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Kaneko T, Newell PC, Nisivaco S, Yoo SGK, Hirji SA, Hou H, Romano M, Lim DS, Chetcuti S, Shah P, Ailawadi G, Thompson M. Incidence, characteristics, and outcomes of reintervention after mitral transcatheter edge-to-edge repair. J Thorac Cardiovasc Surg 2024; 167:143-154.e6. [PMID: 35570022 DOI: 10.1016/j.jtcvs.2022.02.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/20/2022] [Accepted: 02/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The use of transcatheter edge-to-edge repair (TEER) is growing substantially, and reintervention after TEER by way of repeat TEER or mitral valve surgery (MVS) is increasing as a result. In this nationally representative study we examined the incidence, characteristics, and outcomes of reintervention after index TEER. METHODS Between July 2013 and November 2017, we reviewed 11,396 patients who underwent index TEER using Medicare beneficiary data. These patients were prospectively tracked and identified as having repeat TEER or MVS. Primary outcomes included 30-day mortality, 30-day readmission, 30-day composite morbidity, and cumulative survival. RESULTS Among 11,396 patients who underwent TEER, 548 patients (4.8%) required reintervention after a median time interval of 4.5 months. Overall 30-day mortality was 8.6%, 30-day readmission was 20.9%, and 30-day composite morbidity was 48.2%. According to reintervention type, 294 (53.7%) patients underwent repeat TEER, and 254 (46.3%) underwent MVS. Patients who underwent MVS were more likely to be younger and female, but had a similar comorbidity burden compared with the repeat TEER cohort. After adjustment, there were no differences in 30-day mortality (adjusted odds ratio [AOR], 1.26 [95% CI, 0.65-2.45]) or 30-day readmission (AOR, 1.14 [95% CI, 0.72-1.81]). MVS was associated with higher 30-day morbidity (AOR, 4.76 [95% CI, 3.17-7.14]) compared with repeat TEER. Requirement for reintervention was an independent risk factor for long-term mortality in a Cox proportional hazard model (hazard ratio, 3.26 [95% CI, 2.53-4.20]). CONCLUSIONS Reintervention after index TEER is a high-risk procedure that carries a significant mortality burden. This highlights the importance of ensuring procedural success for index TEER to avoid the morbidity of reintervention altogether.
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Affiliation(s)
- Tsuyoshi Kaneko
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Paige C Newell
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sarah Nisivaco
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sang Gune K Yoo
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Sameer A Hirji
- Divisions of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Hechuan Hou
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Matthew Romano
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - D Scott Lim
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, Va
| | - Stan Chetcuti
- Department of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Mich
| | - Pinak Shah
- Division of Cardiology, Brigham and Women's Hospital, Boston, Mass
| | - Gorav Ailawadi
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Michael Thompson
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
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Yoo SGK, Chung GS, Bahendeka SK, Sibai AM, Damasceno A, Farzadfar F, Rohloff P, Houehanou C, Norov B, Karki KB, Azangou-Khyavy M, Marcus ME, Aryal KK, Brant LCC, Theilmann M, Cífková R, Lunet N, Gurung MS, Mwangi JK, Martins J, Haghshenas R, Sturua L, Vollmer S, Bärnighausen T, Atun R, Sussman JB, Singh K, Saeedi Moghaddam S, Guwatudde D, Geldsetzer P, Manne-Goehler J, Huffman MD, Davies JI, Flood D. Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries. JAMA 2023; 330:715-724. [PMID: 37606674 PMCID: PMC10445202 DOI: 10.1001/jama.2023.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 06/26/2023] [Indexed: 08/23/2023]
Abstract
Importance Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. Objective To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries. Design, Setting, and Participants Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years. Exposures Countries' per capita income levels and world region; individuals' socioeconomic demographics. Main Outcomes and Measures Self-reported use of aspirin for secondary prevention of CVD. Results The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries. Conclusion and Relevance Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.
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Affiliation(s)
- Sang Gune K. Yoo
- Cardiovascular Division, Department of Internal Medicine, Washington University in St Louis, St Louis, Missouri
| | - Grace S. Chung
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Silver K. Bahendeka
- Department of Internal Medicine, MKPGMS Uganda Martyrs University, Kampala, Uganda
- St Francis Hospital, Nsambya, Kampala, Uganda
| | - Abla M. Sibai
- Epidemiology and Population Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Nucleo de Investigaçao, Departamento de Medicina, Hospital Central do Maputo, Maputo, Mozambique
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Peter Rohloff
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Bolormaa Norov
- Nutrition Department, National Center for Public Health, Ulaanbaatar, Mongolia
| | - Khem B. Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Mohammadreza Azangou-Khyavy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maja E. Marcus
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Krishna K. Aryal
- Bergen Centre for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Public Health Promotion and Development Organization, Kathmandu, Nepal
| | - Luisa C. C. Brant
- Serviço de Cardiologia e Cirurgia Cardiovascular, Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Clínica Médica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Michaela Theilmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Renata Cífková
- Center for Cardiovascular Prevention, First Faculty of Medicine, and Thomayer University Hospital, Charles University in Prague, Prague, Czechia
- Department of Medicine II, First Faculty of Medicine, Charles University in Prague, Prague, Czechia
| | - Nuno Lunet
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal
| | - Mongal S. Gurung
- Health Research and Epidemiology Unit, Ministry of Health, Thimphu, Bhutan
| | - Joseph Kibachio Mwangi
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
- Faculty of Medicine, The Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Joao Martins
- Faculty of Medicine and Health Sciences, National University of East Timor, Dili, Timor-Leste
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
- Public Health Department, Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Sebastian Vollmer
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts
- Africa Health Research Institute, Somkhele and Durban, South Africa
| | - Rifat Atun
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Jeremy B. Sussman
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Kavita Singh
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Centre for Chronic Disease Control, New Delhi, India
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, California
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark D. Huffman
- Department of Medicine and Global Health Center, Washington University in St Louis, St Louis, Missouri
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Justine I. Davies
- Institute for Applied Health Research, University of Birmingham, Birmingham, England
- Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - David Flood
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Indigenous Health Research, Wuqu’ Kawoq, Tecpán, Guatemala
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
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Yoo SGK, Seth M, Vaduganathan M, Ruwende C, Karve M, Shah I, Hill T, Gurm HS, Sukul D. Marijuana Use and In-Hospital Outcomes After Percutaneous Coronary Intervention in Michigan, United States. JACC Cardiovasc Interv 2021; 14:1757-1767. [PMID: 34412793 DOI: 10.1016/j.jcin.2021.06.036] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/26/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between reported marijuana use and post-percutaneous coronary intervention (PCI) in-hospital outcomes. BACKGROUND Marijuana use is increasing as more states in the United States legalize its use for recreational and medicinal purposes. Little is known about the frequency of use and relative safety of marijuana among patients presenting for PCI. METHODS The authors analyzed Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry data between January 1, 2013, and September 30, 2016. One-to-one propensity matching and multivariable logistic regression were used to adjust for differences between patients with or without reported marijuana use, and rates of post-PCI complications were compared. RESULTS Among 113,477 patients, 3,970 reported marijuana use. Compared with those without reported marijuana use, patients with reported marijuana use were likely to be younger (53.9 years vs 65.8 years), to use tobacco (73.0% vs 26.8%), to present with ST-segment elevation myocardial infarction (27.3% vs 15.9%), and to have fewer cardiovascular comorbidities. After matching, compared with patients without reported marijuana use, those with reported marijuana use experienced significantly higher risks for bleeding (adjusted odds ratio [aOR]: 1.54; 95% confidence interval [CI]: 1.20-1.97; P < 0.001) and cerebrovascular accident (aOR: 11.01; 95% CI: 1.32-91.67; P = 0.026) and a lower risk for acute kidney injury (aOR: 0.61; 95% CI: 0.42-0.87; P = 0.007). There were no significant differences in risks for transfusion and death. CONCLUSIONS A modest fraction of patients undergoing PCI used marijuana. Reported marijuana use was associated with higher risks for cerebrovascular accident and bleeding and a lower risk for acute kidney injury after PCI. Clinicians and patients should be aware of the higher risk for post-PCI complications in these patients.
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Affiliation(s)
- Sang Gune K Yoo
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Milan Seth
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cyril Ruwende
- St Joseph Mercy Ann Arbor Hospital, Ypsilanti, Michigan, USA
| | | | - Ibrahim Shah
- McLaren Greater Lansing Hospital, Lansing, Michigan, USA
| | | | - Hitinder S Gurm
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Devraj Sukul
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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Yoo SGK, Davies D, Mohanan PP, Baldridge AS, Charles PM, Schumacher M, Bhalla S, Devarajan R, Hirschhorn LR, Prabhakaran D, Huffman MD. Hospital-Level Cardiovascular Management Practices in Kerala, India. Circ Cardiovasc Qual Outcomes 2020; 12:e005251. [PMID: 31092020 DOI: 10.1161/circoutcomes.118.005251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 01/24/2023]
Abstract
Background Hospital management practices are associated with cardiovascular process of care measures and patient outcomes. However, management practices related to acute cardiac care in India has not been studied. Methods and Results We measured management practices through semistructured, in-person interviews with hospital administrators, physician managers, and nurse managers in Kerala, India between October and November 2017 using the adapted World Management Survey. Trained interviewers independently scored management interview responses (range: 1-5) to capture management practices ranging from performance data tracking to setting targets. We performed univariate regression analyses to assess the relationship between hospital-level factors and management practices. Using Pearson correlation coefficients and mixed-effect logistic regression models, we explored the relationship between management practices and 30-day major adverse cardiovascular events defined as all-cause mortality, reinfarction, stroke, or major bleeding. Ninety managers from 37 hospitals participated. We found suboptimal management practices across 3 management levels (mean [SD]: 2.1 [0.5], 2.0 [0.3], and 1.9 [0.3] for hospital administrators, physician managers, and nurse managers, respectively [ P=0.08]) with lowest scores related to setting organizational targets. Hospitals with existing healthcare quality accreditation, more cardiologists, and private ownership were associated with higher management scores. In our exploratory analysis, higher physician management practice scores related to operation, performance, and target management were correlated with lower 30-day major adverse cardiovascular event. Conclusions Management practices related to acute cardiac care in participating Kerala hospitals were suboptimal but were correlated with clinical outcomes. We identified opportunities to strengthen nonclinical practices to improve patient care.
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Affiliation(s)
- Sang Gune K Yoo
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.G.K.Y., A.S.B., M.D.H.)
| | - Divin Davies
- WestFort Hi-Tech Hospital Ltd, Thrissur, India (D.D., P.P.M.)
| | | | - Abigail S Baldridge
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.G.K.Y., A.S.B., M.D.H.)
| | | | - Mark Schumacher
- Northwestern Memorial Healthcare, Chicago, IL (P.M.C., M.S.)
| | - Sandeep Bhalla
- Public Health Foundation of India, Gurgaon, India (S.B., D.P.)
| | - Raji Devarajan
- Centre for Chronic Disease Control, New Delhi, India (R.D., D.P.)
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL (L.R.H.)
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurgaon, India (S.B., D.P.).,Centre for Chronic Disease Control, New Delhi, India (R.D., D.P.).,London School of Hygiene and Tropical Medicine, London, United Kingdom (D.P.)
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.G.K.Y., A.S.B., M.D.H.)
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