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Chuzi S, Manning K. Integration of palliative care across the spectrum of heart failure care and therapies: considerations, contemporary data, and challenges. Curr Opin Cardiol 2024; 39:218-225. [PMID: 38567949 DOI: 10.1097/hco.0000000000001120] [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: 04/05/2024]
Abstract
PURPOSE OF REVIEW Heart failure (HF) is characterized by significant symptoms, compromised quality of life, frequent hospital admissions, and high mortality, and is therefore well suited to palliative care (PC) intervention. This review elaborates the current PC needs of patients with HF across the spectrum of disease, including patients who undergo advanced HF surgical therapies, and reviews the current data and future directions for PC integration in HF care. RECENT FINDINGS Patients with chronic HF, as well as those who are being evaluated for or who have undergone advanced HF surgical therapies such as left ventricular assist device or heart transplantation, have a number of PC needs, including decision-making, symptoms and quality of life, caregiver support, and end-of-life care. Available data primarily supports the use of PC interventions in chronic HF to improve quality of life and symptoms. PC skills and teams may also help address preparedness planning, adverse events, and psychosocial barriers in patients who have had HF surgeries, but more data are needed to determine association with outcomes. SUMMARY Patients with HF have tremendous PC needs across the spectrum of disease. Despite this, more data are needed to determine the optimal timing and structure of PC interventions in patients with chronic HF, left ventricular assist device, and heart transplantation. Future steps must be taken in clinical, research, and policy domains in order to optimize care.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Katharine Manning
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center
- Section of Palliative Medicine, Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Godfrey S, Steiner JM, Damluji AA, Sampath R, Chuzi S, Warraich H, Krishnaswami A, Bernacki G, Goodlin S, Josephson R, Mulrow J, Doherty C. Palliative Care Education in Cardiovascular Disease Fellowships: A National Survey of Program Directors. J Card Fail 2024:S1071-9164(24)00116-7. [PMID: 38616006 DOI: 10.1016/j.cardfail.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Palliative care (PC) is an essential component of high-quality cardiovascular disease (CVD) care. However, little is known about the current state of PC education in CVD training including attitudes towards integration in training and implementation among program leadership. METHODS We developed a nationwide, cross-sectional survey querying educational approaches, perspectives, and barriers to PC education in general CVD fellowship training. The survey was distributed to 392 members of the American College of Cardiology Program Director (PD) listserv representing 290 general CVD fellowships between 1/2023 and 4/2023. We performed descriptive and chi square analyses of survey data. RESULTS Fifty-six program representatives completed the survey (response rate = 19.3%). Respondents identified as current PDs (89%), associate PDs (8.9%), and former PDs (1.8%), representing a diverse range of program sizes, types, and regions of the country. Respondents reported use of informal bedside teaching (88%), formal didactics (59%), online or self-paced modules (13%), in-person simulation (11%), and clinical rotations (16%) to teach PC content. Most programs covered PC topics at least annually, although there was variability by topic. We found no associations between program demographics and type or frequency of PC education. Most respondents reported dissatisfaction with the quantity (62%) or quality (59%) of PC education provided. Barriers to PC education included an overabundance of other content to cover (36%) and perceived lack of fellow (20%) or faculty (18%) interest. Comments demonstrated the importance of PC education in fellowship, a lack of a requirement to provide PC education, difficulty covering all topics, and suggestions for how PC skills should be taught. CONCLUSIONS In a national survey of CVD educational leadership on approaches to PC education in CVD training, respondents highlighted both challenges to implementation of formal PC curricula in cardiology training and opportunities for comprehensive PC education.
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Affiliation(s)
| | | | - Abdulla A Damluji
- Inova Center of Outcomes Research, Falls Church, VA; Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | | | - Gwen Bernacki
- University of Washington Medical Center, Seattle, WA; Veterans' Administration of Puget Sound, Seattle WA
| | - Sarah Goodlin
- Patient-Centered Education and Research, Oregon Health and Sciences University, Portland OR
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Chuzi S, Tong W, Nakagawa S. Towards Improved Patient-Centered Communication in High-Stakes Heart Failure Decisions: the "Best Case/Worst Case" Framework. J Card Fail 2023; 29:1561-1563. [PMID: 37343815 DOI: 10.1016/j.cardfail.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/01/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Sarah Chuzi
- Department of Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Wendy Tong
- Department of Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Shunichi Nakagawa
- Department of Medicine, Columbia University Irving Medical Center, New York, NY
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Chuzi S, Wilcox JE, Kao A, Spertus JA, Hsich E, Dew MA, Yancy CW, Pham DT, Hartupee J, Petty M, Cotts W, Pamboukian SV, Pagani FD, Lampert B, Johnson M, Murray M, Takeda K, Yuzefpolskaya M, Silvestry S, Kirklin JK, Wu T, Andrei AC, Baldridge A, Grady KL. Change in Caregiver Health-Related Quality of Life From Before to Early After Surgery: SUSTAIN-IT Study. Circ Heart Fail 2023; 16:e010038. [PMID: 37345518 PMCID: PMC10482357 DOI: 10.1161/circheartfailure.122.010038] [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: 07/29/2022] [Accepted: 04/18/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Information about health-related quality of life (HRQOL) among caregivers of older patients with heart failure who receive heart transplantation (HT) and mechanical circulatory support (MCS) is sparse. We describe differences and factors associated with change in HRQOL before and early post-surgery among caregivers of older heart failure patients who underwent 3 surgical therapies: HT with pretransplant MCS (HT MCS), HT without pretransplant MCS (HT non-MCS), and long-term MCS. METHODS Caregivers of older patients (60-80 years) from 13 US sites completed the EQ-5D-3 L visual analog scale (0 [worst]-100 [best] imaginable health state) and dimensions before and 3 and 6 months post-surgery. Analyses included linear regression, t tests, and nonparametric tests. RESULTS Among 227 caregivers (HT MCS=54, HT non-MCS=76, long-term MCS=97; median age 62.7 years, 30% male, 84% White, 83% spouse/partner), EQ-5D visual analog scale scores were high before (84.8±14.1) and at 3 (84.7±13.0) and 6 (83.9±14.7) months post-surgery, without significant differences among groups or changes over time. Patient pulmonary hypertension presurgery (β=-13.72 [95% CI, -21.07 to -6.36]; P<0.001) and arrhythmia from 3 to 6 months post-operatively (β=-14.22 [95% CI, -27.41 to -1.02]; P=0.035) were associated with the largest decrements in caregiver HRQOL; patient marital/partner status (β=6.21 [95% CI, 1.34-11.08]; P=0.013) and presurgery coronary disease (β=8.98 [95% CI, 4.07-13.89]; P<0.001) were associated with the largest improvements. CONCLUSIONS Caregivers of older patients undergoing heart failure surgeries reported overall high HRQOL before and early post-surgery. Understanding factors associated with caregiver HRQOL may inform decision-making and support needs. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02568930.
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Affiliation(s)
| | | | - Andrew Kao
- St. Luke’s Medical Center, Kansas City, MO
| | | | | | | | | | | | | | - Michael Petty
- University of Minnesota Medical Center, Minneapolis, MN
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.C., J.W.)
| | - Monica Colvin
- Department of Cardiology, University of Michigan, Ann Arbor (M.C.)
| | - Selma F Mohammed
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE (S.F.M.)
| | - Jane Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (S.C., J.W.)
| | - Nancy K Sweitzer
- Department of Medicine, Washington University School of Medicine, St. Louis, MO (N.K.S.)
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Chuzi S, Tanaka Y, Bavishi A, Bruce M, Van Wagner LB, Wilcox JE, Ahmad FS, Ladner DP, Lagu T, Khan SS. Association Between End-Stage Liver Disease and Incident Heart Failure in an Integrated Health System. J Gen Intern Med 2023; 38:2445-2452. [PMID: 37095330 PMCID: PMC10465455 DOI: 10.1007/s11606-023-08199-z] [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: 09/27/2022] [Accepted: 04/05/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND End-stage liver disease (ESLD) and heart failure (HF) often coexist and are associated with significant morbidity and mortality. However, the true incidence of HF among patients with ESLD remains understudied. OBJECTIVE This study aims to evaluate the association between ESLD and incident HF in a real-world clinical cohort. DESIGN AND PARTICIPANTS A retrospective electronic health records database analysis of individuals with ESLD and frequency-matched controls without ESLD in a large integrated health system. MAIN MEASURES The primary outcome was incident HF, which was defined by the International Classification of Disease codes and manually adjudicated by physician reviewers. The Kaplan-Meier method was used to estimate the cumulative incidence of HF. Multivariate proportional hazards models adjusted for shared metabolic factors (diabetes, hypertension, chronic kidney disease, coronary heart disease, body mass index) were used to compare the risk of HF in patients with and without ESLD. KEY RESULTS Of 5004 patients (2502 with ESLD and 2502 without ESLD), the median (Q1-Q3) age was 57.0 (55.0-65.0) years, 59% were male, and 18% had diabetes. Over a median (Q1-Q3) follow-up of 2.3 (0.6-6.0) years, 121 incident HF cases occurred. Risk for incident HF was significantly higher for patients with ESLD compared with the non-ESLD group (adjusted HR: 4.67; 95% CI: 2.82-7.75; p < 0.001), with the majority of the ESLD group (70.7%) having HF with preserved ejection fraction (ejection fraction ≥ 50%). CONCLUSION ESLD was significantly associated with a higher risk of incident HF, independent of shared metabolic risk factors, with the predominant phenotype being HF with preserved ejection fraction.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Yoshihiro Tanaka
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Arrhythmia Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Avni Bavishi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew Bruce
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa B Van Wagner
- Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, USA
| | - Jane E Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Faraz S Ahmad
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniela P Ladner
- Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Chicago, IL, USA
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tara Lagu
- Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Chuzi S, Lindenauer PK, Faridi K, Priya A, Pekow PS, D'Aunno T, Mazor KM, Stefan MS, Spatz ES, Gilstrap L, Werner RM, Lagu T. Variation in Risk-Standardized Acute Admission Rates Among Patients With Heart Failure in Accountable Care Organizations: Implications for Quality Measurement. J Am Heart Assoc 2023; 12:e029758. [PMID: 37345796 PMCID: PMC10356066 DOI: 10.1161/jaha.122.029758] [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: 02/07/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023]
Abstract
Background Accountable care organizations (ACOs) aim to improve health care quality and reduce costs, including among patients with heart failure (HF). However, variation across ACOs in admission rates for patients with HF and associated factors are not well described. Methods and Results We identified Medicare fee-for-service beneficiaries with HF who were assigned to a Medicare Shared Savings Program ACO in 2017 and survived ≥30 days into 2018. We calculated risk-standardized acute admission rates across ACOs, assigned ACOs to 1 of 3 performance categories, and examined associations between ACO characteristics and performance categories. Among 1 232 222 beneficiaries with HF, 283 795 (mean age, 81 years; 54% women; 86% White; 78% urban) were assigned to 1 of 467 Medicare Shared Savings Program ACOs. Across ACOs, the median risk-standardized acute admission rate was 87 admissions per 100 people, ranging from 61 (minimum) to 109 (maximum) admissions per 100 beneficiaries. Compared to the overall average, 13% of ACOs performed better on risk-standardized acute admission rates, 72% were no different, and 14% performed worse. Most ACOs with better performance had fewer Black beneficiaries and were not hospital affiliated. Most ACOs that performed worse than average were large, located in the Northeast, had a hospital affiliation, and had a lower proportion of primary care providers. Conclusions Admissions are common among beneficiaries with HF in ACOs, and there is variation in risk-standardized acute admission rates across ACOs. ACO performance was associated with certain ACO characteristics. Future studies should attempt to elucidate the relationship between ACO structure and characteristics and admission risk.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population SciencesUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMAUSA
| | - Kamal Faridi
- Department of Healthcare Delivery and Population SciencesUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMAUSA
| | - Aruna Priya
- Department of Healthcare Delivery and Population SciencesUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMAUSA
| | - Penelope S. Pekow
- Department of Healthcare Delivery and Population SciencesUniversity of Massachusetts Chan Medical School–BaystateSpringfieldMAUSA
| | - Thomas D'Aunno
- Wagner Graduate School of Public Service at New York UniversityNew YorkNYUSA
| | - Kathleen M. Mazor
- Division of Health Systems Science, Department of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMAUSA
| | - Mihaela S. Stefan
- Department of MedicineUniversity of Massachusetts Chan Medical SchoolSpringfieldMAUSA
| | - Erica S. Spatz
- Section of Cardiovascular MedicineYale School of MedicineNew HavenCTUSA
- Department of EpidemiologyYale School of Public HealthNew HavenCTUSA
- Yale Center for Outcomes Research and EvaluationNew HavenCTUSA
| | - Lauren Gilstrap
- Heart and Vascular Center, Dartmouth Hitchcock Medical CenterThe Dartmouth Institute, Geisel School of Medicine at DartmouthLebanonNHUSA
| | - Rachel M. Werner
- Leonard Davis Institute of Health Economics and Perelman School of MedicineUniversity of Pennsylvania; Corporal Michael J. Crescenz VA Medical CenterPhiladelphiaPAUSA
| | - Tara Lagu
- Institute for Public Health and Medicine, Northwestern University Feinberg School of MedicineChicagoILUSA
- Division of Hospital Medicine, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA
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Chuzi S, Pensa AV, Allen LA, Cross SH, Feder SL, Warraich HJ. Palliative Care for Patients With Heart Failure: Results From a Heart Failure Society of America Survey. J Card Fail 2023; 29:112-115. [PMID: 35842103 DOI: 10.1016/j.cardfail.2022.06.010] [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] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Multiple guidelines recommend specialty palliative care (PC) for patients with heart failure (HF), including patients with left ventricular assist devices (LVADs). However, the degree of integration and clinicians' perceptions of PC in HF care remain incompletely characterized. METHODS AND RESULTS A 36-item survey was sent to 2109 members of the Heart Failure Society of America. Eighty respondents (53% physicians), including 51 respondents from at least 42 medical centers, completed the survey, with the majority practicing in urban (76%) academic medical centers (62%) that implanted LVADs (81%). Among the 42 unique medical centers identified, respondents reported both independent (40%) and integrated (40%) outpatient PC clinic models, whereas 12% reported not having outpatient PC at their institutions. A minority (12%) reported that their institution used triggered PC referrals based on objective clinical data. Of respondents from LVAD sites, the majority reported that a clinician from the PC team was required to see all patients prior to implantation, but there was variability in practices. Among all respondents, the most common reasons for PC referral in HF were poor prognosis, consideration of advanced cardiac therapies or other high-risk procedures and advance-care planning or goals-of-care discussions. The most frequent perceived barriers to PC consultation included lack of PC clinicians, unpredictable HF clinical trajectories and limited understanding of how PC can complement traditional HF care. CONCLUSION PC integration and clinician perceptions of services vary in HF care. More research and guidance regarding evidence-based models of PC delivery in HF are needed.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anthony V Pensa
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Larry A Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah H Cross
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Shelli L Feder
- Yale University School of Nursing, New Haven, Connecticut; Pain Research, Informatics, Multi-Morbidities, and Education (PRIME) Center, Veterans Affairs Connecticut Healthcare System, New Haven, CT
| | - Haider J Warraich
- Division of Cardiovaular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Cardiology Section, VA Boston Healthcare System, Boston, Massachusetts.
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Lee K, Chuzi S, Katz J, Vela A, Wilson H, Wilcox JE, Ghafourian K, Yancy CW, Beach L, Pham DT. Heart-Kidney Transplantation in a Transgender Woman. JACC Case Rep 2022; 4:101523. [PMID: 36507296 PMCID: PMC9730026 DOI: 10.1016/j.jaccas.2022.06.013] [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: 04/10/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 11/06/2022]
Abstract
We describe the care of a transgender woman with heart failure who underwent heart-kidney transplantation. Perioperative management of hormone therapy, considerations for future gender-affirming surgeries, and psychosocial aspects of care are discussed. Interdisciplinary collaboration is essential in the treatment of patients with advanced heart failure in the setting of gender-affirming therapies. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Kristen Lee
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sarah Chuzi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA,Address for correspondence: Dr. Sarah Chuzi, Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, Suite 600, Chicago, Illinois 60611, USA.
| | - Joshua Katz
- Division of Endocrinology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alyssa Vela
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Heather Wilson
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jane E. Wilcox
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kambiz Ghafourian
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Clyde W. Yancy
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lauren Beach
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Duc Thinh Pham
- Division of Cardiac Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Chuzi S, Wu T, Argaw S, Harap R, Ahmad F, Grady K, Pham D, Khan S, Wilcox J, Tibrewala A. Time Spent Engaging In Healthcare In Patients With Left Ventricular Assist Devices. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.107] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chuzi S, Khan SS, Pak ES. Primary Palliative Care Education in Advanced Heart Failure and Transplantation Cardiology Fellowships. J Am Coll Cardiol 2021; 77:501-505. [PMID: 33509401 DOI: 10.1016/j.jacc.2020.11.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/05/2020] [Accepted: 11/23/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Esther S Pak
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Cardiology, Department of Medicine, Philadelphia VA Medical Center, Philadelphia, Pennsylvania, USA
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Chuzi S, Ogunseitan A, Cameron KA, Grady K, Schulze L, Wilcox JE. Perceptions of Bereaved Caregivers and Clinicians About End-of-Life Care for Patients With Destination Therapy Left Ventricular Assist Devices. J Am Heart Assoc 2021; 10:e020949. [PMID: 34308687 PMCID: PMC8475670 DOI: 10.1161/jaha.121.020949] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Patients with left ventricular assist devices (LVADs) implanted as destination therapy may receive suboptimal preparation for and care at the end of life, but there is limited understanding of the reasons for these shortcomings. Exploring perceptions of individuals (caregivers and clinicians) who are closely involved in the end‐of‐life experience with patients with destination therapy LVADs can help identify key opportunities for improving care. Methods and Results We conducted semistructured qualitative interviews with 7 bereaved caregivers of patients with destination therapy LVADs and 10 interdisciplinary LVAD clinicians. Interviews explored perceptions of preparing for end of life, communicating about end of life, and providing and receiving end‐of‐life care, and were analyzed using a 2‐step team‐based inductive approach to coding and analysis. Six themes pertaining to end‐of‐life experiences were derived: (1) timing end‐of‐life discussions in the setting of unpredictable illness trajectories, (2) prioritizing end‐of‐life preparation and decision‐making, (3) communicating uncertainty while providing support and hope, (4) lack of consensus on responsibility for end‐of‐life discussions, (5) perception of the LVAD team as invincible, and (6) divergent perceptions of LVAD withdrawal. Conclusions This study revealed 6 unique aspects of end‐of‐life care for patients with destination therapy LVADs as reported by clinicians and caregivers. Themes coalesced around communication, team‐based care, and challenges unique to patients with LVADs at end of life. Programmatic changes may address some aspects, including training clinicians in LVAD‐specific communication skills. Other aspects, such as standardizing the role of the palliative care team and developing practical interventions that enable timely advance care planning during LVAD care, will require multifaceted interventions.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology Department of Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Adeboye Ogunseitan
- Division of Hospital Medicine (Palliative Care) Department of Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics Department of Medicine Feinberg School of Medicine Northwestern University Chicago IL
| | - Kathleen Grady
- Division of Cardiology Department of Medicine Feinberg School of Medicine Northwestern University Chicago IL.,Division of Cardiac Surgery Department of Surgery Feinberg School of Medicine Northwestern University Chicago IL
| | - Lauren Schulze
- Division of Cardiac Surgery Department of Surgery Feinberg School of Medicine Northwestern University Chicago IL
| | - Jane E Wilcox
- Division of Cardiology Department of Medicine Feinberg School of Medicine Northwestern University Chicago IL
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Chuzi S, Reza N. Cultivating Interest in Heart Failure Careers: Can We Reverse the Current Trend?: Cultivating Interest in Heart Failure Careers. J Card Fail 2021; 27:819-821. [PMID: 34246430 DOI: 10.1016/j.cardfail.2021.04.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Truitt K, Khan SS, Gregory DL, Chuzi S, VanWagner LB. Deaths from hepatocellular carcinoma are more likely to occur in medical facilities than deaths from other cancers: 2003-2018. Liver Int 2021; 41:1489-1493. [PMID: 33932082 PMCID: PMC8822953 DOI: 10.1111/liv.14915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/16/2020] [Revised: 03/09/2021] [Accepted: 04/24/2021] [Indexed: 12/27/2022]
Abstract
Place of death is a key indicator of quality of end-of-life care, and most people with a terminal diagnosis prefer to die at home. Home has surpassed the hospital as the most common location of all-cause and total cancer-related deaths in the United States. However, trends in place of death due to hepatocellular carcinoma (HCC), which is uniquely comanaged by hepatologists and oncologists, have not been described. We analysed US death certificate data from 2003 to 2018 for the proportion of deaths over time at medical facilities, nursing facilities, hospice facilities and home, for HCC and non-HCC cancer. The proportion of deaths increased from 0.6% to 15.2% in hospice facilities (P trend < 0.0001) but did not change at home. In multivariable analysis, persons with HCC were more likely than persons with non-HCC cancer to die in medical facilities, while persons with HCC were less likely to die at home.
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Affiliation(s)
- Katie Truitt
- Department of Internal Medicine, Northwestern McGaw/Northwestern Hospital, Chicago, IL, USA
| | - Sadiya S. Khan
- Department of Medicine, Division of Cardiology and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dyanna L. Gregory
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah Chuzi
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa B. VanWagner
- Department of Medicine, Division of Gastroenterology and Hepatology and Department of Preventive Medicine-Epidemiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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15
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Gong FF, Nishtala A, Chow K, Jafari L, Azizuddin A, Ramirez H, Chuzi S, Akhter N. Inter-vendor variability and reproducibility of subcostal left ventricular longitudinal strain. Int J Cardiovasc Imaging 2021; 37:1669-1678. [PMID: 33454895 DOI: 10.1007/s10554-020-02152-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 12/28/2020] [Indexed: 11/24/2022]
Abstract
Left ventricular longitudinal strain (LVLS) performed using subcostal windows is a novel alternative for patients who require strain imaging but have poor apical windows. We investigated the reproducibility and inter-vendor variability of subcostal LVLS. One hundred and twenty-four echocardiographic studies were analysed from 73 women with early stage HER2-positive breast cancer. Speckle tracking strain was performed offline using EchoPAC and TomTec on subcostal 4-chamber and 3-chamber views to obtain subcostal 4-chamber (SC4_LS) and 3-chamber (SC3_LS) LVLS which was then averaged (SCav_LS). Reproducibility of subcostal single chamber and averaged LVLS were assessed. Measurements between platforms were compared. Strain was reported in absolute magnitude. EchoPAC measurements of SC3_LS (20.5 ± 2.4% vs. 21.2 ± 2.5%, p = 0.002) and SCav_LS (20.9 ± 2.1% vs. 21.2 ± 2.1%, p = 0.02) were lower than TomTec measurements while SC4_LS was similar (21.3 ± 2.7% vs. 21.3 ± 2.5%, p = 0.94). Mean differences between EchoPAC and TomTec were ≤ 0.6% strain units for all subcostal LVLS measurements; SCav_LS showed the narrowest limits of agreement (LOA) (mean difference - 0.3%, LOA - 3.2 to 2.6%). EchoPAC and TomTec measurements of SCav_LS showed good correlation (r = 0.76, p < 0.001). Intra-observer and inter-observer analysis showed good reproducibility. Inter-observer variability was lower than inter-vendor variability; SCav_LS was most reproducible: inter-observer relative mean error was 3.6% for EchoPAC and 4.3% for TomTec and inter-observer LOA were ± 2.1% for EchoPAC and ± 2.6% for TomTec. Averaged subcostal LVLS was highly reproducible with inter-observer variability comparable to GLS. Inter-vendor differences in averaged subcostal LVLS were small but statistically significant.
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Affiliation(s)
- Fei Fei Gong
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA
| | - Arvind Nishtala
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA
| | - Kimberly Chow
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lua Jafari
- Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Asra Azizuddin
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA
| | - Haydee Ramirez
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA
| | - Sarah Chuzi
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA
| | - Nausheen Akhter
- Division of Cardiology, Northwestern University Feinberg School of Medicine, 676 N St Clair, Suite 600, Chicago, IL, 60611, USA.
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Adhikari A, Tripathy S, Chuzi S, Peterson J, Stone NJ. Association between statin use and cognitive function: A systematic review of randomized clinical trials and observational studies. J Clin Lipidol 2021; 15:22-32.e12. [PMID: 33189626 DOI: 10.1016/j.jacl.2020.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 05/31/2020] [Revised: 09/22/2020] [Accepted: 10/25/2020] [Indexed: 01/18/2023]
Abstract
The US Food and Drug Administration issued a black box warning in 2012 regarding the association of statin use with cognitive impairment. This may deter patients and practitioners from using statins for guideline-directed indications. Large studies have not shown an increase in cognitive impairment with statin use. MEDLINE, EMBASE, and Cochrane databases were searched up to October 2019. We present an up-to-date systematic review of randomized controlled trials (RCTs) and prospective observational studies examining the association between statin use and cognitive status in a population aged ≥60 years. Twenty-four studies with 1,404,459 participants were included in the review. Twenty-one were prospective observational studies, and 3 were RCTs. All 3 RCTs, which ranged from 3.2 to 5.6 years of follow-up, showed no significant association between statin use and adverse cognitive effects (odds ratio [OR] 1.03 [0.82-1.30]) and (OR 1.0 [0.61-1.65]). The mean difference in the Mini-Mental State Examination was insignificant (0.06 [-0.04 to 0.16]) in the third RCT. The follow-up for observational studies ranged from 3 to 15 years. Ten observational studies showed reduced incidence of dementia. Seven showed no association with incident dementia. Three studies showed decline in cognition was similar, whereas one showed slower decline with statin use. There was no evidence of adverse cognitive effects, including incidence of dementia, deterioration in global cognition, or specific cognitive domains associated with statin use in individuals aged ≥60 years. Future studies should examine this association in studies with longer follow-up periods.
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Affiliation(s)
| | | | - Sarah Chuzi
- Northwestern University, Feinberg School of Medicine, Department of Medicine, Division of Cardiology
| | - Jonna Peterson
- Galter Health Sciences and Learning Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Neil J Stone
- Northwestern University, Feinberg School of Medicine, Department of Medicine, Division of Cardiology.
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Chuzi S, Eucalitto P, Yee LM. A Pregnant Woman With Shortness of Breath. JAMA Cardiol 2020; 6:113-114. [PMID: 33175087 DOI: 10.1001/jamacardio.2020.5587] [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] [Indexed: 11/14/2022]
Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Patrick Eucalitto
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lynn M Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Chuzi S, Cameron KA, Ogunseitan A, Schulze L, Grady KL, Wilcox JE. Dying with A Destination Therapy Left Ventricular Assist Device: Perspectives, Perceptions, and Experiences of Bereaved Caregivers and Clinicians. J Card Fail 2020. [DOI: 10.1016/j.cardfail.2020.09.359] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chuzi S, Molsberry R, McCabe ME, Yancy CW, Ogunseitan A, Allen NB, Khan SS. Distribution in Place of Death for COVID-19-Related Mortality in the United States. J Am Geriatr Soc 2020; 68:1917-1918. [PMID: 32643800 PMCID: PMC7361863 DOI: 10.1111/jgs.16721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rebecca Molsberry
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
| | - Megan E McCabe
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Clyde W Yancy
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adeboye Ogunseitan
- Division of Hospital Medicine (Palliative Care), Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sadiya S Khan
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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20
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Chuzi S, Molsberry R, Ogunseitan A, Warraich HJ, Wilcox JE, Grady KL, Yancy CW, Khan SS. Trends in Place of Death for Cardiovascular Mortality Related to Heart Failure in the United States From 2003 to 2017. Circ Heart Fail 2020; 13:e006587. [PMID: 32059627 DOI: 10.1161/circheartfailure.119.006587] [Citation(s) in RCA: 8] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The location of death is an important component of end-of-life care. However, contemporary trends in the location of death for cardiovascular deaths related to heart failure (CV-HF) and comparison to cancer deaths have not been fully examined. METHODS We analyzed data from the Centers for Disease Control and Prevention's Control Wide-Ranging Online Data for Epidemiologic Research database between 2003 and 2017 to identify location of death for CV-HF and cancer deaths. The proportions of deaths that occurred in a hospice facility, home, and medical facility were tested for trends using linear regression. Odds ratios were calculated to determine the odds of death occurring in a hospice facility or home (versus a medical facility) stratified by sex and race. RESULTS We identified 2 940 920 CV-HF and 8 852 066 cancer deaths. Increases were noted in the proportion of CV-HF deaths in hospice facilities (0.2% to 8.2%; Ptrend<0.001) and at home (20.6% to 30.7%; Ptrend<0.001), whereas decreases were noted in the proportion of deaths in medical facilities (44.5% to 31.0%; Ptrend<0.001) and nursing homes (30.8% to 25.7%; Ptrend<0.001). The odds of dying in a hospice facility (odds ratio, 1.79 [1.75-1.82]) or at home (odds ratio, 1.55 [1.53-1.56]) versus a medical facility was higher for whites versus blacks. The rate of increase in proportion of deaths in hospice facilities was higher for cancer deaths (β=1.05 [95% CI, 0.97-1.12]) than for CV-HF deaths (β=0.61 [95% CI, 0.58-0.64]). CONCLUSIONS The proportion of CV-HF deaths occurring in hospice facilities is increasing but remains low. Disparities are noted whereby whites are more likely to die in hospice facilities or at home versus medical facilities compared with blacks. More research is needed to determine end-of-life preferences for patients with HF and identify the basis for these differences in location of death.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology (S.C., J.E.W., K.L.G., C.W.Y., S.S.K.), Northwestern University Feinberg School of Medicine
| | - Rebecca Molsberry
- Department of Preventive Medicine (R.M., S.S.K.), Northwestern University Feinberg School of Medicine
| | - Adeboye Ogunseitan
- Division of Hospital Medicine (A.O.), Northwestern University Feinberg School of Medicine
| | - Haider J Warraich
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School (H.J.W.).,Cardiology Section, Veterans Affairs Boston Healthcare System (H.J.W.)
| | - Jane E Wilcox
- Division of Cardiology (S.C., J.E.W., K.L.G., C.W.Y., S.S.K.), Northwestern University Feinberg School of Medicine
| | - Kathleen L Grady
- Division of Cardiology (S.C., J.E.W., K.L.G., C.W.Y., S.S.K.), Northwestern University Feinberg School of Medicine.,Division of Cardiac Surgery (K.L.G.), Northwestern University Feinberg School of Medicine
| | - Clyde W Yancy
- Division of Cardiology (S.C., J.E.W., K.L.G., C.W.Y., S.S.K.), Northwestern University Feinberg School of Medicine
| | - Sadiya S Khan
- Division of Cardiology (S.C., J.E.W., K.L.G., C.W.Y., S.S.K.), Northwestern University Feinberg School of Medicine.,Department of Preventive Medicine (R.M., S.S.K.), Northwestern University Feinberg School of Medicine
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Chuzi S, Pak ES, Desai AS, Schaefer KG, Warraich HJ. Role of Palliative Care in the Outpatient Management of the Chronic Heart Failure Patient. Curr Heart Fail Rep 2019; 16:220-228. [DOI: 10.1007/s11897-019-00440-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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22
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Foster KD, Chuzi S, Beaumont JL, Kircher S, Smith M, Sanford S, Mohindra N. Palliative Care Usage in Young Adult Oncology Population. J Palliat Med 2019; 22:1425-1429. [DOI: 10.1089/jpm.2018.0506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Kelly D. Foster
- Department of Hematology/Oncology, Northwestern Medicine Lake Forest Hospital, Lake Forest, Illinois
| | - Sarah Chuzi
- Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jennifer L. Beaumont
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Terasaki Research Institute, Los Angeles, California
| | - Sheetal Kircher
- Division of Hematology/Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Melanie Smith
- Division of Palliative Medicine, Northwestern University, Chicago, Illinois
| | - Stacy Sanford
- Department of Psychiatry and Behavioral Sciences, Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - Nisha Mohindra
- Division of Hematology/Oncology, Robert H Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Larry A. Allen
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Shannon M. Dunlay
- Division of Cardiology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Haider J. Warraich
- Division of Cardiology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Chuzi S, Molsberry R, Ogunseitan A, Warraich HJ, Wilcox J, Grady KL, Yancy CW, Khan SS. Trends in Place of Cardiovascular Deaths Related to Heart Failure in the United States from 2003-2017. J Card Fail 2019. [DOI: 10.1016/j.cardfail.2019.07.260] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Chuzi S, Pfenniger A, Lloyd-Jones DM, Blumenthal RS, Smith SC, Virani SS, Grundy SM, Stone NJ. Four Cases of Cholesterol Management Informed by the 2018 American Heart Association/American College of Cardiology Multisociety Guideline on the Management of Blood Cholesterol. JAMA Cardiol 2019; 4:473-477. [PMID: 30969319 DOI: 10.1001/jamacardio.2019.0771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/14/2022]
Abstract
These 4 hypothetical cases highlight some of the new features in the 2018 American Heart Association/American College of Cardiology multisociety cholesterol management guidelines. Topics include management issues in a secondary prevention patient judged to be at very high risk of another event, a patient with familial hypercholesterolemia with a low-density lipoprotein cholesterol level of 190 mg/dL or greater (to convert to millimoles per liter, multiply by 0.0259), a primary prevention patient with intermediate (7.5%-19.9%) 10-year atherosclerotic cardiovascular risk, and a patient who has statin-associated adverse effects. A multiple-choice format is used to engage clinicians in selecting the best choice based on guidance from the new 2018 cholesterol management guidelines.
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Affiliation(s)
- Sarah Chuzi
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Anna Pfenniger
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Roger S Blumenthal
- Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, Maryland
| | - Sidney C Smith
- Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill
| | - Salim S Virani
- Section of Cardiovascular Research, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas
| | - Scott M Grundy
- Center for Human Nutrition, University of Texas Southwestern Medical Center, Dallas
| | - Neil J Stone
- Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Chuzi S, Rangarajan V, Jafari L, Vaitenas I, Akhter N. Subcostal View-Based Longitudinal Strain in Patients With Breast Cancer Is an Alternative to Conventional Apical View-Based Longitudinal Strain. J Am Soc Echocardiogr 2019; 32:514-520.e1. [DOI: 10.1016/j.echo.2018.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Indexed: 01/08/2023]
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Chuzi S, Grady KL, Ogunseitan A, Szmuilowicz E, Wilcox JE. Authors' Response. J Pain Symptom Manage 2019; 57:e11-e12. [PMID: 30552959 DOI: 10.1016/j.jpainsymman.2018.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 11/23/2022]
Affiliation(s)
- Sarah Chuzi
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Kathleen L Grady
- Department of Medicine, Division of Cardiology, Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Adeboye Ogunseitan
- Department of Medicine, Division of Hospital Medicine (Palliative Care), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eytan Szmuilowicz
- Department of Medicine, Division of Hospital Medicine (Palliative Care), Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jane E Wilcox
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Chuzi S, Hale S, Arnold J, Zhou A, Harap R, Grady KL, Rich JD, Yancy CW, Ogunseitan A, Szmuilowicz E, Wilcox JE. Pre-Ventricular Assist Device Palliative Care Consultation: A Qualitative Analysis. J Pain Symptom Manage 2019; 57:100-107. [PMID: 30315917 DOI: 10.1016/j.jpainsymman.2018.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 08/21/2018] [Revised: 09/27/2018] [Accepted: 09/30/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In 2013, the Centers for Medicare and Medicaid Services issued a mandate requiring that all patients undergoing destination therapy ventricular assist device (DT VAD) implantation have access to a palliative care team before surgery. Subsequently, many VAD programs implemented a mandatory preimplantation palliative care consultation for patients considering DT VAD. However, little is known about the quality of these consults. METHODS All patients undergoing DT VAD implantation at Northwestern Memorial Hospital from October 30, 2013 (the Centers for Medicare and Medicaid Services decision date), through March 1, 2018, were included. Palliative care consultation notes were qualitatively analyzed for elements of "palliative care assessment" and preparedness planning. RESULTS Sixty-eight preimplantation palliative care consultations were analyzed. Fifty-six percent of the consults occurred in the intensive care unit, and the median time from consult to VAD implant was six days. General palliative care elements were infrequently discussed. Furthermore, the elements of preparedness planning-device failure, post-VAD health-related quality of life, device complications, and progressive comorbidities-were discussed in only 10%, 54%, 49%, and 12% of consultations, respectively. CONCLUSIONS One-time preimplantation palliative care consultations at our institution do not lead to completion of preparedness planning or even general palliative care assessment. Further work is needed to determine the most effective way to integrate palliative care into preimplantation care.
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Affiliation(s)
- Sarah Chuzi
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Sarah Hale
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jason Arnold
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amy Zhou
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Rebecca Harap
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Kathleen L Grady
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Surgery, Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan D Rich
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Clyde W Yancy
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Adeboye Ogunseitan
- Department of Medicine, Division of Hospital Medicine (Palliative Care), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eytan Szmuilowicz
- Department of Medicine, Division of Hospital Medicine (Palliative Care), Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jane E Wilcox
- Department of Medicine, Division of Cardiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Chuzi S, Cantey EP, Unger E, Rosenthal JE, Didwania A, McGaghie WC, Prenner S. Interactive Multimodal Curriculum on Use and Interpretation of Inpatient Telemetry. MedEdPORTAL 2018; 14:10730. [PMID: 30800930 PMCID: PMC6342405 DOI: 10.15766/mep_2374-8265.10730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/14/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Inpatient telemetry monitoring is a commonly used technology designed to detect and monitor life-threatening arrhythmias. However, residents are rarely educated in the proper use and interpretation of telemetry monitoring. METHODS We developed a training module containing an educational video, PowerPoint presentation, and hands-on interactive learning session with a telemetry expert. The module highlights proper use of telemetry monitoring, recognition of telemetry artifact, and interrogation of telemetry to identify clinically significant arrhythmias. Learners completed pre- and postcurriculum knowledge-based assessments and a postcurriculum survey on their experience with the module. In total, the educational curriculum had three 60-minute sessions. RESULTS Thirty-two residents participated in the training module. Residents scored higher on the posttest (77% ± 12%) than on the pretest (70% ± 12%), t(31) = -4.3, p < .001. Wilcoxon signed rank tests indicated PGY-3s performed better on the posttest (Mdn = 0.86) than on the pretest (Mdn = 0.72), z = -2.19, p = .031. PGY-2s also performed better on the posttest (Mdn = 0.86) than on the pretest (Mdn = 0.76), z = -2.04, p = .042. There was no difference between pretest (Mdn = 0.66) and posttest (Mdn = 0.71) scores for PGY-1s, z = -1.50, p = .142. The majority of residents reported that the telemetry curriculum boosted their self-confidence, helped prepare them to analyze telemetry on their patients, and should be a required component of the residency. DISCUSSION This module represents a new paradigm for teaching residents how to successfully and confidently interpret and use inpatient telemetry.
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Affiliation(s)
- Sarah Chuzi
- Chief Resident in Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Eric P. Cantey
- Chief Resident in Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine
| | - Erin Unger
- Cardiology Fellow, Division of Cardiology, Northwestern University Feinberg School of Medicine
| | - James E. Rosenthal
- Associate Professor of Cardiology, Division of Cardiology, Northwestern University Feinberg School of Medicine
| | - Aashish Didwania
- Associate Professor of Medicine and Medical Education, Department of Medicine, Northwestern University Feinberg School of Medicine
- Associate Vice Chair for Education, Department of Medicine, Northwestern University Feinberg School of Medicine
- Internal Medicine Residency Program Director, Department of Medicine, Northwestern University Feinberg School of Medicine
| | - William C. McGaghie
- Professor of Medical Education and Preventive Medicine, Department of Medical Education, Northwestern University Feinberg School of Medicine
| | - Stuart Prenner
- Advanced Heart Failure and Transplant Cardiology Fellow, Division of Cardiology, Perelman School of Medicine at the University of Pennsylvania
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Chuzi S, Tavora F, Cruz M, Costa R, Chae YK, Carneiro BA, Giles FJ. Clinical features, diagnostic challenges, and management strategies in checkpoint inhibitor-related pneumonitis. Cancer Manag Res 2017; 9:207-213. [PMID: 28652812 PMCID: PMC5476791 DOI: 10.2147/cmar.s136818] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Immune checkpoint inhibitors, including cytotoxic T-lymphocyte antigen 4 (CTLA-4) and programmed cell death-1 (PD-1) inhibitors, represent an effective treatment modality for multiple malignancies. Despite the exciting clinical benefits, checkpoint inhibition is associated with a series of immune-related adverse events (irAEs), many of which can be life-threatening and result in significant treatment delays. Pneumonitis is an adverse event of special interest as it led to treatment-related deaths in early clinical trials. This review summarizes the incidence of pneumonitis during treatment with the different checkpoint inhibitors and discusses the prognostic significance of tumor type. The wide range of clinical, radiographic, and histologic characteristics of checkpoint inhibitor-related pneumonitis is reviewed and followed by guidance on the different management strategies.
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Affiliation(s)
- Sarah Chuzi
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Fabio Tavora
- Argos Laboratory, Messejana Heart and Lung Hospital, Fortaleza, Brazil
| | - Marcelo Cruz
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ricardo Costa
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Young Kwang Chae
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Benedito A Carneiro
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Francis J Giles
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Chuzi S, Stein BL. Essential thrombocythemia: a review of the clinical features, diagnostic challenges, and treatment modalities in the era of molecular discovery. Leuk Lymphoma 2017; 58:2786-2798. [DOI: 10.1080/10428194.2017.1312371] [Citation(s) in RCA: 9] [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: 12/22/2022]
Affiliation(s)
- Sarah Chuzi
- Department of Medicine, Northwestern Feinberg University School of Medicine, Chicago, IL, USA
| | - Brady L. Stein
- Department of Medicine, Northwestern Feinberg University School of Medicine, Chicago, IL, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern Feinberg University School of Medicine, Chicago, IL, USA
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Fleischman A, Makimura H, Stanley TL, McCarthy MA, Kron M, Sun N, Chuzi S, Hrovat MI, Systrom DM, Grinspoon SK. Skeletal muscle phosphocreatine recovery after submaximal exercise in children and young and middle-aged adults. J Clin Endocrinol Metab 2010; 95:E69-74. [PMID: 20554709 PMCID: PMC2936068 DOI: 10.1210/jc.2010-0527] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [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] [Indexed: 01/07/2023]
Abstract
CONTEXT Elderly subjects have reduced mitochondrial function. However, it remains unclear whether the decline in mitochondrial function begins earlier in the life span. OBJECTIVE The objective of the study was to determine skeletal muscle mitochondrial oxidative phosphorylation by (31)phosphorous-magnetic resonance spectroscopy (MRS) across a variety of age groups. DESIGN This was a cross-sectional study of 121 healthy normal-weight and overweight individuals from age 8 to 55 yr. SETTING The study was conducted at a single university medical center in Boston, MA. PARTICIPANTS Participants included 68 children and 53 adults from the Boston community. INTERVENTIONS AND MAIN OUTCOME MEASURES Phosphocreatine (PCr) recovery was evaluated by (31)phosphorous-MRS after submaximal exercise. Subjects were also evaluated with anthropometric measurements, metabolic profiles, and measures of physical activity. RESULTS PCr recovery determined by (31)phosphorous-MRS is positively associated with age in univariate analysis in a cohort of individuals aged 8-55 yr (r = +0.55, P < 0.0001). Stratification of subjects into four age groups (prepubertal and early pubertal children, pubertal and postpubertal children < 18 yr, young adults aged 18-39 yr, and middle aged adults aged 40-55 yr) demonstrates prolongation of PCr recovery with increasing age across the four groups (P < 0.0001 by ANOVA). The relationship between PCr recovery and age remains strong when controlling for gender; race; ethnicity; body mass index; measures of physical activity and inactivity; and anthropometric, nutritional, and metabolic parameters (P < 0.004). CONCLUSIONS Skeletal muscle PCr recovery measured by (31)phosphorous-MRS is prolonged with age, even in children and young adults.
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Affiliation(s)
- Amy Fleischman
- Program in Nutritional Metabolism and Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
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Janes AC, Pizzagalli DA, Richardt S, deB Frederick B, Chuzi S, Pachas G, Culhane MA, Holmes AJ, Fava M, Evins AE, Kaufman MJ. Brain reactivity to smoking cues prior to smoking cessation predicts ability to maintain tobacco abstinence. Biol Psychiatry 2010; 67:722-9. [PMID: 20172508 PMCID: PMC2954596 DOI: 10.1016/j.biopsych.2009.12.034] [Citation(s) in RCA: 311] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 12/29/2009] [Accepted: 12/30/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Developing the means to identify smokers at high risk for relapse could advance relapse prevention therapy. We hypothesized that functional magnetic resonance imaging (fMRI) reactivity to smoking-related cues, measured before a quit attempt, could identify smokers with heightened relapse vulnerability. METHODS Before quitting smoking, 21 nicotine-dependent women underwent fMRI during which smoking-related and neutral images were shown. These smokers also were tested for possible attentional biases to smoking-related words using a computerized emotional Stroop (ES) task previously found to predict relapse. Smokers then made a quit attempt and were grouped based on outcomes (abstinence vs. slip: smoking > or = 1 cigarette after attaining abstinence). Prequit fMRI and ES measurements in these groups were compared. RESULTS Slip subjects had heightened fMRI reactivity to smoking-related images in brain regions implicated in emotion, interoceptive awareness, and motor planning and execution. Insula and dorsal anterior cingulate cortex (dACC) reactivity induced by smoking images correlated with an attentional bias to smoking-related words. A discriminant analysis of ES and fMRI data predicted outcomes with 79% accuracy. Additionally, smokers who slipped had decreased fMRI functional connectivity between an insula-containing network and brain regions involved in cognitive control, including the dACC and dorsal lateral prefrontal cortex, possibly reflecting reduced top-down control of cue-induced emotions. CONCLUSIONS These findings suggest that the insula and dACC are important substrates of smoking relapse vulnerability. The data also suggest that relapse-vulnerable smokers can be identified before quit attempts, which could enable personalized treatment, improve tobacco-dependence treatment outcomes, and reduce smoking-related morbidity and mortality.
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Affiliation(s)
- Amy C Janes
- Brain Imaging Center McLean Hospital, Harvard Medical School, Belmont, Massachusetts 02478, USA.
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Yang H, Chuzi S, Sinicropi-Yao L, Johnson D, Chen Y, Clain A, Baer L, McGrath PJ, Stewart JW, Fava M, Papakostas GI. Type of residual symptom and risk of relapse during the continuation/maintenance phase treatment of major depressive disorder with the selective serotonin reuptake inhibitor fluoxetine. Eur Arch Psychiatry Clin Neurosci 2010; 260:145-50. [PMID: 19572158 DOI: 10.1007/s00406-009-0031-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [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: 10/28/2008] [Accepted: 06/15/2009] [Indexed: 12/28/2022]
Abstract
UNLABELLED Relapse of major depressive disorder (MDD) is a common clinical problem. Identifying relapse predictors could lead to strategies that reduce relapse risk. This study is designed to determine whether residual symptoms predict relapse risk during the continuation/maintenance treatment of MDD. 570 MDD patients received open-label fluoxetine for 12 weeks. Under double blind conditions, 262 patients who responded by week 12 were randomly assigned to continue fluoxetine or switch to placebo for 52 weeks or until relapse. Residual symptoms were measured using the Symptom Checklist-90 and the Symptom Questionnaire. The relationship between residual symptom severity and relapse risk was assessed. Without adjusting for overall residual symptom severity, a greater severity of residual obsessive-compulsive and phobic anxiety symptoms predicted greater relapse risk. After adjusting for overall residual symptom severity, only severity of phobic anxiety symptoms predicted relapse risk. The predictive value of phobic anxiety symptoms with respect to relapse risk was independent of treatment assignment. The results indicated that there may be a specific pattern of residual symptoms associated with depressive relapse during antidepressant continuation/maintenance, which is unrelated to treatment assignment. Future studies are needed to further explore the relationship between residual symptoms and relapse risk in MDD. CLINICAL IMPLICATIONS (1) It is important to treat residual symptoms among antidepressant responders/remitters in order to decrease relapse risk. (2) Clinicians should target residual phobic anxiety symptoms in order to decrease relapse risk. (3) Clinicians should target residual obsessive-compulsive symptoms in order to decrease relapse risk. LIMITATIONS (1) limited generalizability due to inclusion/exclusion criteria; (2) lack of active comparator treatment group; (3) post hoc analysis.
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Affiliation(s)
- Huaiyu Yang
- Department of Psychiatry, Depression Clinical and Research Program at Massachusetts General Hospital, Harvard Medical School, 15 Parkman Street, Boston, MA 02114, USA.
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Yang H, Sinicropi-Yao L, Chuzi S, Youn SJ, Clain A, Baer L, Chen Y, McGrath PJ, Fava M, Papakostas GI. Residual sleep disturbance and risk of relapse during the continuation/maintenance phase treatment of major depressive disorder with the selective serotonin reuptake inhibitor fluoxetine. Ann Gen Psychiatry 2010; 9:10. [PMID: 20187924 PMCID: PMC2837657 DOI: 10.1186/1744-859x-9-10] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 02/26/2010] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Relapse of major depressive disorder (MDD) is a common clinical problem. This study was designed to determine whether residual sleep disturbance (insomnia and hypersomnia) predict risk of relapse during the continuation and maintenance treatment of MDD. METHODS A total of 570 patients with MDD were treated with open-label, flexible dose fluoxetine (range 20 to 60 mg; mean dose = 45.8 mg/day; SD = 15.1) for 12 weeks. Under double blind conditions, 262 patients who achieved clinical response were randomly assigned to continue fluoxetine or to switch to placebo for 52 weeks or until relapse. Residual sleep disturbance during the baseline visit of the double-blind phase was assessed using items 4, 5, 6 (insomnia) and 22, 23, 24 (hypersomnia) of the Hamilton Depression Rating Scale (HDRS). Survival analysis was utilized to determine the effect of residual sleep disturbance on risk of relapse. RESULTS The severities of early (P > 0.05), middle (P > 0.05), late (P > 0.05), or total (P > 0.05) residual insomnia were not found to significantly predict risk of relapse during continuation and maintenance-phase treatment. Similarly, the severities of early bedtime (P > 0.05), oversleeping (P > 0.05), napping (P > 0.05), or total (P > 0.05) residual hypersomnia were not found to significantly predict risk of relapse during continuation and maintenance-phase treatment. CONCLUSION The present study did not identify the severity of residual sleep disturbance among fluoxetine responders to predict risk of MDD relapse. The size of our sample may have precluded us from identifying more modest effects of residual sleep disturbance on the risk of relapse in MDD patients. Future studies are needed to further explore the relationship between residual sleep disturbance and relapse in MDD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00427128.
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Affiliation(s)
- Huaiyu Yang
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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