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Iyer V, Faza NN, Pfeiffer M, Kozak M, Peterson B, Wyler von Ballmoos M, Mollenkopf S, Mancilla M, Latibeaudiere-Gardner D, Reardon MJ. Understanding Treatment Preferences for Patients with Tricuspid Regurgitation. MDM Policy Pract 2024; 9:23814683231225667. [PMID: 38250668 PMCID: PMC10798093 DOI: 10.1177/23814683231225667] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/14/2023] [Indexed: 01/23/2024] Open
Abstract
Background. Tricuspid regurgitation (TR) is a high-prevalence disease associated with poor quality of life and mortality. This quantitative patient preference study aims to identify TR patients' perspectives on risk-benefit tradeoffs. Methods. A discrete-choice experiment was developed to explore TR treatment risk-benefit tradeoffs. Attributes (levels) tested were treatment (procedure, medical management), reintervention risk (0%, 1%, 5%, 10%), medications over 2 y (none, reduce, same, increase), shortness of breath (none/mild, moderate, severe), and swelling (never, 3× per week, daily). A mixed logit regression model estimated preferences and calculated predicted probabilities. Relative attribute importance was calculated. Subgroup analyses were performed. Results. An online survey was completed by 150 TR patients. Shortness of breath was the most important attribute and accounted for 65.8% of treatment decision making. The average patients' predicted probability of preferring a "procedure-like" profile over a "medical management-like" profile was 99.7%. This decreased to 78.9% for a level change from severe to moderate in shortness of breath in the "medical management-like" profile. Subgroup analysis confirmed that patients older than 64 y had a stronger preference to avoid severe shortness of breath compared with younger patients (P < 0.02), as did severe or worse TR patients relative to moderate. New York Heart Association class I/II patients more strongly preferred to avoid procedural reintervention risk relative to class III/IV patients (P < 0.03). Conclusion. TR patients are willing to accept higher procedural reintervention risk if shortness of breath is alleviated. This risk tolerance is higher for older and more symptomatic patients. These results emphasize the appropriateness of developing TR therapies and the importance of addressing symptom burden. Highlights This study provides quantitative patient preference data from clinically confirmed tricuspid regurgitation (TR) patients to understand their treatment preferences.Using a targeted literature search and patient, physician, and Food and Drug Administration feedback, a cross-sectional survey with a discrete-choice experiment that focused on 5 of the most important attributes to TR patients was developed and administered online.TR patients are willing to accept higher procedural reintervention risk if shortness of breath is alleviated, and this risk tolerance is higher for older and more symptomatic patients.
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Affiliation(s)
- Vijay Iyer
- Division of Cardiology, Buffalo General Medical Center, Buffalo, NY, USA
| | - Nadeen N. Faza
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Michael Pfeiffer
- Division of Cardiology, Penn State Heart and Vascular Institute, Hershey, PA, USA
| | - Mark Kozak
- Division of Cardiology, Penn State Heart and Vascular Institute, Hershey, PA, USA
| | - Brandon Peterson
- Division of Cardiology, Penn State Heart and Vascular Institute, Hershey, PA, USA
| | | | | | | | | | - Michael J. Reardon
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
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Mancilla M, Iyer VS, Faza NN, Pfieffer M, Wyler von Ballmoos M, Kozak M, Peterson B, Mollenkopf S, Latibeaudiere D, Reardon MJ. Abstract 42: Understanding Treatment Preferences For Patients With Tricuspid Regurgitation. Circ Cardiovasc Qual Outcomes 2022. [DOI: 10.1161/circoutcomes.15.suppl_1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
A quantitative patient preference study aims to understand tricuspid regurgitation (TR) patients’ priorities for symptom relief and treatment risk-benefit tradeoffs.
Methods:
150 clinically confirmed moderate or greater TR patients completed a discrete choice experiment survey online to elicit their preferences. Attributes (levels) tested were treatment (procedure, medical management), re-intervention risk (0%, 1%, 5%, 10%), medications in 2 yrs (none, reduce, same, more), shortness of breath (none/mild, moderate, severe) and swelling (never, 3x a week, daily). A mixed logit regression (MXL) model estimated preferences. MXL choice model calculated predicted probabilities.
Results:
Shortness of breath contributed 66% to patients’ treatment decision making over other attributes. Patients’ predicted probability of preferring a procedure-like profile over a medical management-like profile was 99.7% and it was 78.9% for a medical management shortness of breath level change (Table 1). Subgroup analysis showed that patients over 64 yrs old preferred to more strongly avoid severe shortness of breath compared to under 65 (p<0.02), as did severe or worse TR patients over moderate. NYHA Class I/II patients more strongly preferred to avoid procedural re-intervention risk of 10% over Class III/IV (p<0.03).
Conclusion:
TR patients prioritize improving shortness of breath and are willing to accept higher procedural re-intervention risk if it is alleviated, even to a small degree.
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McCullough PA, Mehta HS, Barker CM, Van Houten J, Mollenkopf S, Gunnarsson C, Ryan M, Cork DP. Mortality and guideline-directed medical therapy in real-world heart failure patients with reduced ejection fraction. Clin Cardiol 2021; 44:1192-1198. [PMID: 34342033 PMCID: PMC8427999 DOI: 10.1002/clc.23664] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To estimate the prevalence of guideline‐directed medical therapy (GDMT) in commercially insured US patients with heart failure with reduced ejection fraction (HFrEF) and examine the effect of GDMT on all‐cause mortality. GDMT for HFrEF includes pharmacologic therapies such as β‐blockers (BB), angiotensin‐converting enzyme inhibitors (ACE‐I), angiotensin receptor blockers (ARB), angiotensin receptor‐neprilysin (ARNI), mineralocorticoid receptor antagonists (MRA), and sodium‐glucose cotransporter inhibitors to reduce morbidity and mortality. Methods Patients in the Optum Integrated File from 2007 to 2019Q3, ≥18 years, with history of HFrEF, were identified. Patients prescribed both a BB and either an ACE‐I, ARB, or ARNI during 6‐month post‐diagnosis were assigned to the GDMT cohort. All others were assigned to the not on GDMT cohort. The GDMT cohort was further classified by those patients with a record of prescription fills for both classes of medications concurrently (GDMT concurrent medication fills). Mortality at 2 years was assessed with a Cox regression model accounting for baseline demographics, comorbidities, and diuretic use. Results This study identified 14 880 HFrEF patients, of which 70% had a record of GDMT, and 57% had a record of concurrent prescriptions. Patients in the not on GDMT cohort had 29% increased risk of mortality versus GDMT (hazard ratio 1.29; 95% CI (1.19–1.40); p < .0001). As a sensitivity analysis, the effect of patients not on GDMT compared to GDMT with concurrent medication fills was more pronounced, with a 37% increased mortality risk. Conclusion In a real‐world population of HFrEF patients, inadequate GDMT confers a 29% excess mortality risk over the 2‐year follow‐up.
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Affiliation(s)
| | - Hirsch S Mehta
- San Diego Cardiac Center, SHARP Healthcare, San Diego, California, USA
| | - Colin M Barker
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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McCullough PA, Mehta HS, Barker CM, Houten JV, Mollenkopf S, Gunnarsson C, Ryan M, Cork DP. Healthcare utilization and guideline-directed medical therapy in heart failure patients with reduced ejection fraction. J Comp Eff Res 2021; 10:1055-1063. [PMID: 34225473 DOI: 10.2217/cer-2021-0118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study examines the effect of guideline-directed medical therapy (GDMT) on healthcare utilization in patients with heart failure with reduced ejection fraction from Optum® Integrated File from 1 January 2007 to 30 June 2020. Materials & methods: Patients with both a beta blocker and either an ACE inhibitor (ACE-I), angiotensin receptor blocker (ARB) or angiotensin receptor neprilysin inhibitor were assigned to the GDMT cohort. All others were not on GDMT. Results: Estimated annual all cause hospitalizations and emergency department visits per 100 patients was 29% (80 vs 62 patients) and 26% higher (54 vs 43 patients; p < 0.0001) and annualized hospital days were longer (1.88 vs 1.64; p = 0.0020) for patients not on GDMT. Conclusion: In a real-world population, heart failure with reduced ejection fraction, patients not optimally managed on GDMT had higher annualized healthcare utilization when compared with patients on GDMT.
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Affiliation(s)
| | - Hirsch S Mehta
- San Diego Cardiac Center, SHARP Healthcare, San Diego, CA, USA
| | - Colin M Barker
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
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McCullough PA, Mehta H, Barker C, Van Houten J, Mollenkopf S, Gunnarsson C, Ryan M, Cork D. MORTALITY AND GUIDELINE DIRECTED MEDICAL THERAPY IN HEART FAILURE PATIENTS WITH REDUCED EJECTION FRACTION: EVIDENCE FROM REAL WORLD DATA. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02029-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chung C, Murphy SM, Mollenkopf S, Redeker N, Green P, Feldman T, Davidson C, Eleid M, Kipperman R, Lim S, Gray W, Leon M, Kodali S. IMPROVEMENTS IN PATIENT-REPORTED SLEEP AFTER TRANSCATHETER TRICUSPID VALVE REPAIR. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02562-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barker CM, Cork DP, McCullough PA, Mehta HS, Van Houten J, Gunnarsson C, Ryan M, Irish W, Mollenkopf S, Verta P. Comparison of Survival in Patients With Clinically Significant Tricuspid Regurgitation With and Without Heart Failure (From the Optum Integrated File). Am J Cardiol 2021; 144:125-130. [PMID: 33385352 DOI: 10.1016/j.amjcard.2020.12.070] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022]
Abstract
This study aimed to quantify survival rates for patients with tricuspid regurgitation (TR) using real-world data. Several clinical conditions are associated with TR, including heart failure (HF), other valve disease (OVD), right-sided heart disease (RSHD), and others that impact mortality. Optum data from January 1, 2007, through December 31, 2018 included patients age ≥18 years with TR and 12 months of continuous health plan enrollment before TR. Exclusion criteria were end-stage renal disease or known/primary organ pathology. Cohorts were created hierarchically: (1) TR with HF; (2) TR with OVD (no HF); (3) TR with RSHD only (no OVD or HF); (4) TR only. Survival was estimated using a Cox hazard model with an interaction term for TR severity and adjusted for patient demographics and Elixhauser co-morbidities. A total of 33,686 met study inclusion (1) TR with HF (26.6%); (2) TR with OVD (36.7%); (3) TR with RSHD only (17.1%); (4) TR only (19.6%). TR patients (regardless of severity) with HF, OVD or RSHD had an increased risk of mortality compared with patients with TR alone. TR severity was also significantly associated (hazard ratio = 1.33; p = 0.0002) with an increased risk of all-cause mortality. In conclusion, TR severity is significantly associated with an increased risk of all-cause mortality, independent of associated conditions including HF, OVD, or RSHD. In patients with severe TR, the mortality risk is most pronounced for patients who had RSHD without HF or OVD before their TR diagnosis.
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Affiliation(s)
- Colin M Barker
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Hirsch S Mehta
- San Diego Cardiac Center, SHARP Healthcare, San Diego, California
| | | | | | | | - William Irish
- Brody School of Medicine, Greenville, North Carolina
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Barker CM, Cork DP, McCullough PA, Mehta HS, Houten JV, Gunnarsson C, Mollenkopf S, Verta P. Healthcare utilization in clinically significant tricuspid regurgitation patients with and without heart failure. J Comp Eff Res 2020; 10:29-37. [PMID: 33174767 DOI: 10.2217/cer-2020-0198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study evaluated how the presence of right-sided heart disease (RSHD), other valve disease (OVD) and heart failure (HF) impacts healthcare utilization in patients with tricuspid valve disease (tricuspid regurgitation [TR]). Materials & methods: Of the 33,686 patients with TR: 6618 (19.6%) had TR-only; 8952 (26.6%) had TR with HF; 12,367 (36.7%) had TR with OVD but no HF; and 5749 (17.1%) had TR with RSHD only. Results: The presence of RSHD, OVD or HF in patients with TR was independently associated with increased annualized hospitalizations, hospital days and costs relative to patients with TR alone. Conclusion: All three co-morbidities were associated with increased healthcare utilization, with HF showing the greatest impact across all measures.
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Affiliation(s)
- Colin M Barker
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Peter A McCullough
- Baylor University Medical Center, Baylor Heart & Vascular Institute, Baylor Jack & Jane Hamilton Heart & Vascular Hospital, Dallas, TX, USA
| | - Hirsch S Mehta
- San Diego Cardiac Center, SHARP Advanced Heart Failure, San Diego, CA, USA
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Janssen E, Murphy S, Mancilla M, Mollenkopf S, Verta P, Feldman T, Davidson C, Eleid M, Kipperman R, Smith R, Lim S, Zahr F, Gray W, Greenbaum A, Leon M, Kodali S. TCT CONNECT-494 Importance of Symptom and Activity Improvement for Patients With Tricuspid Regurgitation (TR). J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Reynolds M, Song Y, Al-Ghusain A, Mollenkopf S, Feldman T, Davidson C, Eleid M, Kipperman R, Smith R, Lim S, Zahr F, Gray W, Greenbaum A, Leon M, Kodali S. TCT CONNECT-490 Health Status Improvements Following Transcatheter Tricuspid Repair With the PASCAL Device in the CLASP TR Early Feasibility Study. J Am Coll Cardiol 2020. [DOI: 10.1016/j.jacc.2020.09.519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cork DP, McCullough PA, Mehta HS, Barker CM, Gunnarsson C, Ryan MP, Baker ER, Van Houten J, Mollenkopf S, Verta P. Impact of mitral regurgitation on cardiovascular hospitalization and death in newly diagnosed heart failure patients. ESC Heart Fail 2020; 7:1502-1509. [PMID: 32469120 PMCID: PMC7373926 DOI: 10.1002/ehf2.12653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 01/15/2020] [Accepted: 02/04/2020] [Indexed: 01/14/2023] Open
Abstract
AIMS Heart failure (HF) carries a poor prognosis, and the impact of concomitant mitral regurgitation (MR) is not well understood. This analysis aimed to estimate the incremental effect of MR in patients newly diagnosed with HF. METHODS AND RESULTS Data from the IBM® MarketScan® Research Databases were analysed. Included patients had at least one inpatient or two outpatient HF claims. A 6 month post-period after HF index was used to capture MR diagnosis and severity. HF patients were separated into three cohorts: without MR (no MR), not clinically significant MR (nsMR), and significant MR (sMR). Time-to-event analyses were modelled to estimate the clinical burden of disease. The primary outcome was a composite endpoint of death or cardiovascular (CV)-related admission. Secondary outcomes were death and CV hospitalization alone. All models controlled for baseline demographics and co-morbidities. Patients with sMR were at significantly higher risk of either death or CV admission compared with patients with no MR [hazard ratio (HR) 1.26; 95% confidence interval (CI) 1.15-1.39]. When evaluating death alone, patients with sMR had significantly higher risk of death (HR 1.24; 95% CI 1.08-1.43) compared with patients with no MR. When evaluating CV admission alone, patients with MR were at higher risk of hospital admission vs. patients with no MR, and the magnitude was dependent upon the MR severity: sMR (HR 1.55; 95% CI 1.38-1.74) and nsMR (HR 1.23; 95% CI 1.08-1.40). CONCLUSIONS Evidence of MR in retrospective claims significantly increases the clinical burden of incident HF patients. Time to death and CV hospitalizations are increased when MR is clinically significant.
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Affiliation(s)
| | - Peter A McCullough
- Baylor Heart and Vascular Institute, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, TX, USA
| | - Hirsch S Mehta
- San Diego Cardiac Center, SHARP Memorial Hospital, San Diego, CA, USA
| | - Colin M Barker
- Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Michael P Ryan
- CTI Clinical Trial and Consulting Services, Covington, KY, USA
| | - Erin R Baker
- CTI Clinical Trial and Consulting Services, Covington, KY, USA
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Cork DP, McCullough PA, Mehta HS, Barker CM, Van Houten J, Gunnarsson C, Ryan MP, Baker ER, Mollenkopf S, Verta P. The economic impact of clinically significant tricuspid regurgitation in a large, administrative claims database. J Med Econ 2020; 23:521-528. [PMID: 31952454 DOI: 10.1080/13696998.2020.1718681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: This study aimed to quantify the healthcare burden of clinically significant tricuspid regurgitation (TR) in patients with and without heart failure (HF).Materials and Methods: Data were from the IBM MarketScan Research Databases from October 2011 to September 2016. Eligible patients met the following inclusion criteria: age ≥18 with a TR diagnosis, 12 months pre (baseline), and 6 months post (landmark) medical enrollment. The landmark period was used to categorize TR severity, defined as a record of pulmonary hypertension with ascites, lower extremity edema or hepatic insufficiency, or tricuspid valve surgery. Cohorts were defined based on TR etiology and severity: (1) no HF and no clinically significant TR; (2) HF with no clinically significant TR; (3) no HF with clinically significant TR; and (4) HF with clinically significant TR. Outcomes of interest were all-cause hospitalizations, hospital days, and expenditures. Multivariable models were fit for each of the annualized outcomes and adjusted for patient demographics, comorbidities, and other concomitant valve diseases.Results: There were 92,994 patients eligible for analysis. Patients with no HF and no clinically significant TR had the annualized healthcare burden of 0.20 all-cause hospitalizations (approximately one inpatient hospitalization every 5 years), 1.07 hospital days, and $17,478 in expenditures. The presence of clinically significant TR, alone or with HF, significantly increased healthcare utilization and expenditures. For patients with no HF with clinically significant TR, the annualized economic burden increased to 0.41 all-cause hospitalizations, 3.13 hospital days, and $29,985 in expenditures. For patients with HF and clinically significant TR, the annualized economic burden was even greater with 0.59 all-cause hospitalizations, 4.31 hospital days, and $42,255 in expenditures.Conclusion: The presence of clinically significant TR is associated with an increase in healthcare utilization and expenditures, irrespective of the presence of HF.
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Affiliation(s)
| | - Peter A McCullough
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, TX, USA
| | - Hirsch S Mehta
- San Diego Cardiac Center, SHARP Memorial Hospital, San Diego, CA, USA
| | - Colin M Barker
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | - Michael P Ryan
- CTI Clinical Trial and Consulting Services, Covington, KY, USA
| | - Erin R Baker
- CTI Clinical Trial and Consulting Services, Covington, KY, USA
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Mehta H, McCullough P, Cork DP, Barker C, Van Houten J, Gunnarsson C, Mollenkopf S, Verta P. MEDICAL THERAPY IN PATIENTS WITH FUNCTIONAL MITRAL REGURGITATION: ARE PATIENTS OPTIMIZED IN THE REAL WORLD? J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Green P, Chung C, Murphy S, Al-Ghusain A, Mollenkopf S, Feldman T, Davidson C, Eleid M, Kipperman R, Smith R, Lim S, Zahr F, Gray WA, Greenbaum A, Leon M, Kodali SK. IMPACT OF TRANSCATHETER TRICUSPID VALVE REPAIR ON DAILY PHYSICAL ACTIVITY: AN ANALYSIS OF WEARABLE ACTIVITY MONITORING IN THE CLASP TR EARLY FEASIBILITY STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31836-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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McCullough PA, Mehta HS, Barker CM, Cork DP, Gunnarsson C, Ryan MP, Baker ER, Van Houten J, Mollenkopf S, Verta P. The Economic Impact of Mitral Regurgitation on Patients With Medically Managed Heart Failure. Am J Cardiol 2019; 124:1226-1231. [PMID: 31470974 DOI: 10.1016/j.amjcard.2019.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 11/27/2022]
Abstract
The objective of this study was to quantify the financial healthcare burden of mitral regurgitation (MR) on medically managed heart failure (HF) patients. Data from the Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases were analyzed. Included patients had a minimum of 1 inpatient or 2 outpatient claims for HF with a 6-month preperiod (baseline). A 6-month postperiod (landmark) after HF index was used to capture MR diagnosis and severity. Following the landmark period, patients had to have 12 months of continuous medical and prescription drug plan enrollment with at least 2 records of HF medication refills. A therapeutic intensity score was calculated based on HF medication usage. Medically managed HF patients were separated into 3 cohorts: without MR (no MR), insignificant MR (iMR), and significant MR (sMR). Healthcare utilization and all-cause expenditures were modeled to quantify the burden of MR. All models controlled for baseline demographics, co-morbid conditions, and HF therapeutic intensity. Medically managed incident HF patients with sMR had significantly more hospital days (1.91 vs 1.72 days; p = 0.0096) and annual expenditures ($23,988 vs $21,530; p < 0.0001) compared with no MR patients. No differences were identified when comparing iMR and no MR. When evaluating HF admissions, sMR patients had an estimated 50% greater HF admissions rate (0.036 vs 0.024; p < 0.0001) compared with no MR patients. Additionally, HF admits for iMR were 23% more than those with no MR (0.029 vs 0.024; p = 0.0064). In conclusion, evidence of MR in retrospective claims significantly increases the healthcare impact of medically managed HF patients. Both utilization and financial burden is more pronounced when MR is clinically significant.
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Verta P, McCullough P, Barker C, Cork D, Mehta H, Gunnarsson C, Ryan M, Baker E, Mollenkopf S, Van Houten J. TCT-432 The Economic Impact of Clinically Significant Tricuspid Regurgitation. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mehta HS, Houten JV, Verta P, Gunnarsson C, Mollenkopf S, Cork DP. Twelve-month healthcare utilization and expenditures in Medicare fee-for-service patients with clinically significant mitral regurgitation. J Comp Eff Res 2019; 8:1089-1098. [DOI: 10.2217/cer-2019-0026] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: This study sought to quantify the healthcare burden of Medicare patients with clinically significant mitral regurgitation (sMR). Materials & methods: Proxy definitions were used for sMR, including MR surgery, atrial fibrillation, pulmonary hypertension or >2 echocardiograms. Results: In this study, 11,173 patients had significant degenerative MR (sDMR); 25,402 had significant functional MR (sFMR); and 12,232 had significant uncharacterized MR (sUMR). Patients with sFMR (18,880) were more likely to be hospitalized and present to the emergency department compared with patients with sDMR (9,795) or sUMR (10,587). Annual healthcare expenditures for sMR patients were: US$29,328 for sFMR; US$17,112 for sUMR; and US$12,870 for sDMR. Conclusion: Novel therapeutic interventions merit further evaluation to reduce the substantial healthcare burden of sMR in the Medicare population.
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Affiliation(s)
- Hirsch S Mehta
- San Diego Cardiac Center, SHARP Memorial Hospital, San Diego, CA, USA
| | | | | | | | | | - David P Cork
- San Diego Cardiac Center, SHARP Memorial Hospital, San Diego, CA, USA
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McCullough PA, Mehta HS, Cork DP, Barker CM, Gunnarsson C, Mollenkopf S, Van Houten J, Verta P. The healthcare burden of disease progression in medicare patients with functional mitral regurgitation. J Med Econ 2019; 22:909-916. [PMID: 31104524 DOI: 10.1080/13696998.2019.1621325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 10/26/2022]
Abstract
Objective: This retrospective database analysis estimated the incremental effect that disease progression from non-clinically significant functional mitral regurgitation (nsFMR) to clinically significant FMR (sFMR) has on clinical outcomes and costs. Methods: Medicare Fee for Service beneficiaries with nsFMR were examined, defined as those with a heart failure diagnosis prior to MR. Patients were classified as ischemic if there was a history of: CAD, AMI, PCI, or CABG. The primary outcome was time to sFMR, defined as pulmonary hypertension, atrial fibrillation, mitral valve surgery, serial echocardiography, or death, using a Cox hazard regression model. Annualized hospitalizations, inpatient hospital days, and healthcare expenditures were also modeled. Results: Patients with IHD had higher risk (Hazard Ratio = 1.22 [1.14-1.30]) for disease progression compared to patients without. The progression cohort had significantly more annual inpatient hospitalizations (non-IHD = 1.32; IHD = 1.40) than the non-progression cohort (non-IHD = 0.36; IHD = 0.34), and significantly more annual inpatient hospital days (non-IHD = 13.07; IHD = 13.52) than the non-progression cohort (non-IHD = 2.29; with IHD = 2.08). The progression cohort had over 3.5-times higher costs vs the non-progression cohort, independent of IHD (non-IHD = $12,798 vs $46,784; IHD = $12,582 vs $49,348). Conclusion: Treating FMR patients earlier in their clinical trajectory may prevent disease progression and reduce high rates of healthcare utilization and expenditures.
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Affiliation(s)
- Peter A McCullough
- a Baylor Heart and Vascular Hospital, Baylor Heart and Vascular Institute, Baylor University Medical Center , Dallas , TX , USA
| | - Hirsch S Mehta
- b SHARP Memorial Hospital, San Diego Cardiac Center , San Diego , CA , USA
| | - David P Cork
- b SHARP Memorial Hospital, San Diego Cardiac Center , San Diego , CA , USA
| | - Colin M Barker
- c Department of Medicine, Division of Cardiology, Vanderbilt University Medical Center , Nashville , TN , USA
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Cork DP, Mehta H, Barker C, Verta P, Gunnarsson C, Ryan MP, Baker ER, Mollenkopf S, Van Houten J, McCullough P. THE ECONOMIC IMPACT OF MITRAL REGURGITATION ON MEDICALLY MANAGED INCIDENT HEART FAILURE PATIENTS. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31737-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Vinkeles Melchers NVS, Mollenkopf S, Colebunders R, Edlinger M, Coffeng LE, Irani J, Zola T, Siewe JN, de Vlas SJ, Winkler AS, Stolk WA. Burden of onchocerciasis-associated epilepsy: first estimates and research priorities. Infect Dis Poverty 2018; 7:101. [PMID: 30253788 PMCID: PMC6156959 DOI: 10.1186/s40249-018-0481-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 08/30/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Since the 1990s, evidence has accumulated of an increased prevalence of epilepsy in onchocerciasis-endemic areas in Africa as compared to onchocerciasis-free areas. Although the causal relationship between onchocerciasis and epilepsy has yet to be proven, there is likely an association. Here we discuss the need for disease burden estimates of onchocerciasis-associated epilepsy (OAE), provide them, detail how such estimates should be refined, and discuss the socioeconomic impact of OAE, including a cost-estimate for anti-epileptic drugs. MAIN BODY Providing OAE burden estimates may aid prevention of epilepsy in onchocerciasis- endemic areas by inciting and informing collaboration between onchocerciasis control programmes and mental health services. Epilepsy not only massively impacts the health of those affected, but it also carries a high socioeconomic burden for the households and communities involved. We used previously published geospatial estimates of onchocerciasis in Africa and a separately published logistic regression model quantifying the association between onchocerciasis and epilepsy to estimate the number of OAE cases. We then applied disability weights for epilepsy to quantify the burden in terms of years of life lived with disability (YLD) and estimate the cost of treatment. We estimate that in 2015 roughly 117 000 people were affected by OAE across onchocerciasis-endemic areas previously under the African Programme for Onchocerciases control (APOC) mandate where OAE has ever been reported or suspected, and another 264 000 persons in onchocerciasis-endemic areas where OAE has never been investigated before. The total number of YLDs due to OAE was 39 300 and 88 700 in these areas respectively, based on a weighted mean disability weight of 0.336. The burden of OAE is approximately 13% of the total YLDs attributable to onchocerciasis and 10% of total YLDs attributable to epilepsy. We estimated that by 2015 the total costs of treatment with anti-epileptic drug for OAE cases would have been a minimum of 12.4 million US$. CONCLUSIONS These estimates suggest a considerable health, social and economic burden of OAE in Africa. The treatment and care for people with epilepsy, especially in hyperendemic onchocerciasis areas with high epilepsy prevalence thus requires more financial and human resources.
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Affiliation(s)
- Natalie V S Vinkeles Melchers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Sarah Mollenkopf
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA, 98121, USA
| | | | - Michael Edlinger
- Department of Medical Statistics, Informatics, and Health Economics, Medical University Innsbruck, Vienna, Austria
| | - Luc E Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Julia Irani
- Department of Public Health, Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Trésor Zola
- Department of Tropical Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Joseph N Siewe
- Global Health Institute, University of Antwerp, Antwerp, Belgium
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Andrea S Winkler
- Centre for Global Health, Institute for Health and Society, Oslo, Norway.,Center for Global Health, Department of Neurology, Technical University of Munich, Munich, Germany
| | - Wilma A Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. box 2040, 3000, CA, Rotterdam, The Netherlands
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Cork D, Kottenmeier E, Mollenkopf S, Gunnarsson C, Verta P, Mehta H. Abstract 112: 12-Month Healthcare Utilization and Expenditures in Medicare Advantage Patients With Mitral Regurgitation From the Medical Outcomes Research for Effectiveness and Economics Registry. Circ Cardiovasc Qual Outcomes 2018. [DOI: 10.1161/circoutcomes.11.suppl_1.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Mitral Regurgitation (MR) is associated with significant health care costs. This study aims to quantify the financial healthcare burden of Medicare Advantage (MA) patients across all MR patients from the Medical Outcomes Research for Effectiveness and Economics (MORE2) Registry.
Methods:
MA patients with a minimum of 1 inpatient or 2 outpatient claims for MR from 2008-2014 were reviewed. The index date was defined as a first inpatient claim or second outpatient claim. A 6-month pre-period (baseline) and 6-month post (washout) after index was used to define baseline etiology and severity. Three MR cohorts were defined: (1) Functional MR (FMR) was defined by the presence of heart failure during washout; (2) Degenerative MR (DMR) was defined by presence of chordal rupture or the absence of both heart failure and ischemia; and (3) Uncharacterized MR (UMR) was defined by patients otherwise not meeting the criteria for FMR or DMR. sMR was defined by a history of MR surgery, a diagnosis of atrial fibrillation or pulmonary hypertension, chordal rupture (DMR only), or record of two or more echocardiograms (per clinical guidelines) during washout. Demographics, comorbidities, healthcare utilization, and all-cause expenditures were summarized.
Results:
Of the 164,682 MA patients with MR who met inclusion criteria, 70,452 (43%) had FMR, 51,399 (31%) had DMR, and 42,831 (26%) had UMR. Average age (SD) was similar across cohorts: 74 (7.95), 72 (8.46), and 74 (7.45) years for FMR, DMR, and UMR, respectively. Proportion of severe patients and Charlson Comorbidity Index (CCI) indicates that the FMR cohort was “sicker” as compared to the others: FMR (41,325 [59% of 70,452]; CCI 4.56), DMR (16,169 [32% of 51,399]; CCI 1.67), and UMR (16,131 [38% of 42,831]; CCI 2.80). 2,079 patients (1.26% of total 164,682) received mitral valve surgery at index or washout with the highest occurrence in FMR patients (1,663), followed by UMR (327) and DMR (89). When comparing across the MR cohorts, the FMR cohort had higher rates of hospital admission, but length of stay was similar between cohorts (FMR [19.9%, 4-days], DMR [9.4%, 4-days], and UMR [13.6%, 3-days]). FMR had the highest annual all-cause healthcare costs (SD) ($22,569, [$59,876]), followed by UMR ($14,735 [$32,070]) and DMR ($10,485 [$23,934]).
Conclusions:
MR in the Medicare Advantage population is associated with a substantial health care burden, with FMR patients having the highest cost and utilization patterns. This population should, therefore, have access to innovative treatment options that relieve symptoms and reduce economic burden.
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Cork DP, Kottenmeier E, Verta P, Mollenkopf S, Green T, Mehta H. 12-MONTH PROGRESSION TO SEVERITY IN NON-CLINICALLY SIGNIFICANT FUNCTIONAL MITRAL REGURGITATION [NSFMR] PATIENTS WITH AND WITHOUT ISCHEMIA IN MEDICARE FEE-FOR-SERVICE PATIENTS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31801-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Mollenkopf S, Murphy EL. Measuring incidence of HTLV-1: the other human retrovirus. Lancet Infect Dis 2016; 16:1205-1206. [PMID: 27567104 DOI: 10.1016/s1473-3099(16)30322-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Sarah Mollenkopf
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA; Blood Systems Research Institute, San Francisco, CA, USA
| | - Edward L Murphy
- Blood Systems Research Institute, San Francisco, CA, USA; University of California San Francisco, San Francisco, CA, USA.
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Nazarian S, Reynolds M, Ryan M, Hunter T, Wolff S, Mollenkopf S, Turakhia M. ESTIMATING THE LIKELIHOOD OF MRI IN PATIENTS AFTER ICD IMPLANTATION: A 10-YEAR PREDICTION MODEL. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61090-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Keating J, Yukich JO, Mollenkopf S, Tediosi F. Lymphatic filariasis and onchocerciasis prevention, treatment, and control costs across diverse settings: a systematic review. Acta Trop 2014; 135:86-95. [PMID: 24699086 DOI: 10.1016/j.actatropica.2014.03.017] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 12/07/2013] [Revised: 03/21/2014] [Accepted: 03/23/2014] [Indexed: 11/18/2022]
Abstract
The control and eventual elimination of neglected tropical disease (NTD) requires the expansion of interventions such as mass drug administration (MDA), vector control, diagnostic testing, and effective treatment. The purpose of this paper is to present the evidence base for decision-makers on the cost and cost-effectiveness of lymphatic filariasis (LF) and onchocerciasis prevention, treatment, and control. A systematic review of the published literature was conducted. All studies that contained primary or secondary data on costs or cost-effectiveness of prevention and control were considered. A total of 52 papers were included for LF and 24 papers were included for onchocerciasis. Large research gaps exist on the synergies and cost of integrating NTD prevention and control programs, as well as research on the role of health information systems, human resource systems, service delivery, and essential medicines and technology for elimination. The literature available on costs and cost-effectiveness of interventions is also generally older, extremely focal geographically and of limited usefulness for developing estimates of the global economic burden of these diseases and prioritizing among various intervention options. Up to date information on the costs and cost-effectiveness of interventions for LF and onchocerciasis prevention are needed given the vastly expanded funding base for the control and elimination of these diseases.
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Affiliation(s)
- Joseph Keating
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, United States; Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, United States.
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, United States; Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, United States.
| | - Sarah Mollenkopf
- Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, United States.
| | - Fabrizio Tediosi
- Department of Public Health and Epidemiology, Swiss Tropical and Public Health Institute, Socinstrasse 57, 4001 Basel, Switzerland; University of Basel, Switzerland; Centre for Research on Health and Social Care Management (CERGAS), Università Bocconi, Milan, Italy.
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