Mahmoudimanesh M, Mai AT, Majeed A, Majma Sanaye P, Makris KC, Malhotra K, Malik AA, Malik I, Mallhi TH, Malta DC, Mamun AA, Mansouri B, Marateb HR, Mardi P, Martini S, Martorell M, Marzo RR, Masoudi R, Masoudi S, Mathews E, Maugeri A, Mazzaglia G, Mekonnen T, Meshkat M, Mestrovic T, Miao Jonasson J, Miazgowski T, Michalek IM, Minh LHN, Mini GK, Miranda JJ, Mirfakhraie R, Mirrakhimov EM, Mirza-Aghazadeh-Attari M, Misganaw A, Misgina KH, Mishra M, Moazen B, Mohamed NS, Mohammadi E, Mohammadi M, Mohammadian-Hafshejani A, Mohammadshahi M, Mohseni A, Mojiri-forushani H, Mokdad AH, Momtazmanesh S, Monasta L, Moniruzzaman M, Mons U, Montazeri F, Moodi Ghalibaf A, Moradi Y, Moradi M, Moradi Sarabi M, Morovatdar N, Morrison SD, Morze J, Mossialos E, Mostafavi E, Mueller UO, Mulita F, Mulita A, Murillo-Zamora E, Musa KI, Mwita JC, Nagaraju SP, Naghavi M, Nainu F, Nair TS, Najmuldeen HHR, Nangia V, Nargus S, Naser AY, Nassereldine H, Natto ZS, Nauman J, Nayak BP, Ndejjo R, Negash H, Negoi RI, Nguyen HTH, Nguyen DH, Nguyen PT, Nguyen VT, Nguyen HQ, Niazi RK, Nigatu YT, Ningrum DNA, Nizam MA, Nnyanzi LA, Noreen M, Noubiap JJ, Nzoputam OJ, Nzoputam CI, Oancea B, Odogwu NM, Odukoya OO, Ojha VA, Okati-Aliabad H, Okekunle AP, Okonji OC, Okwute PG, Olufadewa II, Onwujekwe OE, Ordak M, Ortiz A, Osuagwu UL, Oulhaj A, Owolabi MO, Padron-Monedero A, Padubidri JR, Palladino R, Panagiotakos D, Panda-Jonas S, Pandey A, Pandey A, Pandi-Perumal SR, Pantea Stoian AM, Pardhan S, Parekh T, Parekh U, Pasovic M, Patel J, Patel JR, Paudel U, Pepito VCF, Pereira M, Perico N, Perna S, Petcu IR, Petermann-Rocha FE, Podder V, Postma MJ, Pourali G, Pourtaheri N, Prates EJS, Qadir MMF, Qattea I, Raee P, Rafique I, Rahimi M, Rahimifard M, Rahimi-Movaghar V, Rahman MO, Rahman MA, Rahman MHU, Rahman M, Rahman MM, Rahmani M, Rahmani S, Rahmanian V, Rahmawaty S, Rahnavard N, Rajbhandari B, Ram P, Ramazanu S, Rana J, Rancic N, Ranjha MMAN, Rao CR, Rapaka D, Rasali DP, Rashedi S, Rashedi V, Rashid AM, Rashidi MM, Ratan ZA, Rawaf S, Rawal L, Redwan EMM, Remuzzi G, Rengasamy KRR, Renzaho AMN, Reyes LF, Rezaei N, Rezaei N, Rezaeian M, Rezazadeh H, Riahi SM, Rias YA, Riaz M, Ribeiro D, Rodrigues M, Rodriguez JAB, Roever L, Rohloff P, Roshandel G, Roustazadeh A, Rwegerera GM, Saad AMA, Saber-Ayad MM, Sabour S, Sabzmakan L, Saddik B, Sadeghi E, Saeed U, Saeedi Moghaddam S, Safi S, Safi SZ, Saghazadeh A, Saheb Sharif-Askari N, Saheb Sharif-Askari F, Sahebkar A, Sahoo SS, Sahoo H, Saif-Ur-Rahman KM, Sajid MR, Salahi S, Salahi S, Saleh MA, Salehi MA, Salomon JA, Sanabria J, Sanjeev RK, Sanmarchi F, Santric-Milicevic MM, Sarasmita MA, Sargazi S, Sathian B, Sathish T, Sawhney M, Schlaich MP, Schmidt MI, Schuermans A, Seidu AA, Senthil Kumar N, Sepanlou SG, Sethi Y, Seylani A, Shabany M, Shafaghat T, Shafeghat M, Shafie M, Shah NS, Shahid S, Shaikh MA, Shanawaz M, Shannawaz M, Sharfaei S, Shashamo BB, Shiri R, Shittu A, Shivakumar KM, Shivalli S, Shobeiri P, Shokri F, Shuval K, Sibhat MM, Silva LMLR, Simpson CR, Singh JA, Singh P, Singh S, Siraj MS, Skryabina AA, Sohag AAM, Soleimani H, Solikhah S, Soltani-Zangbar MS, Somayaji R, Sorensen RJD, Starodubova AV, Sujata S, Suleman M, Sun J, Sundström J, Tabarés-Seisdedos R, Tabatabaei SM, Tabatabaeizadeh SA, Tabish M, Taheri M, Taheri E, Taki E, Tamuzi JJLL, Tan KK, Tat NY, Taye BT, Temesgen WA, Temsah MH, Tesler R, Thangaraju P, Thankappan KR, Thapa R, Tharwat S, Thomas N, Ticoalu JHV, Tiyuri A, Tonelli M, Tovani-Palone MR, Trico D, Trihandini I, Tripathy JP, Tromans SJ, Tsegay GM, Tualeka AR, Tufa DG, Tyrovolas S, Ullah S, Upadhyay E, Vahabi SM, Vaithinathan AG, Valizadeh R, van Daalen KR, Vart P, Varthya SB, Vasankari TJ, Vaziri S, Verma MV, Verras GI, Vo DC, Wagaye B, Waheed Y, Wang Z, Wang Y, Wang C, Wang F, Wassie GT, Wei MYW, Weldemariam AH, Westerman R, Wickramasinghe ND, Wu Y, Wulandari RDWI, Xia J, Xiao H, Xu S, Xu X, Yada DY, Yang L, Yatsuya H, Yesiltepe M, Yi S, Yohannis HK, Yonemoto N, You Y, Zaman SB, Zamora N, Zare I, Zarea K, Zarrintan A, Zastrozhin MS, Zeru NG, Zhang ZJ, Zhong C, Zhou J, Zielińska M, Zikarg YT, Zodpey S, Zoladl M, Zou Z, Zumla A, Zuniga YMH, Magliano DJ, Murray CJL, Hay SI, Vos T. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2023; 402:203-234. [PMID: 37356446 PMCID: PMC10364581 DOI: 10.1016/s0140-6736(23)01301-6] [Citation(s) in RCA: 250] [Impact Index Per Article: 250.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. FINDINGS In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. INTERPRETATION Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. FUNDING Bill & Melinda Gates Foundation.
Collapse
|
14
|
Deo SV, Motairek I, Nasir K, Mentias A, Elgudin Y, Virani SS, Rajagopalan S, Al-Kindi S. Association Between Historical Neighborhood Redlining and Cardiovascular Outcomes Among US Veterans With Atherosclerotic Cardiovascular Diseases. JAMA Netw Open 2023; 6:e2322727. [PMID: 37432687 PMCID: PMC10336624 DOI: 10.1001/jamanetworkopen.2023.22727] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/19/2023] [Indexed: 07/12/2023] Open
Abstract
Importance In the 1930s, the government-sponsored Home Owners' Loan Corporation (HOLC) established maps of US neighborhoods that identified mortgage risk (grade A [green] characterizing lowest-risk neighborhoods in the US through mechanisms that transcend traditional risk factors to grade D [red] characterizing highest risk). This practice led to disinvestments and segregation in neighborhoods considered redlined. Very few studies have targeted whether there is an association between redlining and cardiovascular disease. Objective To evaluate whether redlining is associated with adverse cardiovascular outcomes in US veterans. Design, Setting, and Participants In this longitudinal cohort study, US veterans were followed up (January 1, 2016, to December 31, 2019) for a median of 4 years. Data, including self-reported race and ethnicity, were obtained from Veterans Affairs medical centers across the US on individuals receiving care for established atherosclerotic disease (coronary artery disease, peripheral vascular disease, or stroke). Data analysis was performed in June 2022. Exposure Home Owners' Loan Corporation grade of the census tracts of residence. Main Outcomes and Measures The first occurrence of major adverse cardiovascular events (MACE), comprising myocardial infarction, stroke, major adverse extremity events, and all-cause mortality. The adjusted association between HOLC grade and adverse outcomes was measured using Cox proportional hazards regression. Competing risks were used to model individual nonfatal components of MACE. Results Of 79 997 patients (mean [SD] age, 74.46 [10.16] years, female, 2.9%; White, 55.7%; Black, 37.3%; and Hispanic, 5.4%), a total of 7% of the individuals resided in HOLC grade A neighborhoods, 20% in B neighborhoods, 42% in C neighborhoods, and 31% in D neighborhoods. Compared with grade A neighborhoods, patients residing in HOLC grade D (redlined) neighborhoods were more likely to be Black or Hispanic with a higher prevalence of diabetes, heart failure, and chronic kidney disease. There were no associations between HOLC and MACE in unadjusted models. After adjustment for demographic factors, compared with grade A neighborhoods, those residing in redlined neighborhoods had an increased risk of MACE (hazard ratio [HR], 1.139; 95% CI, 1.083-1.198; P < .001) and all-cause mortality (HR, 1.129; 95% CI, 1.072-1.190; P < .001). Similarly, veterans residing in redlined neighborhoods had a higher risk of myocardial infarction (HR, 1.148; 95% CI, 1.011-1.303; P < .001) but not stroke (HR, 0.889; 95% CI, 0.584-1.353; P = .58). Hazard ratios were smaller, but remained significant, after adjustment for risk factors and social vulnerability. Conclusions and Relevance In this cohort study of US veterans, the findings suggest that those with atherosclerotic cardiovascular disease who reside in historically redlined neighborhoods continue to have a higher prevalence of traditional cardiovascular risk factors and higher cardiovascular risk. Even close to a century after this practice was discontinued, redlining appears to still be adversely associated with adverse cardiovascular events.
Collapse
Affiliation(s)
- Salil V. Deo
- Surgical Services, Louis Stokes Veteran Affairs Hospital, Cleveland, Ohio
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | | | - Amgad Mentias
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yakov Elgudin
- Surgical Services, Louis Stokes Veteran Affairs Hospital, Cleveland, Ohio
| | - Salim S. Virani
- Michael E. DeBakey Veterans Affairs Medical Center, Section of Cardiovascular Research, Baylor College of Medicine, Houston, Texas
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio
| |
Collapse
|
15
|
Marin-Cuartas M, de Waha S, Naumann S, Deo SV, Kang J, Noack T, Hoyer A, Holzhey D, Leontyev S, Saeed D, Misfeld M, Meineri M, Ender J, Abdel-Wahab M, Desch S, Thiele H, Borger MA, Kiefer P. Incidence and Outcomes of Emergency Intraprocedural Surgical Conversion during Transcatheter Aortic Valve Implantation: Insights from a Large Tertiary Care Centre. Eur J Cardiothorac Surg 2023:7110896. [PMID: 37027228 DOI: 10.1093/ejcts/ezad142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/06/2023] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVE In transcatheter aortic valve implantation (TAVI), intraprocedural complications, which are only manageable by conversion to emergency open-heart surgery (E-OHS), occasionally occur. Contemporary data on the incidence and outcome of TAVI patients undergoing E-OHS are scarce. METHODS Data of all patients undergoing transfemoral TAVI between 2006 and 2020 at the Heart Centre Leipzig were analyzed. The study time was divided into 3 periods: 2006-2010 (P1), 2011-2015 (P2), 2016-2020 (P3). Patients were grouped according to their surgical risk (high risk: EuroSCORE II ≥ 6%, low/intermediate risk: EuroSCORE II < 6%). Primary outcomes were intraprocedural and in-hospital mortality, and1-year survival. RESULTS During the study period, a total of 6903 patients underwent transfemoral TAVI. Among them, 74 (1.1%) required E-OHS [high risk, n = 66 (89.2%); low/intermediate risk, n = 8 (10.8%)]. The rate of patients requiring E-OHS was 3.5% (20/577 patients), 1.8% (35/1967 patients), and 0.4% (19/4359 patients) in study periods P1-P3, respectively (p < 0.001). The proportion of E-OHS patients who were low/intermediate risk considerably increased over time (P1:0%; P28.6%; P3:26.3%; p = 0.077). Intraprocedural mortality occurred in 10 patients (13.5%), all of which were high-risk. In-hospital mortality was 62.1% in high-risk patients and 12.5% in low/intermediate risk patients (p = 0.007). One-year survival was 37.8% in all patients undergoing E-OHS, 31.8% in high-risk patients, and 87.5% in low/intermediate risk patients (Log-rank p = 0.002). CONCLUSIONS In-hospital and 1-year survival rates following E-OHS are higher in low/intermediate risk than high risk TAVI patients. An on-site cardiac surgical department with immediately available E-OHS capabilities is an important component of the TAVI team.
Collapse
Affiliation(s)
- Mateo Marin-Cuartas
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Suzanne de Waha
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Stefanie Naumann
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Salil V Deo
- Louis Stokes Cleveland VA Medical Centre, Department of Veterans Affairs, Cleveland, Ohio, USA
| | - Jagdip Kang
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Thilo Noack
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Alexandro Hoyer
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - David Holzhey
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Sergey Leontyev
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Diyar Saeed
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Martin Misfeld
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Massimiliano Meineri
- Heart Centre Leipzig at University of Leipzig, Department of Anesthesiology, Leipzig, Germany
| | - Joerg Ender
- Heart Centre Leipzig at University of Leipzig, Department of Anesthesiology, Leipzig, Germany
| | - Mohamed Abdel-Wahab
- Heart Centre Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Steffen Desch
- Heart Centre Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Holger Thiele
- Heart Centre Leipzig at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - Michael A Borger
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| | - Philipp Kiefer
- Heart Centre Leipzig at University of Leipzig, Department of Cardiac Surgery, Leipzig, Germany
| |
Collapse
|
16
|
Deo SV, McAllister D, LaForest S, Altarabsheh S, Elgudin YE, Dunlay S, Singh S, Parikh S, Sattar N, Pell JP. Disparities in PCSK9 Initiation Among US Veterans with Peripheral Arterial Disease or Cerebrovascular Disease. Am J Cardiovasc Drugs 2023; 23:311-321. [PMID: 36947397 DOI: 10.1007/s40256-023-00576-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Effective lipid lowering is essential in patients with peripheral arterial disease (PAD) and cerebrovascular disease (CeVD). Proprotein convertase subtilsin/kexin type 9 inhibitors (PCSK9i) efficiently lower low-density lipoprotein (LDL) levels; however, use in PAD and CeVD patients is limited. Therefore, our aim was to evaluate the use of PCSK9i among US Veterans and compare rates between patients with PAD, CeVD, and coronary artery disease (CAD). METHODS We evaluated PCSK9i initiation (2016-2019) in US Veterans with CAD, PAD, or CeVD treated at 124 Veterans Affairs (VA) hospitals. We fit a hierarchical logistic regression model to evaluate the association of the patient's primary diagnosis, baseline low-density lipoprotein cholesterol (LDL-C) levels, socioeconomic indicators, and the Department of Veterans Affairs medical center enrollment with PCSK9i initiation. RESULTS Of 519,566 patients with atherosclerotic vascular disease, 337,766 (65%), 79,926 (15%) and 101,874 (20%) had CAD, PAD, and CeVD, respectively. Among 2115/519,566 (0.4%) initiated on PCSK9i therapy, 84.3% had CAD, while only 7.2% and 8.5% had PAD and CeVD, respectively. Compared with CAD patients, PAD {odds ratio [OR] 0.50 (0.36-0.70)} and CeVD [OR 0.24 (0.15-0.37)] patients were less likely to receive PCSK9i. Relative to under $40K per year, PCSK9i initiation was higher if earning $40,000-$80,000 [OR 1.13 (1.01-1.27)] or > $80,000 [OR 1.41 (1.14-1.75)]. Even moderate community deprivation [OR 0.87 (0.77-0.97)] was associated with lower PCSK9i therapy. CONCLUSIONS Adjusted for LDL-C levels, PAD and CeVD patients are much less likely to receive PCSK9i therapy. Despite low co-pay, PCSK9i initiation rates among US veterans, nationwide, is low, with household income and community deprivation appearing to predict PCSK9i use.
Collapse
Affiliation(s)
- Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, 10701 E Boulevard, Cleveland, OH, 44106, USA.
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
- Case School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
| | - David McAllister
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Sharon LaForest
- Pharmacy Services, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | | | - Yakov E Elgudin
- Surgical Services, Louis Stokes Cleveland VA Medical Center, 10701 E Boulevard, Cleveland, OH, 44106, USA
- Case School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Shannon Dunlay
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Simerpreet Singh
- Department of Neurosciences, University of Calgary, Calgary, AB, Canada
| | - Sahil Parikh
- Department of Cardiology, Columbia University, New York, NY, USA
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, 1 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| |
Collapse
|
17
|
Makhlouf MHE, Motairek I, Chen Z, Nasir K, Deo SV, Rajagopalan S, Al-Kindi SG. Neighborhood Walkability and Cardiovascular Risk in the United States. Curr Probl Cardiol 2023; 48:101533. [PMID: 36481391 PMCID: PMC9892210 DOI: 10.1016/j.cpcardiol.2022.101533] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Neighborhood walkability may be associated with increased physical activity and thus may confer protection against cardiovascular disease and associated risk factors. We sought to characterize the association between neighborhood-level cardiovascular diseases and risk factors with neighborhood walkability across US census tracts.We linked the Centers for Disease Control and Prevention (CDC) PLACES dataset which provided census-tract level prevalence of coronary artery disease (CAD) and cardiovascular risk factors (hypertension, high cholesterol, obesity, and diabetes), with census tract population-weighted national walkability index (NWI) from the US Environmental Protection Agency (EPA). We calculated the mean prevalence of each cardiovascular health indicator per quartile of the walkability score. We also fit a multivariable linear regression model to estimate the association between walkability index and the prevalence of CAD adjusting for age, sex, race, and the CDC'S social vulnerability index, an integrated metric of socioeconomic position. We additionally performed mediation analyses to understand the mediating effects of CAD risk factors on the relationship between NWI and CAD prevalence. A total of 70,123 census tracts were analyzed nationwide. Across walkability quartiles Q1 (least walkable) through Q4 (most walkable), we found statistically significant decrease in the prevalence of CAD (7.0% to 5.4%), and risk factors including hypertension (35.5% to 29.7%), high cholesterol (34.5% to 29.2%), obesity (35.0% to 30.2%), and diabetes (11.6% to 10.6%). After multivariable adjustment, continuous walkability index was negatively and significantly associated with the prevalence of CAD (β = -0.09, P<0.0001). The relationship between NWI and CAD is partially mediated by the risk factors. High cholesterol accounted for 45%, high blood pressure 41% and diabetes 10% of the total effect of walkability on CAD. While direct relationship between walkability and CAD accounted for 9% of the total effect. This nationwide analysis demonstrates that neighborhood walkability is associated with a lower prevalence of cardiovascular risk factors and CAD. The association between NWI and CAD seems to be partly mediated by prevalence of traditional risk factors.
Collapse
Affiliation(s)
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH
| | - Khurram Nasir
- Houston Methodist Hospital and Weill Cornell Medicine, Houston, TX
| | - Salil V Deo
- Louis Stokes VA Medical Center, Cleveland, OH
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH.
| |
Collapse
|
18
|
Deo SV, Sundaram V, Sahadevan J, Selvaganesan P, Mohan SM, Rubelowsky J, Josephson R, Elgudin Y, Kilic A, Cmolik B. Outcomes of coronary artery bypass grafting in patients with heart failure with a midrange ejection fraction. J Thorac Cardiovasc Surg 2023; 165:149-158.e4. [PMID: 33618872 DOI: 10.1016/j.jtcvs.2021.01.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) improves survival in patients with heart failure and severely reduced left ventricular systolic function (LVEF). Limited data exist regarding adverse cardiovascular event rates after CABG in patients with heart failure with midrange ejection fraction (HFmrEF; LVEF > 40% and < 55%). METHODS We analyzed data on isolated CABG patients from the Veterans Affairs national database (2010-2019). We stratified patients into control (normal LVEF and no heart failure), HFmrEF, and heart failure with reduced LVEF (HFrEF) groups. We compared all-cause mortality and heart failure hospitalization rates between groups with a Cox model and recurrent events analysis, respectively. RESULTS In 6533 veterans, HFmrEF and HFrEF was present in 1715 (26.3%) and 566 (8.6%) respectively; the control group had 4252 (65.1%) patients. HFrEF patients were more likely to have diabetes mellitus (59%), insulin therapy (36%), and previous myocardial infarction (31%). Anemia was more prevalent in patients with HFrEF (49%) as was a lower serum albumin (mean, 3.6 mg/dL). Compared with the control group, a higher risk of death was observed in the HFmrEF (hazard ratio [HR], 1.3 [1.2-1.5)] and HFrEF (HR, 1.5 [1.2-1.7]) groups. HFmrEF patients had the higher risk of myocardial infarction (subdistribution HR, 1.2 [1-1.6]; P = .04). Risk of heart failure hospitalization was higher in patients with HFmrEF (HR, 4.1 [3.5-4.7]) and patients with HFrEF (HR, 7.2 [6.2-8.5]). CONCLUSIONS Heart failure with midrange ejection fraction negatively affects survival after CABG. These patients also experience higher rates myocardial infarction and heart failure hospitalization.
Collapse
Affiliation(s)
- Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; Cleveland VA CV Research Group, Cleveland, Ohio.
| | - Varun Sundaram
- Cleveland VA CV Research Group, Cleveland, Ohio; Department of Cardiovascular Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Jayakumar Sahadevan
- Cleveland VA CV Research Group, Cleveland, Ohio; Department of Cardiovascular Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Padmini Selvaganesan
- Department of Cardiovascular Medicine, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | | | - Joseph Rubelowsky
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Richard Josephson
- Cleveland VA CV Research Group, Cleveland, Ohio; Department of Cardiovascular Medicine, Harrington Heart and Vascular Institute, Cleveland Medical Center, Cleveland, Ohio
| | - Yakov Elgudin
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Ahmet Kilic
- Department of Cardiac Surgery, John Hopkins School of Medicine, Baltimore, Md
| | - Brian Cmolik
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| |
Collapse
|
19
|
Davierwala PM, Verevkin A, Bergien L, von Aspern K, Deo SV, Misfeld M, Holzhey D, Borger MA. Twenty-year outcomes of minimally invasive direct coronary artery bypass surgery: The Leipzig experience. J Thorac Cardiovasc Surg 2023; 165:115-127.e4. [PMID: 33757682 DOI: 10.1016/j.jtcvs.2020.12.149] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/10/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Minimally invasive direct coronary artery bypass (MIDCAB) surgery involving left anterior descending coronary artery grafting with the left internal thoracic artery through a left anterior small thoracotomy is being routinely performed in some specified centers for patients with isolated complex left anterior descending coronary artery disease, but very few reports regarding long-term outcomes exist in literature. Our study was aimed at assessing and analyzing the early and long-term outcomes of a large cohort of patients who underwent MIDCAB procedures and identifying the effects of changing trends in patient characteristics on early mortality. METHODS A total of 2667 patients, who underwent MIDCAB procedures between 1996 and 2018, were divided into 3 groups on the basis of the year of surgery: group A, 1996-2003 (n = 1333); group B, 2004-2010 (n = 627) and group C, 2011-2018 (n = 707). Groupwise characteristics and early postoperative outcomes were compared. Long-term survival for all patients was analyzed and predictors for late mortality were identified using Cox proportional hazards methods. RESULTS The mean age was 64.5 ± 10.9 years and 691 (25.9%) patients were female. Group C patients (log EuroSCORE I = 4.9 ± 6.9) were older with more cardiac risk factors and comorbidities than groups A (log EuroSCORE I = 3.1 ± 4.5) and B (log EuroSCORE I = 3.5 ± 4.7). Overall and groupwise in-hospital mortality was 0.9%, 1.0%, 0.6%, and 1.0% (P = .7), respectively. Overall 10-, 15-, and 20-year survival estimates for all patients were 77.7 ± 0.9%, 66.1 ± 1.2%, and 55.6 ± 1.6%, respectively. CONCLUSIONS MIDCAB can be safely performed with very good early and long-term outcomes. In-hospital mortality remained constant over the 22-year period of the study despite worsening demographic profile of patients.
Collapse
Affiliation(s)
- Piroze M Davierwala
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany.
| | - Alexander Verevkin
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany
| | - Laura Bergien
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany
| | | | - Salil V Deo
- North East Ohio VA Healthcare System, Louis Stokes Cleveland VA Medical Center, Department of Veterans Affairs, Cleveland, Ohio
| | - Martin Misfeld
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany
| | - David Holzhey
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany
| | - Michael A Borger
- Leipzig Heart Center, University Department for Cardiac Surgery, Leipzig, Germany
| |
Collapse
|
20
|
Deo SV, McAllister DA, Al-Kindi S, Elgudin Y, Chu D, Pell J, Sattar N. Trends in Prescriptions of Cardioprotective Diabetic Agents After Coronary Artery Bypass Grafting Among U.S. Veterans. Diabetes Care 2022; 45:3054-3057. [PMID: 36256925 DOI: 10.2337/dc22-0570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 09/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Patients with type 2 diabetes undergoing coronary artery bypass grafting (CABG) are at risk for cardiovascular events. Sodium-glucose cotransporter 2 receptor inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RA) are effective cardioprotective agents; however, their prescription among CABG patients is uncertain. The aims of this study were 1) to evaluate the overall use of SGLT2i/GLP-1RA after CABG and explore longitudinal trends and 2) to examine patient-related factors associated with the use of SGLT2i or GLP-1RA. RESEARCH DESIGN AND METHODS We analyzed the nationwide Veterans Affairs (VA) database (2016-2019) to report trends and factors associated with SGLT2i or GLP-1RA prescription after CABG. RESULTS Among 5,109 patients operated on at 40 different VA medical centers, 525 of 5,109 (10.4%), 352 of 5,109 (6.8%), and 91 of 5,109 (1.8%) were prescribed SGLT2i, GLP-1RA, and both, respectively. A substantial increase in the quarterly SGLT2i prescription rates (1.6% [first quarter of 2016 (2016Q1)], 33% [2019Q4]) was present but was lower for GLP-1RA (0.8% [2016Q1], 11.2% [2019Q4]). SGLT2i use was less likely with preexisting vascular disease (odd ratio [OR] 0.75, 95% CI 0.75, 0.94) or kidney disease (OR 0.72, 95% CI 0.58, 0.88), while GLP-1RA use was associated with obesity (OR 1.91, 95% CI 1.50, 2.46). CONCLUSIONS The overall utilization of SGLT2i or GLP-1RA drugs in U.S. veterans with type 2 diabetes undergoing CABG is low, with SGLT2i preferred over GLP-1RA.
Collapse
Affiliation(s)
- Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.,Institute of Health and Wellbeing, University of Glasgow, Glasgow, U.K.,Department of Surgery, Case School of Medicine, Case Western Reserve University, Cleveland, OH
| | | | - Sadeer Al-Kindi
- Center for Integrated and Novel Approaches in Vascular Metabolic Disease, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH.,Division of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.,Department of Medicine, Case School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Yakov Elgudin
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, OH.,Department of Surgery, Case School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Danny Chu
- Surgical Services, Pittsburgh VA Medical Center, Pittsburgh, PA
| | - Jill Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, U.K
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| |
Collapse
|
21
|
Deo SV. Commentary: Losing sight of the forest for the trees. J Thorac Cardiovasc Surg 2022; 164:553-554. [PMID: 33277024 DOI: 10.1016/j.jtcvs.2020.10.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
| |
Collapse
|
22
|
Deo SV, Marsia S, McAllister DA, Elgudin Y, Sattar N, Pell JP. The time-varying cardiovascular benefits of glucagon-like peptide-1 receptor agonist therapy in patients with type 2 diabetes mellitus: Evidence from large multinational trials. Diabetes Obes Metab 2022; 24:1607-1616. [PMID: 35491516 PMCID: PMC9540124 DOI: 10.1111/dom.14738] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the time-varying cardio-protective effect of glucagon-like peptide-1 receptor agonists (GLP-1RAs) using pooled data from eight contemporary cardiovascular outcome trials using the difference in the restricted mean survival time (ΔRMST) as the effect estimate. MATERIAL AND METHODS Data from eight multinational cardiovascular outcome randomized controlled trials of GLP-1RAs for type 2 diabetes mellitus were pooled. Flexible parametric survival models were fit from published Kaplan-Meier plots. The differences between arms in RMST (ΔRMST) were calculated at 12, 24, 36 and 48 months. ΔRMST values were pooled using an inverse variance-weighted random-effects model; heterogeneity was tested with Cochran's Q statistic. The endpoints studied were: three-point major adverse cardiovascular events (MACE), all-cause mortality, stroke, cardiovascular mortality and myocardial infarction. RESULTS We included eight large (3183-14 752 participants, total = 60 080; median follow-up range: 1.5 to 5.4 years) GLP-1RA trials. Among GLP-1RA recipients, we observed an average delay in three-point MACE of 0.03, 0.15, 0.37 and 0.63 months at 12, 24, 36 and 48 months, respectively. At 48 months, while cardiovascular mortality was comparable in both arms (pooled ΔRMST 0.163 [-0.112, 0.437]; P = 0.24), overall survival was higher (ΔRMST = 0.261 [0.08-0.43] months) and stroke was delayed (ΔRMST 0.22 [0.15-0.33]) in patients receiving GLP-1RAs. CONCLUSIONS Glucagon-like peptide-1 receptor agonists may delay the occurrence of MACE by an average of 0.6 months at 48 months, with meaningfully larger gains in patients with cardiovascular disease. This metric may be easier for clinicians and patients to interpret than hazard ratios, which assume a knowledge of absolute risk in the absence of treatment.
Collapse
Affiliation(s)
- Salil V. Deo
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
- Surgical ServicesLouis Stokes Cleveland VA Medical CenterClevelandOhioUSA
- Case School of MedicineCase Western Reserve UniversityClevelandOhioUSA
| | - Shayan Marsia
- Department of Internal MedicineDow Medical CollegeKarachiPakistan
| | | | - Yakov Elgudin
- Surgical ServicesLouis Stokes Cleveland VA Medical CenterClevelandOhioUSA
- Case School of MedicineCase Western Reserve UniversityClevelandOhioUSA
| | - Naveed Sattar
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
| | - Jill P. Pell
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| |
Collapse
|
23
|
Marin-Cuartas M, Hoyer A, Naumann S, Deo SV, Noack T, Abdel-Wahab M, Thiele H, Lauten P, Holzhey DM, Borger MA, Kiefer P. Early and mid-term outcomes following redo surgical aortic valve replacement in patients with previous transcatheter aortic valve implantation. Eur J Cardiothorac Surg 2022; 62:6625654. [PMID: 35775888 DOI: 10.1093/ejcts/ezac375] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/13/2022] [Accepted: 06/29/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To analyze the early and mid-term outcomes after redo surgical aortic valve replacement (SAVR) in patients with previous transcatheter aortic valve implantation (TAVI). METHODS Retrospective single-center analysis of early and mid-term outcomes following redo SAVR in patients with previous TAVI between 2013 and 2020. Primary outcomes were in-hospital mortality and mid-term survival. RESULTS During the study period a total of 5756 patients underwent TAVI. Amongst them, 28 (0.5%) patients required redo SAVR after TAVI. During periods 2013-2016 and 2017-2020, 4/2184 (0.2%) patients and 24/3572 (0.7%) patients required SAVR after TAVI, respectively. Median logistic EuroSCORE was significantly higher at the time of SAVR than at the time of the index TAVI (5.9% vs 11.6%; P < 0.001). Median elapsed time between TAVI and redo SAVR was 7 months (3.5 -14 months). Infective endocarditis (IE) was the most frequent indication for surgery [19 (67.8%) patients]. A total of 11 (39.3%) patients underwent isolated SAVR and 17 (60.7%) SAVR + additional cardiac surgical procedures. The overall in-hospital mortality was 14.3% (4/28). In-hospital mortality was 15.8% (3/19) among IE patients and 11.1% (1/9) among non-IE patients (p = 0.7). Overall estimated survival was 66.5%, 59.9% and 48.0% at 12, 18 and 24 months, respectively. Patients with IE showed a trend towards a lower estimated mid-term survival compared to non-IE patients [41.6% (95% CI; 22.0% - 78.0%) vs 58.3% (95% CI; 30.0% - 100%) survival at 24 months (p = 0.3)]. CONCLUSION SAVR can be successfully performed in patients with prior TAVI despite the increased surgical risk and technical difficulty. IE is associated with decreased mid-term survival.
Collapse
Affiliation(s)
- Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Alexandro Hoyer
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Stefanie Naumann
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Salil V Deo
- Louis Stokes Cleveland VA Medical Center, Department of Veterans Affairs, Cleveland Ohio, United States of America
| | - Thilo Noack
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | - Holger Thiele
- Department of Cardiology, Leipzig Heart Center, Leipzig, Germany
| | - Philipp Lauten
- Department of Cardiology, Zentralklinik, Bad Berka, Germany
| | - David M Holzhey
- Department of Cardiac Surgery, Helios Universitätsklinikum Wuppertal, Witten-Herdecke University, Wuppertal, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Philipp Kiefer
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| |
Collapse
|
24
|
Deo SV, Elgudin Y, Shroyer ALW, Altarabsheh S, Sharma V, Rubelowsky J, Cornwell L, Davierwala P, Chu D, Cmolik B. Off-Pump Coronary Artery Bypass Grafting: Department of Veteran Affairs' Use and Outcomes. J Am Heart Assoc 2022; 11:e023514. [PMID: 35229663 PMCID: PMC9075317 DOI: 10.1161/jaha.121.023514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Coronary artery bypass can be performed off pump (OPCAB) without cardiopulmonary bypass. However, trends over time for OPCAB versus on-pump (ONCAB) use and long-term outcome has not been reported, nor has their long-term outcome been compared. Methods and Results We queried the national Veterans Affairs database (2005-2019) to identify isolated coronary artery bypass procedures. Procedures were classified as OPCAB on ONCAB using the as-treated basis. Trend analyses were performed to evaluate longitudinal changes in the preference for OPCAB. The median follow-up period was 6.6 (3.5-10) years. An inverse probability weighted Cox model was used to compare all-cause mortality between OPCAB and ONCAB. From 47 685 patients, 6759 (age 64±8 years) received OPCAB (14%). OPCAB usage declined from 16% (2005-2009) to 8% (2015-2019). Patients with triple vessel disease who received OPCAB received a lower mean number of grafts (2.8±0.8 versus 3.2±0.8; P<0.01). The ONCAB 5-, 10-, and 15-year survival rates were 82.9% (82.5-83.3), 60.4% (59.8-61.1), and 37.2% (36.1-38.4); correspondingly, OPCAB rates were 80.7% (79.7-81.7), 57.4% (56-58.7), and 34.1% (31.7-36.6) (P<0.01). OPCAB was associated with increased risk-adjusted all-cause mortality (hazard ratio, 1.15 [1.13-1.18]; P<0.01) and myocardial infarction (incident rate ratio, 1.16 [1.05-1.28]; P<0.01). Conclusions Over 15 years, OPCAB use declined considerably in Veterans Affairs medical centers. In Veterans Affairs hospitals, late all-cause mortality and myocardial infarction rates were higher in the OPCAB cohort.
Collapse
Affiliation(s)
- Salil V. Deo
- Surgical ServicesLouis Stokes Cleveland VA Medical CenterClevelandOH
- Cleveland Cardiothoracic Research GroupClevelandOH
- Department of SurgeryCase School of Medicine, Case Western Reserve UniversityClevelandOH
| | - Yakov Elgudin
- Surgical ServicesLouis Stokes Cleveland VA Medical CenterClevelandOH
- Cleveland Cardiothoracic Research GroupClevelandOH
| | - A. Laurie W. Shroyer
- Department of SurgeryHealth Sciences CenterStony Brook Renaissance School of MedicineStony BrookNew York
- Research and Development OfficeNorthport VA Medical CenterNorthportNY
| | - Salah Altarabsheh
- Department of Cardiac SurgeryQueen Alia Heart InstituteAmmanJordan
- Division of Cardiovascular SurgeryMayo ClinicRochesterMinnesota
| | - Vikas Sharma
- Surgical ServicesGeorge E Wahlen VA Medical CenterSalt Lake CityUT
- Division of Cardiothoracic SurgeryUniversity of Utah School of MedicineSalt Lake CityUT
| | - Joseph Rubelowsky
- Surgical ServicesLouis Stokes Cleveland VA Medical CenterClevelandOH
- Cleveland Cardiothoracic Research GroupClevelandOH
| | | | | | - Danny Chu
- Division of Cardiac SurgeryDepartment of Cardiothoracic SurgeryUniversity of PittsburghPA
| | - Brian Cmolik
- Surgical ServicesLouis Stokes Cleveland VA Medical CenterClevelandOH
- Cleveland Cardiothoracic Research GroupClevelandOH
| |
Collapse
|
25
|
Sheikh MA, Deo SV, Ueda P, Altarabsheh S, Elgudin Y, Rubelowsky J, Cmolik B, Hawkins N, McAllister D, Sattar N, Pell J. STEPWISE APPROACH TO LIPID LOWERING IN ‘VERY HIGH RISK’ PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY: A MONTE CARLO SIMULATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01952-0] [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: 10/18/2022]
|
26
|
Thuijs DJFM, Davierwala P, Milojevic M, Deo SV. Reply to Royse et al. Eur J Cardiothorac Surg 2022; 62:6524610. [PMID: 35137034 PMCID: PMC9525003 DOI: 10.1093/ejcts/ezac058] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 01/28/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands,Corresponding author. Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands. Tel: +31 10 70 354 11; e-mail:
| | - Piroze Davierwala
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany,Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, 15 University Health Network, Toronto, ON, Canada,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands,Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Salil V Deo
- Department of Cardiovascular Surgery, Louis Stokes Cleveland VA Medical Centre, Cleveland, OH, USA
| |
Collapse
|
27
|
Deo SV, Reddy YN, Zakeri R, Karnib M, Selvaganesan P, Elgudin Y, Kilic A, Rubelowsky J, Altarabsheh SE, Osman MN, Josephson RA, Mohan SKM, Cmolik B, Simon DI, Rajagopalan S, Cleland JG, Sahadevan J, Sundaram V. Revascularization in Ischemic Heart Failure with Preserved Ejection Fraction: A Nationwide Cohort Study. Eur J Heart Fail 2022; 24:1427-1438. [PMID: 35119162 DOI: 10.1002/ejhf.2446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Salil V Deo
- Louis Stokes Veteran Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | - Mohamad Karnib
- Louis Stokes Veteran Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Padmini Selvaganesan
- Louis Stokes Veteran Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Yakov Elgudin
- Louis Stokes Veteran Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ahmet Kilic
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Mohammed N Osman
- Louis Stokes Veteran Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Richard A Josephson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Brian Cmolik
- Louis Stokes Veteran Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Daniel I Simon
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - Sanjay Rajagopalan
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| | - John Gf Cleland
- Robertson Center for Biostatistics, University of Glasgow, Glasgow, UK
| | - Jayakumar Sahadevan
- Louis Stokes Veteran Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Varun Sundaram
- Louis Stokes Veteran Affairs Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH
| |
Collapse
|
28
|
Thuijs DJFM, Davierwala P, Milojevic M, Deo SV, Noack T, Kappetein AP, Serruys PW, Mohr FW, Morice MC, Mack MJ, Ståhle LEGE, Verberkmoes NJ, Holmes DR, Head SJ. Long-term survival after coronary bypass surgery with multiple versus single arterial grafts. Eur J Cardiothorac Surg 2021; 61:925-933. [PMID: 34618017 PMCID: PMC8947797 DOI: 10.1093/ejcts/ezab392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 07/21/2021] [Accepted: 08/01/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES This study sought to evaluate the long-term differences in survival between multiple arterial grafts (MAG) and single arterial grafts (SAG) in patients who underwent coronary artery bypass grafting (CABG) in the SYNTAX study. METHODS The present analysis included the randomized and registry-treated CABG patients (n = 1509) from the SYNTAX Extended Survival study (SYNTAXES). Patients with only venous (n = 42) or synthetic grafts (n = 1) were excluded. The primary end point was all-cause death at the longest follow-up. Multivariable Cox regression was used to adjust for differences in baseline characteristics. Sensitivity analysis using propensity matching with inverse probability for treatment weights was performed. RESULTS Of the 1466 included patients, 465 (31.7%) received MAG and 1001 (68.3%) SAG. Patients receiving MAG were younger and at lower risk. At the longest follow-up of 12.6 years, all-cause death occurred in 23.6% of MAG and 40.0% of SAG patients [adjusted hazard ratio (HR) 0.74, 95% confidence interval (CI) (0.55-0.98); P = 0.038], which was confirmed by sensitivity analysis. MAG in patients with the three-vessel disease was associated with significant lower unadjusted and adjusted all-cause death at 12.6 years [adjusted HR 0.65, 95% CI (0.44-0.97); P = 0.033]. In contrast, no significance was observed after risk adjustment in patients with the left main disease, with and without diabetes, or among SYNTAX score tertiles. CONCLUSIONS In the present post hoc analysis of all-comers patients from the SYNTAX trial, MAG resulted in markedly lower all-cause death at 12.6-year follow-up compared to a SAG strategy. Hence, this striking long-term survival benefit of MAG over SAG encourages more extensive use of multiple arterial grafting in selected patients with reasonable life expectancy. TRIAL REGISTRATION SYNTAXES ClinicalTrials.gov reference: NCT03417050; SYNTAX ClinicalTrials.gov reference: NCT00114972.
Collapse
Affiliation(s)
- Daniel J F M Thuijs
- Corresponding author. Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Dr. Molewaterplein 40, POBox 2040, 3015 GD Rotterdam, The Netherlands. Tel: +31-10-7035411; fax: +31-10-7033993; e-mail: (dr. D.J.F.M. Thuijs)
| | | | - Milan Milojevic
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands,Department of Cardiac Surgery and Cardiovascular Research, Dedinje Cardiovascular Institute, Belgrade, Serbia
| | - Salil V Deo
- Department of Cardiovascular Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - A Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway, Ireland
| | | | - Marie-Claude Morice
- Department of Cardiology, Cardiovascular Institute Paris-Sud (ICPS), Hopital privé Jacques Cartier, Ramsay, Générale de Santé Massy, France
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, TX, USA
| | | | - Niels J Verberkmoes
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, Netherlands
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | | |
Collapse
|
29
|
Sheikh MA, Ngendahimana D, Deo SV, Raza S, Altarabsheh SE, Reed GW, Kalra A, Cmolik B, Kapadia S, Eagle KA. Home health care after discharge is associated with lower readmission rates for patients with acute myocardial infarction. Coron Artery Dis 2021; 32:481-488. [PMID: 33471476 DOI: 10.1097/mca.0000000000001000] [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: 10/22/2022]
Abstract
OBJECTIVE We studied the utilization of home health care (HHC) among acute myocardial infarction (AMI) patients, impact of HHC on and predictors of 30-day readmission. METHODS We queried the National Readmission Database (NRD) from 2012 to 2014identify patients with AMI discharged home with (HHC+) and without HHC (HHC-). Linkage provided in the data identified patients who had 30-day readmission, our primary end-point. The probability for each patient to receive HHC was calculated by a multivariable logistic regression. Average treatment of treated weights were derived from propensity scores. Weight-adjusted logistic regression was used to determine impact of HHC on readmission. RESULTS A total of 406 237 patients with AMI were discharged home. Patients in the HHC+ cohort (38 215 patients, 9.4%) were older (mean age 77 vs. 60 years P < 0.001), more likely women (53 vs. 26%, P < 0.001), have heart failure (5 vs. 0.5%, P < 0.001), chronic kidney disease (26 vs. 6%, P < 0.001) and diabetes (35 vs. 26%, P < 0.001). Patients readmitted within 30-days were older with higher rates of diabetes (RR = 1.4, 95% CI: 1.37-1.48) and heart failure (RR = 5.8, 95% CI: 5.5-6.2). Unadjusted 30-day readmission rates were 21 and 8% for HHC+ and HHC- patients, respectively. After adjustment, readmission was lower with HHC (21 vs. 24%, RR = 0.89, 95% CI: 0.82-0.96; P < 0.001). CONCLUSION In the United States, AMI patients receiving HHC are older and have more comorbidities; however, HHC was associated with a lower 30-day readmission rate.
Collapse
Affiliation(s)
- Muhammad A Sheikh
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - David Ngendahimana
- Department of Population and Quantitative Health Sciences, Case Western Reserve University
| | - Salil V Deo
- Department of Cardiothoracic Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Sajjad Raza
- PRECISIONheor, Precision Value & Health, Boston, MA USA
| | | | - Grant W Reed
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Cmolik
- Department of Cardiothoracic Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kim A Eagle
- Department of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
30
|
Marin-Cuartas M, Deo SV, Ramirez P, Verevkin A, Leontyev S, Borger MA, Davierwala PM. Off-pump coronary artery bypass grafting is safe and effective in patients with severe left ventricular dysfunction. Eur J Cardiothorac Surg 2021; 61:705-713. [PMID: 34392337 DOI: 10.1093/ejcts/ezab371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/12/2021] [Accepted: 07/14/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Severe left ventricular dysfunction (LVD) is associated with increased risk following coronary artery bypass grafting (CABG). Due to a dearth of reports on the choice of CABG technique in patients with LVD, this study aims to compare the outcomes of off-pump CABG (OPCAB) and conventional CABG (ONCAB) in such patients. METHODS Retrospective single-centre propensity-matched analysis comparing early- and long-term outcomes of OPCAB and ONCAB in patients with severe LVD. Primary outcome was long-term all-cause mortality. RESULTS Between 2002 and 2014, a total of 1161 consecutive patients with severe LVD underwent isolated CABG [442 patients underwent OPCAB and 719 ONCAB (430 matched pairs)]. Incomplete revascularization was observed more frequently among OPCAB than ONCAB patients (35.3% vs 21.6%; P < 0.01). The overall 30-day mortality was 5% and was comparable between the matched groups [OR 0.64 (0.34-1.22); P = 0.18]. OPCAB patients had shorter median hospital stay (11 vs 12 days; P = 0.02) and lower packed red blood cell transfusion rates [2.7 (2.21-3.19) vs 4.4 (3.56-5.24); P < 0.01]. Estimated adjusted survival was 86.0% vs 85.8%, 69.1% vs 65.5% and 59.9% vs 49.1% at 1, 5 and 10 years for OPCAB and ONCAB patients, respectively (P = 0.99). Long-term risk of mortality was similar between groups [hazard ratio (HR) 0.94 (0.66-1.32); P = 0.7]. Incomplete revascularization was weakly associated with increased risk of long-term all-cause mortality [HR 1.33 (0.99-1.77); P = 0.05]. CONCLUSIONS OPCAB is safe and effective in patients with severe LVD. Although incomplete revascularization is more commonly observed in patients undergoing OPCAB, it is not associated with increased late mortality.
Collapse
Affiliation(s)
- Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Salil V Deo
- Department of Veterans Affairs, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Paulina Ramirez
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Alexander Verevkin
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Sergey Leontyev
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.,Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| |
Collapse
|
31
|
Altarabsheh SE, Deo SV, Rababa'h AM, Alhusban FH, Alsharbini RA. Anomalous and Diseased Left Main Coronary Artery Arising fromthe RightCoronarySinus in an Elderly Lady. J Saudi Heart Assoc 2021. [PMID: 34183908 DOI: 10.37616/2212-5043.1248.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We report a case of 66-year-old female patient who presented with unstable angina and New York Heart Association Class III symptoms. Echocardiogram demonstrated wall motion abnormalities in the anterior and inferior walls. Coronary angiography demonstrated a severely diseased right coronary artery (RCA) and anomalous left main (LM) coronary artery arising from the right coronary sinus and courses posterior to the aorta and runs between the aorta and the main pulmonary artery with severe multiple atherosclerotic disease. Patient underwent successful coronary artery bypass grafting and was dismissed in good general status.
Collapse
Affiliation(s)
- Salah E Altarabsheh
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Salil V Deo
- Division of Cardiovascular Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Abeer M Rababa'h
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Fadi H Alhusban
- Department of Cardiac Anesthesia, Queen Alia Heart Institute, Amman, Jordan
| | - Rami A Alsharbini
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| |
Collapse
|
32
|
Davierwala PM, Marin-Cuartas M, Misfeld M, Deo SV, Lehmann S, Garbade J, Holzhey DM, Borger MA, Bakhtiary F. Five-year outcomes following complex reconstructive surgery for infective endocarditis involving the intervalvular fibrous body. Eur J Cardiothorac Surg 2021; 58:1080-1087. [PMID: 32380545 DOI: 10.1093/ejcts/ezaa146] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 12/07/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Destruction of the intervalvular fibrous body (IFB) due to infective endocarditis (IE) warrants a complex operation involving radical debridement of all infected tissue, followed by double valve replacement (aortic and mitral valve replacement) with patch reconstruction of the IFB. This study assesses the 5-year outcomes in patients undergoing this complex procedure for treatment of double valve IE with IFB involvement. METHODS A total of 127 consecutive patients underwent double valve replacement with reconstruction of the IFB for active complex IE between January 1999 and December 2018. Primary outcomes were 3-year and 5-year survival, as well as 5-year freedom from reoperation. RESULTS Patients' mean age was 65.3 ± 12.9 years. Preoperative cardiogenic shock and sepsis were present in 17.3% and 18.9%, respectively. The majority of patients (81.3%) had undergone previous cardiac surgery. Overall, 30-day and 90-day mortality rates were 28.3% and 37.0%, respectively. The 3- and 5-year survival rates for all patients were 45.3 ± 5.1% and 41.8 ± 5.8%, and for those who survived the first 90 postoperative days 75.8 ± 6.1% and 70.0 ± 8.0%, respectively. The overall 5-year freedom from reoperation was 85.1 ± 5.7%. Preoperative predictors for 30-day mortality were Staphylococcus aureus [odds ratio (OR) 1.65; P = 0.04] and left ventricular ejection fraction (LVEF) <35% (OR 12.06; P = 0.03), for 90-day mortality acute kidney injury requiring dialysis (OR 6.2; P = 0.02) and LVEF <35% (OR 9.66; P = 0.03) and for long-term mortality cardiogenic shock (hazard ratio 2.46; P = 0.01). CONCLUSIONS Double valve replacement with reconstruction of the IFB in patients with complex IE is a challenging operation associated with high morbidity and mortality, particularly in the first 90 days after surgery. Survival and freedom from reoperation rates are acceptable thereafter, particularly considering the severity of disease and complex surgery.
Collapse
Affiliation(s)
- Piroze M Davierwala
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Mateo Marin-Cuartas
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Martin Misfeld
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Salil V Deo
- Department of Veterans Affairs, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Sven Lehmann
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Jens Garbade
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - David M Holzhey
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Farhad Bakhtiary
- Department of Cardiothoracic Surgery, Helios Klinikum Siegburg, Siegburg, Germany
| |
Collapse
|
33
|
Altarabsheh SE, Deo SV, Rababa'h AM, Alhusban FH, Alsharbini RA. Anomalous and Diseased Left Main Coronary Artery Arising fromthe RightCoronarySinus in an Elderly Lady. J Saudi Heart Assoc 2021; 33:124-127. [PMID: 34183908 PMCID: PMC8143727 DOI: 10.37616/2212-5043.1248] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 03/21/2021] [Accepted: 03/21/2021] [Indexed: 11/23/2022] Open
Abstract
We report a case of 66-year-old female patient who presented with unstable angina and New York Heart Association Class III symptoms. Echocardiogram demonstrated wall motion abnormalities in the anterior and inferior walls. Coronary angiography demonstrated a severely diseased right coronary artery (RCA) and anomalous left main (LM) coronary artery arising from the right coronary sinus and courses posterior to the aorta and runs between the aorta and the main pulmonary artery with severe multiple atherosclerotic disease. Patient underwent successful coronary artery bypass grafting and was dismissed in good general status.
Collapse
Affiliation(s)
- Salah E Altarabsheh
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Salil V Deo
- Division of Cardiovascular Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Abeer M Rababa'h
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Fadi H Alhusban
- Department of Cardiac Anesthesia, Queen Alia Heart Institute, Amman, Jordan
| | - Rami A Alsharbini
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| |
Collapse
|
34
|
Ngendahimana DK, Deo SV, Sundaram V, Lentine KL, Herzog CA, Al Dahabreh L, Srinivas TR, Chavin KD, Sarabu N. Outcomes of Surgical Mitral and Aortic Valve Replacements Among Kidney Transplant Candidates: Implications for Valve Selection. J Am Heart Assoc 2021; 10:e018971. [PMID: 33599143 PMCID: PMC8174273 DOI: 10.1161/jaha.120.018971] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Limited literature exists that evaluated outcomes of kidney transplant–eligible patients who are having dialysis and who are undergoing valve replacement. Our main objective in this study was to compare mortality, reoperation, and bleeding episodes between bioprosthetic and mechanical valve procedures among kidney transplant–eligible patients who are having dialysis. Methods and Results We studied 887 and 1925 dialysis patients from the United States Renal Data System, who underwent mitral valve replacement and aortic valve replacement (AVR) after being waitlisted for a kidney transplant (2000–2015), respectively. Time to death, time to reoperation, and time to bleeding requiring hospitalizations were compared separately for AVR and mitral valve replacement. Kaplan–Meier survival curves, Cox proportional hazards model for time to death, accelerated time to event model for time to reoperation, and counting process model for time to recurrent bleeding were used. There were no differences in mortality (hazard ratio [HR], 0.92; 95% CI, 0.77–1.09) or risk of reoperation or risk of significant bleeding events between bioprosthetic and mechanical mitral valve replacement. However, mechanical AVR was associated with a modestly significant less hazard of death (HR, 0.83; 95% CI, 0.74–0.94) compared with bioprosthetic AVR. There were no differences in time to reoperation, or time to significant bleeding events between bioprosthetic and mechanical AVR. Conclusions For kidney transplant waitlisted patients who are on dialysis and who are undergoing surgical valve replacement, bioprosthetic and mechanical valves have comparable survival, reoperation rates, and bleeding episodes requiring hospitalizations at both mitral and aortic locations. These findings emphasize that an individualized informed decision is recommended when choosing the type of valve for this special group of patients having dialysis.
Collapse
Affiliation(s)
| | - Salil V Deo
- Division of Cardiac Surgery Louis Stokes Veterans Affairs Medical Center Cleveland OH
| | - Varun Sundaram
- Division of Cardiology Department of Medicine University Hospitals Cleveland Medical Center Cleveland OH
| | - Krista L Lentine
- Center for Abdominal Transplantation Saint Louis University St. Louis MO
| | - Charles A Herzog
- Division of Cardiology Department of Internal Medicine Hennepin Healthcare and University of Minnesota Minneapolis MN
| | - Laith Al Dahabreh
- Transplant Institute University Hospitals Cleveland Medical Center Cleveland OH
| | - Titte R Srinivas
- Transplant Institute University Hospitals Cleveland Medical Center Cleveland OH
| | - Kenneth D Chavin
- Transplant Institute University Hospitals Cleveland Medical Center Cleveland OH
| | - Nagaraju Sarabu
- Transplant Institute University Hospitals Cleveland Medical Center Cleveland OH
| |
Collapse
|
35
|
Sheikh MA, Deo SV, Riaz H, Raza S, Altarabsheh SE, Wilson B, Elgudin Y, Cmolik B, Pelletier M, Markowitz AH. Safety-net hospitals versus non-safety centers and clinical outcomes after trans-catheter aortic valve replacement. Catheter Cardiovasc Interv 2021; 97:E425-E430. [PMID: 32681697 DOI: 10.1002/ccd.29123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare post-procedural outcomes of trans-catheter valve replacement (TAVR) among safety-net (SNH) and non-safety net hospitals (non-SNH). BACKGROUND SNH treat a large population of un-insured and low income patients; prior studies report worse outcome at these centers. Results of TAVR at these centers is limited. METHODS Adults undergoing TAVR at hospitals in the US participating in the National In-patient sample (NIS) database from January 2014 to December 2015 were included. A 1:1 propensity-matched cohort of patients operated at SNH and non-SNH institutions was analyzed, on the basis of 16 demographic and clinical co-variates. Main outcome was all-cause post-procedural mortality. Secondary outcomes included stroke, acute kidney injury and length of post-operative stay. RESULTS Between 2014 and 2015, 41,410 patients (mean age 80 ± 0.11 years, 46% female) underwent TAVR at 731 centers; 6,996 (16.80%) procedures were performed at SNH comprising 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49% vs. 46%, p < .001); admitted emergently (31% vs. 21%; p < .001; at the lowest quartile for household income (25% % vs. 20%; p < .001) and from minorities (Blacks 5.9% vs. 3.9%; Hispanic 7.2% vs. 3.2%).Adjusted logistic regression was performed on 6,995 propensity-matched patient pairs. Post-procedural mortality [OR 0.99(0.98-1.007); p = .43], stroke [OR 1.009(0.99-1.02); p = .08], acute kidney injury [OR 0.99(0.96-1.01); p = .5] and overall length of stay (6.9 ± 0.1 vs. 7.1 ± 0.2 days; p = .57) were comparable in both cohorts. CONCLUSION Post-procedural outcomes after TAVR at SNH are comparable to national outcomes and wider adoption of TAVR at SNH may not adversely influence outcomes.
Collapse
Affiliation(s)
- Muhammad Adil Sheikh
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Salil V Deo
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Haris Riaz
- Division of Cardiovascular Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Brigid Wilson
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Yakov Elgudin
- Division of Cardiovascular Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Brian Cmolik
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Marc Pelletier
- Division of Cardiac Surgery, University Hospitals, Cleveland, Ohio
| | - Alan H Markowitz
- Division of Cardiac Surgery, University Hospitals, Cleveland, Ohio
| |
Collapse
|
36
|
Sheikh MA, Deo SV, Riaz H, Raza S, Altarabsheh SE, Wilson B, Elgudin Y, Cmolik B, Pelletier M, Markowitz AH. Safety-net hospitals versus non-safety centers and clinical outcomes after trans-catheter aortic valve replacement. Catheter Cardiovasc Interv 2021. [PMID: 32681697 DOI: 10.1002/ccd.29123.] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare post-procedural outcomes of trans-catheter valve replacement (TAVR) among safety-net (SNH) and non-safety net hospitals (non-SNH). BACKGROUND SNH treat a large population of un-insured and low income patients; prior studies report worse outcome at these centers. Results of TAVR at these centers is limited. METHODS Adults undergoing TAVR at hospitals in the US participating in the National In-patient sample (NIS) database from January 2014 to December 2015 were included. A 1:1 propensity-matched cohort of patients operated at SNH and non-SNH institutions was analyzed, on the basis of 16 demographic and clinical co-variates. Main outcome was all-cause post-procedural mortality. Secondary outcomes included stroke, acute kidney injury and length of post-operative stay. RESULTS Between 2014 and 2015, 41,410 patients (mean age 80 ± 0.11 years, 46% female) underwent TAVR at 731 centers; 6,996 (16.80%) procedures were performed at SNH comprising 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49% vs. 46%, p < .001); admitted emergently (31% vs. 21%; p < .001; at the lowest quartile for household income (25% % vs. 20%; p < .001) and from minorities (Blacks 5.9% vs. 3.9%; Hispanic 7.2% vs. 3.2%).Adjusted logistic regression was performed on 6,995 propensity-matched patient pairs. Post-procedural mortality [OR 0.99(0.98-1.007); p = .43], stroke [OR 1.009(0.99-1.02); p = .08], acute kidney injury [OR 0.99(0.96-1.01); p = .5] and overall length of stay (6.9 ± 0.1 vs. 7.1 ± 0.2 days; p = .57) were comparable in both cohorts. CONCLUSION Post-procedural outcomes after TAVR at SNH are comparable to national outcomes and wider adoption of TAVR at SNH may not adversely influence outcomes.
Collapse
Affiliation(s)
- Muhammad Adil Sheikh
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Salil V Deo
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Haris Riaz
- Division of Cardiovascular Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Brigid Wilson
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Yakov Elgudin
- Division of Cardiovascular Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Brian Cmolik
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Marc Pelletier
- Division of Cardiac Surgery, University Hospitals, Cleveland, Ohio
| | - Alan H Markowitz
- Division of Cardiac Surgery, University Hospitals, Cleveland, Ohio
| |
Collapse
|
37
|
Deo SV. Reply: Mīlle viae dūcunt hominēs per saecula Rōmam. J Thorac Cardiovasc Surg 2021; 164:e89-e90. [PMID: 33551076 DOI: 10.1016/j.jtcvs.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Northeast Ohio VA Healthcare System, Cleveland, Ohio
| |
Collapse
|
38
|
Kalra A, Raza S, Hussain M, Shorbaji K, Delozier S, Deo SV, Khera S, Kleiman NS, Reardon MJ, Kolte D, Gupta T, Mustafa R, Bhatt DL, Sabik JF. Aortic Valve Replacement in Bioprosthetic Failure: Insights From The Society of Thoracic Surgeons National Database. Ann Thorac Surg 2020; 110:1637-1642. [DOI: 10.1016/j.athoracsur.2019.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 07/11/2019] [Accepted: 08/08/2019] [Indexed: 10/25/2022]
|
39
|
Deo SV, Sundaram V, Wilson B, Sahadevan J, Madan Mohan SK, Rubelowsky J, Elgudin Y, Cmolik B. Adverse events after coronary artery bypass grafting in patients with preoperative metabolic syndrome: A 10-year follow-up of the Veterans Affairs Database. J Thorac Cardiovasc Surg 2020; 163:2096-2103.e3. [PMID: 32919773 DOI: 10.1016/j.jtcvs.2020.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/01/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Data regarding 10-year survival and adverse cardiovascular events in patients with metabolic syndrome (MET) after coronary artery bypass grafting (CABG) is limited. METHODS We compared 10-year events rates for veterans undergoing isolated CABG (January 1, 2005, to December 31, 2014, follow-up October 31, 2019) stratified by presence of metabolic syndrome (MET+) versus without (MET-). A multivariable weighted Cox model was used to analyze all-cause mortality. Competing risk analysis was used to calculate cumulative event rates for congestive heart failure, myocardial infarction, and cerebrovascular events. The Fine-Gray subhazard model was used to determine adjusted association of MET with myocardial infarction and stroke. Congestive heart failure was modeled as a recurrent-event analysis. RESULTS Nationally, 9615 adults (median age, 60 years; 98.9% men) underwent isolated coronary artery bypass grafting at 41 centers); among them, 3121 out of 9615 (32.5%) had MET. The prevalence of MET increased from (27.88% in 2005 to 34.02% in 2014; P = .02). MET+ group members were likely younger (median age, 63 vs 64 years; P < .01), White (72% vs 68%), and had more peripheral vascular disease (30% vs 28%; P = .04). Multivessel (72% vs 70%; P = .23) and multiarterial (4% vs 4%; P = .14) grafting was performed equally. With a median follow-up of 6.5 years, survival was similar (P = .26); however, MET was associated with higher risks for myocardial infarction (21% vs 16%; hazard ratio, 1.3; P < .01) and recurrent admissions for congestive heart failure. CONCLUSIONS Patients with metabolic syndrome undergoing coronary artery bypass grafting have higher 10-year cardiovascular event rates.
Collapse
Affiliation(s)
- Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Case School of Medicine, Case Western Reserve University, Cleveland, Ohio; VA Cardiovascular Research Group, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
| | - Varun Sundaram
- VA Cardiovascular Research Group, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; Division of Cardiovascular Medicine, University Hospitals, Cleveland, Ohio
| | - Brigid Wilson
- Research Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Jay Sahadevan
- VA Cardiovascular Research Group, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; Division of Cardiology, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Sri Krishna Madan Mohan
- VA Cardiovascular Research Group, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio; Division of Cardiology, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Joseph Rubelowsky
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Case School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Yakov Elgudin
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Case School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Brian Cmolik
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Case School of Medicine, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
40
|
Altarabsheh SE, Deo SV, Rababa'h A, Mayaah S, Alkhasawneh M, Alhabahbeh DA, Obeidat YM. Giant right coronary artery aneurysm in the setting of the acute coronary syndrome: A case report. J Card Surg 2020. [PMID: 32652673 DOI: 10.1111/jocs.14717.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Giant right coronary artery (RCA) aneurysm is a rare coronary artery pathology. We describe a 45-year-old gentleman who presented with unstable angina of recent onset. Diagnostic workup including chest computed tomography angiography and left heart catheterization demonstrated three-vessel coronary artery disease with giant proximal RCA aneurysm. In the view of the severity of the coronary artery disease and the risk of rupture associated with the giant RCA aneurysm and the clinical presentation, the patient was successfully treated by coronary artery bypass surgery. During this procedure, the RCA aneurysm was ligated at both inflow and outflow. The patient recovered well and was discharged home.
Collapse
Affiliation(s)
- Salah E Altarabsheh
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Salil V Deo
- Department of Cardiac Surgery, Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Abeer Rababa'h
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Sakher Mayaah
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | | | - Dalia A Alhabahbeh
- Department of Internal Medicine, King Hussein Medical Center, Amman, Jordan
| | - Yagthan M Obeidat
- Department of Cardiac Surgery, AlMana General Hospital, AL Khobar, Saudi Arabia
| |
Collapse
|
41
|
Altarabsheh SE, Deo SV, Rababa'h A, Mayaah S, Alkhasawneh M, Alhabahbeh DA, Obeidat YM. Giant right coronary artery aneurysm in the setting of the acute coronary syndrome: A case report. J Card Surg 2020; 35:2379-2381. [PMID: 32652673 DOI: 10.1111/jocs.14717] [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: 11/30/2022]
Abstract
Giant right coronary artery (RCA) aneurysm is a rare coronary artery pathology. We describe a 45-year-old gentleman who presented with unstable angina of recent onset. Diagnostic workup including chest computed tomography angiography and left heart catheterization demonstrated three-vessel coronary artery disease with giant proximal RCA aneurysm. In the view of the severity of the coronary artery disease and the risk of rupture associated with the giant RCA aneurysm and the clinical presentation, the patient was successfully treated by coronary artery bypass surgery. During this procedure, the RCA aneurysm was ligated at both inflow and outflow. The patient recovered well and was discharged home.
Collapse
Affiliation(s)
- Salah E Altarabsheh
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | - Salil V Deo
- Department of Cardiac Surgery, Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Abeer Rababa'h
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Sakher Mayaah
- Division of Cardiovascular Surgery, Queen Alia Heart Institute, Amman, Jordan
| | | | - Dalia A Alhabahbeh
- Department of Internal Medicine, King Hussein Medical Center, Amman, Jordan
| | - Yagthan M Obeidat
- Department of Cardiac Surgery, AlMana General Hospital, AL Khobar, Saudi Arabia
| |
Collapse
|
42
|
Kazimi M, Deo SV, Altarabsheh SE, Deo VS, Niforatos JD, Elgudin YE. Acute aortic dissection in patients presenting to US emergency department, 2006-2014. Am J Emerg Med 2020. [PMID: 32354527 DOI: 10.1016/j.ajem.2020.04.060.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Maher Kazimi
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, United States of America
| | - Salil V Deo
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, United States of America; Division of Cardiothoracic Surgery, Cleveland VA Medical Centers, Department of Veteran Affairs, Cleveland, United States of America
| | | | - Vaishali S Deo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States of America
| | - Joshua D Niforatos
- Department of Emergency Medicine, The Johns Hopkins Hospital/The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Yakov E Elgudin
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, United States of America; Division of Cardiothoracic Surgery, Cleveland VA Medical Centers, Department of Veteran Affairs, Cleveland, United States of America
| |
Collapse
|
43
|
Kazimi M, Deo SV, Altarabsheh SE, Deo VS, Niforatos JD, Elgudin YE. Acute aortic dissection in patients presenting to US emergency department, 2006-2014. Am J Emerg Med 2020; 38:2745-2747. [PMID: 32354527 DOI: 10.1016/j.ajem.2020.04.060] [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: 04/11/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022] Open
Affiliation(s)
- Maher Kazimi
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, United States of America
| | - Salil V Deo
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, United States of America; Division of Cardiothoracic Surgery, Cleveland VA Medical Centers, Department of Veteran Affairs, Cleveland, United States of America
| | | | - Vaishali S Deo
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, United States of America
| | - Joshua D Niforatos
- Department of Emergency Medicine, The Johns Hopkins Hospital/The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
| | - Yakov E Elgudin
- Department of Population & Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, United States of America; Division of Cardiothoracic Surgery, Cleveland VA Medical Centers, Department of Veteran Affairs, Cleveland, United States of America
| |
Collapse
|
44
|
Sheikh MA, Deo SV, Riaz H, Khan S, Raza S, Altarabsheh SE, Wilson B, Deo VS, Elgudin Y, Cmolik BL, Markowitz AH, Pelletier M. Abstract 356: Hospital Safety Net Status and Clinical Outcomes After Trans-catheter Aortic Valve Replacement. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Safety-net hospitals (SNH) treat a large population of un-insured and low income patients; several prior studies report worse outcome at these centers. Trans-catheter valve replacement (TAVR) is emerging as first-line therapy for aortic stenosis irrespective of surgical risk scores. However, results of TAVR performed at these centers is limited.
Objective:
To determine whether post-procedural outcomes of TAVR are comparable at safety-net (SNH) and non-safety net hospitals (non-SNH).
Methods:
We conducted a retrospective, cohort study with propensity-matched analysis. Complex survey data from the Agency for Healthcare Quality and Research containing weighted sample of all hospital admissions nationwide was utilized for this study. Adults undergoing TAVR at US hospitals participating in the National In-patient sample (NIS) database from January 2014 - December 2015 were included. A 1:1 propensity-matched cohort of patients operated at safety-net hospitals (SNH) and non-SNH institutions was analyzed. Propensity-matching was performed on the basis of sixteen demographic and clinical confounding co-variates. Main outcome studied was all-cause post-procedural mortality. Secondary outcomes compared were stroke, acute kidney injury and length of post-operative stay.
Results:
Between 2014 - 2015, 41410 patients (mean age 80 +/- 0.11 years, 46% female) underwent TAVR at 731 centers nationwide; 6996 (16.80 %) procedures were performed at safety net centers. SNH comprised 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49 % vs 46 %, p <0.001); admitted emergently (31% vs 21%; p <0.001) and at the lowest quartile for household income (25% % vs 20 %; p <0.001). A large proportion of SNH patients were minorities (Blacks 5.9% vs 3.9%; Hispanic 7.2% vs 3.2%). Adjusted logistic regression was performed on 6995 propensity-matched patient pairs. Post-procedural mortality [OR 0.99 (0.98 - 1.007); p = 0.43], stroke [OR 1.009 (0.99-1.02); p = 0.08], and acute kidney injury [OR 0.99 (0.96 - 1.01); p = 0.5] were comparable in both cohorts. Overall length of stay was also similar (6.9 +/- 0.1 vs 7.1 +/- 0.2 days; p = 057).
Conclusion:
Post-procedural outcomes after TAVR at SNH are comparable to national outcomes. Our study provides preliminary evidence that wider adoption of TAVR may not adversely influence outcomes at SNH.
Collapse
|
45
|
Sheikh MA, Ngendahimana D, Deo SV, Raza S, Altarabsheh S, Reed GW, Kalra A, Kapadia SR, Eagle K. Abstract 107: Home Health Care After Discharge is Associated With Less Early Readmissions for Patients With Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective:
Home health care (HHC) is a support tool to transition patients after discharge and acute myocardial infarction (AMI) is a significant cause of morbidity and mortality in the U.S. However, little is known regarding the impact of HHC on AMI patients. We sought to identify predictors of readmissions among AMI patients, characteristics of those who receive HHC and investigate the association of HHC with readmission.
Methods:
We queried the National Readmission Database (NRD) (January 2012 - December 2014), to identify patients discharged after AMI and selected patients who were discharged home with (HHC+) and without HHC (HHC-). We reported national estimates with survey methods with weights provided in our data. After univariate exploratory analyses, we developed a regression model to identify the probability of each patient to receive HHC. From the propensity score, we calculated average treatment on the treated (ATT) weights. These ATT weights were included in the logistic regression model to determine the impact of HHC on readmission after adjusting for available clinical confounders. We considered post-weighting standardized differences <10% as appropriate for our ATT model. To determine clinical factors associated with readmission, we also performed a multi-variable logistic regression with readmission as the end-point. All results were reported as risk ratios (RR) with their 95% confidence intervals (CI).
Results:
Between January 2012 to December 2014, 406,237 patients were treated for AMI and discharged home with or without HHC. Among these 9.4% (38,215) received HHC. HHC+ patients were older (mean age 77 ± 11 vs 60 ±12 years p<0.001), more likely to be female (53.6% vs. 26.9%, p <0.001), and have cancer (3.7% vs 1.3%, p <0.001), congestive heart failure (5.7% vs. 0.5%, p <0.001), chronic pulmonary disease (23.2% vs. 12.7%, p <0.001), chronic kidney disease (26.9% vs 6.9%, p <0.001), diabetes (35.6% vs. 26.7%, p <0.001), hypertension (70.7% vs. 64.8%, p <0.001) and peripheral vascular disease (14.6% vs 6.4%, p <0.001). Patients readmitted after MI were more likely to be older and have diabetes (RR 1.42, 95% CI 1.37-1.48), CHF (RR 5.89, CI 5.55-6.26) or COPD (RR 1.59, 1.52-1.65). Unadjusted 30-day readmission rate was 20.9% for HHC+ and 8.2% for HHC- patients. Propensity-weighted adjustment for covariates yielded 36,979 HHC+ patients and 37,785 HHC- patients. Adjusted risk rations (RR) for 30-day readmission were computed using ATT weights, and HHC+ patients had significantly lower readmission risk (RR 0.89, 95% CI 0.82 - 0.96) compared to HHC- (RR 1.12, 95% CI 1.04 - 1.21; p < 0.001)
Conclusion:
In the United States, a small proportion of patients receive home health care after discharge post-AMI. Older, females and those with diabetes or heart failure are more likely to receive home health care. Use of home health care may be associated with lower 30-day readmission rates after AMI.
Collapse
Affiliation(s)
| | | | - Salil V Deo
- Louis Stokes Cleveland VA Med center, Cleveland, OH
| | | | | | | | | | | | | |
Collapse
|
46
|
Deo SV, Chang C, Neudecker M, Raza S, Altarabsheh S, Cmolik BL. Abstract 337: Gender Differences and Outcome After Isolated Coronary Artery Bypass Grafting: A Systematic Review and Meta-analysis. Circ Cardiovasc Qual Outcomes 2020. [DOI: 10.1161/hcq.13.suppl_1.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Coronary artery bypass grafting (CABG) is among the most common surgical procedures performed in developed nations. In spite of this, studies have reported gender differences in clinical outcome exist in outcome after CABG. As data is limited to observational studies, we performed a systematic review to compare CABG outcome between women and men.
Methods:
We queried databases (1
st
January 2000 - 20
th
January 2020) to identify original studies comparing CABG outcome between genders. Our aims were (1) to study differences in risk factors (2) to compare early mortality, stroke, wound infection, acute kidney injury rates and long-term survival. We pooled risk ratios (RR) with inverse variance weighting and a random effects model for early end-points. Long-term survival was compared using incident risk ratios (IRR). All results are presented with their 95% confidence interval.
Results:
We identified 24 observational studies (1,647,035 women and 3,642,057 men) from 13 countries for inclusion. At time of CABG, women were older (66 vs 64 years; p < 0.01) and had a higher incidence of diabetes mellitus (32% vs 24%; p < 0.01), congestive heart failure (12% vs 8%; p < 0.01) and emergent surgery (13% vs 9%). More men had left ventricular dysfunction (12% vs 10%; p < 0.01) and prior myocardial infarction (40% vs 37%). Women received fewer grafts (mean difference -0.22; p < 0.01) and arterial conduits (OR 0.51, CI 0.41 - 0.63; p < 0.01). Early mortality (4% vs 2.5%, OR 1.5, CI 1.4 - 1.7) and stroke rates (OR 1.9, CI 1.3 - 1.7) were higher in women. Sternal wound infection (4.7% vs 2%) was also higher in women (OR 1.8, CI 1.1 - 1.8, p = 0.001). Acute kidney injury (OR 1.1, p = 0.09) and long-term survival (IRR 0.9, CI 0.8 - 1.2, p = 0.9) are comparable.
Conclusion:
Our meta-analysis demonstrates that women and men have significant differences in presentation and outcome after CABG. While women have worse post-operative outcomes, long-term survival is comparable.
Collapse
|
47
|
Zia A, Hasan M, Ilyas S, Siddiqui HU, Tappuni B, Marsia S, Zubair MM, Raza S, Mustafa RR, Baloch ZQ, Deo SV, Sharma UM, Sheikh MA. Reining in Sternal Wound Infections: The Achilles' Heel of Bilateral Internal Thoracic Artery Grafting. Surg Infect (Larchmt) 2020; 21:323-331. [DOI: 10.1089/sur.2018.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Aisha Zia
- Department of Thoracic & Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marium Hasan
- Department of Urology, The Kidney Centre, Karachi, Pakistan
| | - Sidra Ilyas
- Department of Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan, USA
| | - Hafiz Umair Siddiqui
- Department of Thoracic & Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bassman Tappuni
- Department of Thoracic & Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shayan Marsia
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - M. Mujeeb Zubair
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Sajjad Raza
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Rami R. Mustafa
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Salil V. Deo
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Umesh M. Sharma
- Community Division of Hospital Medicine, Mayo Clinic Health System, Rochester, Minnesota, USA
| | - Mohammad Adil Sheikh
- Department of Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan, USA
| |
Collapse
|
48
|
Deo SV, Sharma V, Altarabsheh SE, Raza S, Wilson B, Elgudin Y, Cmolik B. Home health care visits may reduce the need for early readmission after coronary artery bypass grafting. J Thorac Cardiovasc Surg 2020. [PMID: 32173106 DOI: 10.1016/j.jtcvs.2020.02.037.] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
BACKGROUND The Center for Medicaid and Medicare Services penalizes hospitals with high readmission rates after coronary artery bypass grafting (CABG). Home health care (HHC) is a proven discharge support tool. We performed a propensity-matched analysis to determine impact of HHC on readmissions after CABG. METHODS We queried the National Readmissions Database (January 2012-December 2014) for patients undergoing isolated CABG discharged home with and without HHC. Primary end point was 30-day readmission. A well-balanced subset of patients with and without HHC was created with propensity matching. Weight-adjusted logistic regression was performed to determine impact of HHC on readmissions after CABG. RESULTS In our study, 204,184 patients (mean age. 64 years; 22% female) were discharged home after CABG; 86,206 (42%) received HHC. Old age (66 vs 63 years; P < .01), diabetes (46% vs 41%; P < .001), COPD (21% vs 18%; P < .01), peripheral arterial disease (14% vs 11%; P < .001), and chronic kidney disease (2% vs 1.5%; P = .01) were factors associated with HHC. With nearest-neighbor 1:1 matching without replacement, we identified 66,610 patient pairs (unweighted) for further analysis. Readmission occurred in 11.1% and 12.5% of patients with and without HHC, respectively. After adjustment for 21 clinical covariates, use of HHC (odds ratio, 0.816; 95% confidence interval, 0.808-0.823) led to significantly lower readmission rates (P < .001). CONCLUSIONS HHC after coronary artery bypass surgery is more often provided to women, older patients, and those with diabetes mellitus, peripheral arterial disease, and chronic lung or kidney dysfunction. HHC appears to be associated with reduced rates of early readmission.
Collapse
Affiliation(s)
- Salil V Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
| | - Vikas Sharma
- Department of Cardiac Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Sajjad Raza
- Precision Health Economics and Outcomes Research, Boston, Mass
| | - Brigid Wilson
- Research Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Yakov Elgudin
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Brian Cmolik
- Surgical Services, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| |
Collapse
|
49
|
Deo SV, Raza S, Altarabsheh SE, Deo VS, Elgudin YE, Marsia S, Mitchell S, Chang C, Kalra A, Khera S, Kolte D, Costa M, Simon D, Markowitz AH, Park SJ, Sabik JF. Risk Calculator to Predict 30-Day Readmission After Coronary Artery Bypass: A Strategic Decision Support Tool. Heart Lung Circ 2019; 28:1896-1903. [PMID: 30528815 DOI: 10.1016/j.hlc.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/11/2018] [Accepted: 11/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Salil V Deo
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Cleveland, OH, USA.
| | - Sajjad Raza
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Vaishali S Deo
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Yakov E Elgudin
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Shayan Marsia
- Dow Medical College, Dow University of Health Sciences, Pakistan
| | - Stephen Mitchell
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Carolyn Chang
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Ankur Kalra
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sahil Khera
- Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Dhaval Kolte
- Division of Cardiovascular Diseases, Harrington Heart and Vascular Institute, Cleveland Medical Center, Cleveland, OH, USA
| | - Marco Costa
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Daniel Simon
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Alan H Markowitz
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Cleveland, OH, USA
| | - Soon J Park
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Cleveland, OH, USA
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Division of Cardiac Surgery, Harrington Heart and Vascular Institute, Cleveland, OH, USA
| |
Collapse
|
50
|
Raza S, Deo SV, Kalra A, Zia A, Altarabsheh SE, Deo VS, Mustafa RR, Younes A, Rao SV, Markowitz AH, Park SJ, Costa MA, Simon DI, Bhatt DL, Sabik JF. Stability After Initial Decline in Coronary Revascularization Rates in the United States. Ann Thorac Surg 2019. [PMID: 31039350 DOI: 10.1016/j.athoracsur.2019.03.080.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
BACKGROUND It remains uncertain how advances in revascularization techniques, availability of new evidence, and updated guidelines have influenced the annual rates of coronary revascularization in the United States. METHODS We used the Nationwide Inpatient Sample data from 2005 to 2014 with appropriate weighting to determine national procedural volumes. To present accurately overall percutaneous coronary intervention (PCI) rates, PCI with same-day discharge numbers per year were estimated from the available literature and added to annual PCI procedures performed. RESULTS Annual PCI rate declined from 353 per 100,000 adults in 2005 to 277 per 100,000 adults in 2009 (P < .001) but remained stable thereafter (P = .50). Annual coronary artery bypass grafting (CABG) rate declined steadily, at a shallower slope than PCI, from 120 per 100,000 in 2005 to 93 per 100,000 in 2009 (P = .02) but remained stable thereafter (P = .60). Similar trends were seen in men and women. Both PCI and CABG rates were lower in women than men over the study period (PCI, 482 to 324/100,000 in men vs 232 to 153/100,000 in women; CABG, 172 to 118/100,000 in men vs 64 to 38/100,000 in women). Annual PCI rates were higher than CABG rates in patients of all age groups including in younger patients (age < 50) and octogenarians. The proportion of coronary revascularization procedures performed per insurance type remained relatively similar across the study period. CONCLUSIONS Annual rates of coronary revascularization have changed significantly over time, potentially because of advances in revascularization techniques, availability of new evidence, and updated guidelines. Rates of PCI declined more steeply than CABG before plateauing but remained higher than rates of CABG across the study period.
Collapse
Affiliation(s)
- Sajjad Raza
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Salil V Deo
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ankur Kalra
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Aisha Zia
- Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | | | - Vaishali S Deo
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Rami R Mustafa
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ahmad Younes
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina
| | - Alan H Markowitz
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Soon J Park
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Marco A Costa
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Daniel I Simon
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Joseph F Sabik
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| |
Collapse
|