1
|
Henkin S, Kearing SA, Martinez-Camblor P, Zacharias N, Creager MA, Young MN, Goodney PP, Columbo JA. The impact of the Affordable Care Act Medicaid Expansion in Medicare beneficiaries with peripheral artery disease. Vasc Med 2024:1358863X241237776. [PMID: 38607558 DOI: 10.1177/1358863x241237776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Background: In 2014, the Affordable Care Act Medicaid Expansion (ME) increased Medicaid eligibility for adults with an income level up to 138% of the federal poverty level. In this study, we examined the impact of ME on mortality and amputation in patients with peripheral artery disease (PAD). Methods: The 100% MedPAR and Part-B Carrier files from 2011 to 2018 were queried to identify all fee-for-service Medicare beneficiaries with PAD using International Classification of Diseases codes. Our primary exposure was whether a state had adopted the ME on January 1, 2014. Our primary outcomes were the change in all-cause 1-year mortality and leg amputation. We used a state-level difference-in-differences (DID) analysis to compare the rates of the primary outcomes among patients who were in states (including the District of Columbia) who adopted ME (n = 25) versus those who were in states that did not (n = 26). We performed a subanalysis stratifying by sex, race, region, and dual-eligibility status. Results: Over the 8-year period, we studied 37,743,929 patients. The average unadjusted 1-year mortality decreased from 2011 to 2018 in both non-ME (9.5% to 8.7%, p < 0.001) and ME (9.1% to 8.3%, p < 0.001) states. The average unadjusted 1-year amputation rate did not improve in either the non-ME (0.86% to 0.87%, p = 0.17) or ME (0.69% to 0.69%, p = 0.65) states. Across the entire cohort, the DID model revealed that ME did not lead to a significant change in mortality (p = 0.15) or amputation (p = 0.34). Conclusion: Medicaid Expansion was not associated with reduced mortality or leg amputation in Medicare beneficiaries with PAD.
Collapse
Affiliation(s)
- Stanislav Henkin
- Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Stephen A Kearing
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Nikolaos Zacharias
- Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Mark A Creager
- Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Michael N Young
- Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Philip P Goodney
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jesse A Columbo
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
2
|
Sumner JA, Kim ESH, Wood MJ, Chi G, Nolen J, Grodzinsky A, Gornik HL, Kadian-Dodov D, Wells BJ, Hess CN, Lewey J, Tam L, Henkin S, Orford J, Wells G, Kumbhani DJ, Lindley KJ, Gibson CM, Leon KK, Naderi S. Posttraumatic Stress Disorder After Spontaneous Coronary Artery Dissection: A Report of the International Spontaneous Coronary Artery Dissection Registry. J Am Heart Assoc 2024; 13:e032819. [PMID: 38533943 DOI: 10.1161/jaha.123.032819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Myocardial infarction secondary to spontaneous coronary artery dissection (SCAD) can be traumatic and potentially trigger posttraumatic stress disorder (PTSD). In a large, multicenter, registry-based cohort, we documented prevalence of lifetime and past-month SCAD-induced PTSD, as well as related treatment seeking, and examined a range of health-relevant correlates of SCAD-induced PTSD. METHODS AND RESULTS Patients with SCAD were enrolled in the iSCAD (International SCAD) Registry. At baseline, site investigators completed medical report forms, and patients reported demographics, medical/SCAD history, psychosocial factors (including SCAD-induced PTSD symptoms), health behaviors, and health status via online questionnaires. Of 1156 registry patients, 859 patients (93.9% women; mean age, 52.3 years) completed questionnaires querying SCAD-induced PTSD. Nearly 35% (n=298) of patients met diagnostic criteria for probable SCAD-induced PTSD in their lifetime, and 6.4% (n=55) met criteria for probable past-month PTSD. Of 811 patients ever reporting any SCAD-induced PTSD symptoms, 34.8% indicated seeking treatment for this distress. However, 46.0% of the 298 patients with lifetime probable SCAD-induced PTSD diagnoses reported never receiving trauma-related treatment. Younger age at first SCAD, fewer years since SCAD, being single, unemployed status, more lifetime trauma, and history of anxiety were associated with greater past-month PTSD symptom severity in multivariable regression models. Greater past-month SCAD-induced PTSD symptoms were associated with greater past-week sleep disturbance and worse past-month disease-specific health status when adjusting for various risk factors. CONCLUSIONS Given the high prevalence of SCAD-induced PTSD symptoms, efforts to support screening for these symptoms and connecting patients experiencing distress with empirically supported treatments are critical next steps. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04496687.
Collapse
Affiliation(s)
- Jennifer A Sumner
- Department of Psychology University of California, Los Angeles Los Angeles CA USA
| | - Esther S H Kim
- Division of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA
| | - Malissa J Wood
- Division of Cardiology Massachusetts General Hospital and Harvard Medical School Boston MA USA
| | - Gerald Chi
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | | | - Anna Grodzinsky
- Saint Luke's Mid America Heart Institute, Muriel I. Kauffman Women's Heart Center University of Missouri-Kansas City Kansas City MO USA
| | - Heather L Gornik
- Harrington Heart & Vascular Institute, University Hospitals, Division of Cardiovascular Medicine Case Western Reserve University Cleveland OH USA
| | - Daniella Kadian-Dodov
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health Icahn School of Medicine at Mount Sinai New York NY USA
| | - Bryan J Wells
- Division of Cardiology, Department of Medicine Emory University School of Medicine Atlanta GA USA
| | - Connie N Hess
- Division of Cardiology, Department of Medicine University of Colorado School of Medicine Aurora CO USA
| | - Jennifer Lewey
- Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA USA
| | - Lori Tam
- Providence Heart Institute Portland OR USA
| | - Stanislav Henkin
- Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH USA
| | - James Orford
- Intermountain Heart Institute, Intermountain Medical Center Murray UT USA
| | - Gretchen Wells
- Division of Cardiovascular Medicine, Department of Medicine University of Kentucky Lexington KY USA
| | - Dharam J Kumbhani
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX USA
| | - Kathryn J Lindley
- Division of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA
| | - C Michael Gibson
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | | | - Sahar Naderi
- Division of Cardiology Kaiser Permanente San Francisco CA USA
| |
Collapse
|
3
|
McBane RD, Loprinzi CL, Zemla T, Tafur A, Sanfilippo K, Liu JJ, Garcia DA, Heun J, Gundabolu K, Onitilo AA, Perepu U, Drescher MR, Henkin S, Houghton D, Ashrani A, Billett H, McCue SA, Lee MK, Le-Rademacher JG, Wysokinski WE. Extending venous thromboembolism secondary prevention with apixaban in cancer patients. The EVE trial. J Thromb Haemost 2024:S1538-7836(24)00169-7. [PMID: 38537780 DOI: 10.1016/j.jtha.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/05/2024] [Accepted: 03/09/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Cancer-associated venous thromboembolism (VTE) management guideline recommendations include continued therapeutic anticoagulation while active cancer persists. The Federal Drug Administration label for apixaban for secondary VTE prevention includes a dose reduction to 2.5 mg twice daily after 6 months of treatment. OBJECTIVES The study's purpose was to determine whether this dose reduction is advisable for cancer-associated VTE. METHODS A randomized, double-blind trial compared apixaban 2.5 mg with 5 mg twice daily for 12 months among cancer patients with VTE who had completed 6 to 12 months of anticoagulation therapy. The primary outcome was combined major bleeding plus clinically relevant nonmajor bleeding. RESULTS Of 370 patients recruited, 360 were included in the intention-to-treat analyses. Major plus clinically relevant nonmajor bleeding occurred in 16 of 179 patients (8.9%) in the apixaban 2.5 mg group compared with 22 of 181 patients (12.2%) in the 5 mg group (hazard ratio [HR], 0.72; 95% CI, 0.38-1.37; P = .39). Major bleeding occurred in 2.8% of the apixaban 2.5 mg group and in 2.2% of the 5 mg group (HR, 1.26; 95% CI, 0.34-4.66; P = .73). Recurrent VTE or arterial thrombosis occurred in 9 of 179 patients (5.0%) in the apixaban 2.5 mg group and 9 of 181 patients (5.0%) in the 5 mg group (HR, 1.0; 95% CI, 0.40-2.53; P = 1.00). All-cause mortality rates were similar between groups, 13% vs 12% (HR, 1.14; 95% CI, 0.63-2.04; P = .67). CONCLUSION For secondary prevention of cancer-associated VTE, apixaban 2.5 mg compared with 5 mg twice daily did not lower combined bleeding events (EVE trial NCT03080883).
Collapse
Affiliation(s)
- Robert D McBane
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA.
| | | | - Tyler Zemla
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Alfonso Tafur
- Cardiovascular Division, North Shore University Health System, Evanston, Illinois, USA
| | - Kristen Sanfilippo
- Hematology and Medical Oncology, Siteman Cancer Center, Washington University, St. Louis, Missouri, USA
| | - Jane Jijun Liu
- Hematology and Medical Oncology, Illinois Cancer Care, Peoria, Illinois, USA
| | - David A Garcia
- Hematology Division, University of Washington, Seattle, Washington, USA
| | - James Heun
- Dean Hematology and Medical Oncology Group, Madison, Wisconsin, USA
| | - Krishna Gundabolu
- Hematology and Medical Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Adedayo A Onitilo
- Hematology and Medical Oncology, Cancer Care & Research Center, Marshfield Clinic, Marshfield, Wisconsin, USA
| | - Usha Perepu
- Hematology and Medical Oncology, University of Iowa/Holden Comprehensive Cancer Center, Iowa City, Iowa, USA
| | - Monic R Drescher
- Cardiovascular Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Stanislav Henkin
- Cardiovascular Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Damon Houghton
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Aneel Ashrani
- Hematology Division, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Shaylene A McCue
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Minji K Lee
- Clinical Trials and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Waldemar E Wysokinski
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Zuin M, Piazza G, Rigatelli G, Bilato C, Bongarzoni A, Henkin S, Zonzin P, Casazza F, Roncon L. Prognostic Role of Tricuspid Annular Plane Systolic Excursion to Systolic Pulmonary Artery Pressure Ratio for the Identification of Early Clinical Deterioration in Intermediate-High-Risk Pulmonary Embolism Patients. Am J Cardiol 2024; 214:40-46. [PMID: 38218392 DOI: 10.1016/j.amjcard.2023.12.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/22/2023] [Indexed: 01/15/2024]
Abstract
The ratio of tricuspid annular plane systolic excursion (TAPSE) to echocardiographically measured systolic pulmonary artery pressure (PASP) has been proposed as a surrogate of RV-arterial coupling. In this analysis, we assess the prognostic role of TAPSE/PASP for early clinical deterioration and short-term mortality in an often clinically challenging population of intermediate-high-risk patients with pulmonary embolism (PE). A post hoc analysis of intermediate-high-risk patients with PE enrolled in the Italian Pulmonary Embolism Registry (ClinicalTrials.gov: NCT01604538) was performed. All patients underwent transthoracic echocardiography at admission. The primary and secondary outcomes were clinical deterioration within 48 hours from admission and 30-day all-cause mortality, respectively. In 422 intermediate-high-risk patients with PE (mean age 71.2 ± 5.3 years, 238 men), 37 (8.7%) experienced clinical deterioration within 48 hours of admission. The 30-day mortality rate was 6.6% (n = 28). The receiver operating characteristic analysis established 0.33 as the optimal cut-off value for the TAPSE/PASP in predicting 48-hour clinical deterioration (area under the curve 0.79 ± 0.1). The sensitivity, specificity, positive predictive value, and negative predictive value were 81%, 88.5%, 40.5%, and 97.9%, respectively. The multivariate Cox regression analysis showed that a TAPSE/PASP ≤0.33 was an independent predictor of 48-hour clinical deterioration (hazard ratio 2.06, 95% confidence interval 1.98 to 2.11, p <0.0001) and 30-day mortality (hazard ratio 2.28, 95% confidence interval 2.25 to 2.33, p <0.001). TAPSE/PASP shows promise as a noninvasive prognostic predictor to identify intermediate-high-risk patients with PE at a higher risk of early clinical deterioration and short-term mortality.
Collapse
Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
| | - Gregory Piazza
- Cardiovascular Medicine Division and Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Amedeo Bongarzoni
- Department of Cardiology, ASST Santi Paolo e Carlo, University of Milan, Milano, Italy
| | | | - Pietro Zonzin
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Franco Casazza
- Department of Cardiology, San Carlo Borromeo Hospital, Milano, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy; Cardiology Clinic, Casa di Cura Città di Rovigo, Rovigo, Italy
| |
Collapse
|
5
|
Brunton N, McBane R, Casanegra AI, Houghton DE, Balanescu DV, Ahmad S, Caples S, Motiei A, Henkin S. Risk Stratification and Management of Intermediate-Risk Acute Pulmonary Embolism. J Clin Med 2024; 13:257. [PMID: 38202264 PMCID: PMC10779572 DOI: 10.3390/jcm13010257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Pulmonary embolism (PE) is the third most common cause of cardiovascular death and necessitates prompt, accurate risk assessment at initial diagnosis to guide treatment and reduce associated mortality. Intermediate-risk PE, defined as the presence of right ventricular (RV) dysfunction in the absence of hemodynamic compromise, carries a significant risk for adverse clinical outcomes and represents a unique diagnostic challenge. While small clinical trials have evaluated advanced treatment strategies beyond standard anticoagulation, such as thrombolytic or endovascular therapy, there remains continued debate on the optimal care for this patient population. Here, we review the most recent risk stratification models, highlighting differences between prediction scores and their limitations, and discuss the utility of serologic biomarkers and imaging modalities to detect right ventricular dysfunction. Additionally, we examine current treatment recommendations including anticoagulation strategies, use of thrombolytics at full and reduced doses, and utilization of invasive treatment options. Current knowledge gaps and ongoing studies are highlighted.
Collapse
Affiliation(s)
- Nichole Brunton
- Gonda Vascular Center, Mayo Clinic, Rochester, MN 55901, USA; (N.B.)
| | - Robert McBane
- Gonda Vascular Center, Mayo Clinic, Rochester, MN 55901, USA; (N.B.)
| | - Ana I. Casanegra
- Gonda Vascular Center, Mayo Clinic, Rochester, MN 55901, USA; (N.B.)
| | - Damon E. Houghton
- Gonda Vascular Center, Mayo Clinic, Rochester, MN 55901, USA; (N.B.)
| | - Dinu V. Balanescu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55901, USA
| | - Sumera Ahmad
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55901, USA
| | - Sean Caples
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55901, USA
| | - Arashk Motiei
- Gonda Vascular Center, Mayo Clinic, Rochester, MN 55901, USA; (N.B.)
| | - Stanislav Henkin
- Gonda Vascular Center, Mayo Clinic, Rochester, MN 55901, USA; (N.B.)
| |
Collapse
|
6
|
Lee C, Ramkumar N, Young MN, Goodney PP, Creager MA, Henkin S. Therapeutic anticoagulation after index peripheral endovascular intervention in patients with claudication. J Vasc Surg 2023; 78:1461-1470.e2. [PMID: 37579865 DOI: 10.1016/j.jvs.2023.08.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/31/2023] [Accepted: 08/06/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE Antiplatelet agents are commonly used after peripheral endovascular intervention (PVI). However, the effect of full-dose anticoagulation on outcomes after PVI is not well-established. We sought to investigate whether full-dose anticoagulation after PVI is associated with adverse events. METHODS We utilized the Vascular Quality Initiative to study patients undergoing index PVI for claudication (2010-2019), stratified by the presence or absence of an anticoagulant on discharge. The primary outcomes were 2-year patency, major adverse limb events (MALE), and mortality. We built a propensity score adjusting for comorbidities and employed inverse probability weighting to estimate the association of anticoagulation with outcomes. RESULTS We identified 26,240 patients; 9.1% were discharged on an anticoagulant. Patients receiving any anticoagulation had a significantly higher risk of mortality (adjusted hazard ratio [aHR], 1.61; 95% confidence interval [CI], 1.35-1.92), but not MALE, or patency loss. Patients receiving a vitamin K antagonist had a significantly higher risk of patency loss (aHR, 1.32; 95% CI, 1.09-1.60), MALE (aHR, 1.33; 95% CI, 1.13-1.57), and mortality (aHR, 1.46; 95% CI, 1.27-1.69). Patients on an oral Factor Xa inhibitors had a significantly lower risk of patency loss (aHR, 0.61; 95% CI, 0.41-0.93) but increased mortality (aHR, 1.51; 95% CI, 1.19-1.92). CONCLUSIONS Therapeutic anticoagulation after PVI is associated with higher risk of all-cause mortality. Although oral Factor Xa inhibitors are associated with decreased risk of patency loss, vitamin K antagonists are associated with higher risk of patency loss, MALE, and death. Further prospective studies are necessary to study the safety and efficacy of full-dose anticoagulation after PVI.
Collapse
Affiliation(s)
- Christopher Lee
- Heart and Vascular Center, Dartmouth Hitchcock Medical Center, and the Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Niveditta Ramkumar
- Heart and Vascular Center, Dartmouth Hitchcock Medical Center, and the Geisel School of Medicine at Dartmouth, Lebanon, NH; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Michael N Young
- Heart and Vascular Center, Dartmouth Hitchcock Medical Center, and the Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Philip P Goodney
- Heart and Vascular Center, Dartmouth Hitchcock Medical Center, and the Geisel School of Medicine at Dartmouth, Lebanon, NH; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Mark A Creager
- Heart and Vascular Center, Dartmouth Hitchcock Medical Center, and the Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth Hitchcock Medical Center, and the Geisel School of Medicine at Dartmouth, Lebanon, NH.
| |
Collapse
|
7
|
Lee C, Dow S, Shah K, Henkin S, Taub C. Complications of exercise and pharmacologic stress echocardiography. Front Cardiovasc Med 2023; 10:1228613. [PMID: 37600036 PMCID: PMC10435903 DOI: 10.3389/fcvm.2023.1228613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Stress echocardiography is a diagnostic cardiovascular exam that is commonly utilized for multiple indications, including but not limited to the assessment of obstructive coronary artery disease, valvular disease, obstructive hypertrophic cardiomyopathy, and diastolic function. Stress echocardiography can be performed via both exercise and pharmacologic modalities. Exercise stress is performed with either treadmill or bicycle-based exercise. Pharmacologic stress is performed via either dobutamine or vasodilator-mediated (i.e., dipyridamole, adenosine) stress testing. Each of these modalities is associated with a low overall prevalence of major, life-threatening adverse outcomes, though adverse events are most common with dobutamine stress echocardiography. In light of the recent COVID-19 pandemic, the risk of infectious complications to both the patient and stress personnel cannot be negated; however, when certain precautions are taken, the risk of infectious complications appears minimal. In this article, we review each of the stress echocardiographic modalities, examine major potential adverse outcomes and contraindications, assess the risks of stress testing in the setting of a global pandemic, and examine the utilization and safety of stress testing in special patient populations (i.e., language barriers, pediatric patients, pregnancy).
Collapse
Affiliation(s)
| | | | | | | | - Cynthia Taub
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Dartmouth College, Lebanon, NH, United States
| |
Collapse
|
8
|
Kadian-Dodov D, Keefe JG, Henkin S, Ratchford EV. SVM Communications: Membership spotlight and highlights from the Fellows and Advanced Practice Provider course. Vasc Med 2023; 28:377-382. [PMID: 37387554 DOI: 10.1177/1358863x231182744] [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] [Indexed: 07/01/2023]
Affiliation(s)
| | - Joel G Keefe
- University of South Carolina School of Medicine, Columbia, SC, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Elizabeth V Ratchford
- Johns Hopkins Center for Vascular Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
9
|
Lee C, Dow S, Henkin S, Morley BD, Rassias AJ, Taub C, Costa SP. A Sticky Situation: The Unfortunate Consequence of Chewing Gum. CASE (Phila) 2023; 7:212-214. [PMID: 37396473 PMCID: PMC10307584 DOI: 10.1016/j.case.2023.02.005] [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] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Foreign substances can interfere with the TEE probe, causing poor image quality. Operators should be aware of the reasons for diffusely anechoic TEE images. Poor identification of echocardiographic artifacts may lead to adverse outcomes.
Collapse
Affiliation(s)
- Christopher Lee
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Sam Dow
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Benjamin D. Morley
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Athos J. Rassias
- Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Cynthia Taub
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| | - Salvatore P. Costa
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, New Hampshire, Lebanon
| |
Collapse
|
10
|
Ramkumar N, Goodney PP, Creager MA, Henkin S. Association of Anticoagulation and Major Adverse Limb Events After Index Peripheral Endovascular Intervention. Am J Cardiol 2023; 192:124-131. [PMID: 36787683 DOI: 10.1016/j.amjcard.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/13/2023] [Accepted: 01/14/2023] [Indexed: 02/13/2023]
Abstract
Dual-antiplatelet therapy is commonly prescribed after endovascular intervention for peripheral artery disease. However, it is not known whether therapeutic anticoagulation affects outcomes after peripheral endovascular intervention. We sought to investigate whether therapeutic anticoagulation after peripheral endovascular intervention is associated with lower risk of major adverse limb events (MALEs) and all-cause mortality. We studied patients who underwent index endovascular intervention for peripheral artery disease in the Vascular Study Group of New England (2010 to 2018). The main exposure was anticoagulation at the time of discharge. Outcomes included patency loss (occlusion or target lesion reintervention), MALE (any major amputation or reintervention), and all-cause mortality. We compared outcomes between patients who received anticoagulation on discharge versus those who did not receive anticoagulation using Kaplan-Meier survival analysis and Cox regression. In the cohort of 6,809 patients, 15% were discharged on an anticoagulant (mostly warfarin). These patients had a higher prevalence of acute or chronic limb ischemia than those not receiving an anticoagulant (74% vs 47%, p < 0.001) and were less likely to receive any antiplatelet agent after peripheral endovascular intervention (5% vs 14%, p < 0.001). After risk adjustment, compared with patients not on an anticoagulant, patients receiving therapeutic anticoagulation had a higher risk of 2-year patency loss (hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.05 to 1.89), MALE (HR 1.39, 95% CI 1.09 to 1.76), and all-cause mortality (HR 1.24, 95% CI 1.05 to 1.47). In conclusion, anticoagulation after peripheral endovascular intervention was associated with higher risk of adverse events, including patency loss, MALE, and all-cause mortality.
Collapse
Affiliation(s)
- Niveditta Ramkumar
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, and the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Philip P Goodney
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire; Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, and the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Mark A Creager
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, and the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, and the Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| |
Collapse
|
11
|
Henkin S, Gornik HL, Kim ES. Improving the care of patients with spontaneous coronary artery dissection (SCAD): Are we doing enough? Vasc Med 2023; 28:139-140. [PMID: 37025020 DOI: 10.1177/1358863x231165553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Heather L Gornik
- Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Esther Sh Kim
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC, USA
| |
Collapse
|
12
|
Shi H, Ganesh R, Moudgal R, Gongal P, Henkin S. RESCUE CARDIAC RESYNCHRONIZATION THERAPY AND AV NODE ABLATION FOR END STAGE DILATED CARDIOMYOPATHY AND INCESSANT ATRIAL ARRHYTHMIA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03976-1] [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: 03/06/2023]
|
13
|
Verma R, Lee C, Young MN, Henkin S. FACTOR V LEIDEN MUTATION: A RARE CAUSE OF ARTERIAL THROMBOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03192-3] [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: 03/06/2023]
|
14
|
Dow S, Lee C, Amin A, Opsahl A, Henkin S. SINGLE CORONARY ARTERY - AN UNEXPECTED FINDING. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
|
15
|
Brunton N, Tomihama R, Henkin S. SVM Communications: Increasing awareness of vascular medicine as a specialty. Vasc Med 2023; 28:97-98. [PMID: 36759933 DOI: 10.1177/1358863x221146588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
| | - Roger Tomihama
- Interventional Radiology, Loma Linda University Health, Loma Linda, CA, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
16
|
Whipple MO, Henkin S, Chaudhury P, Clark V, Gornik HL. Strengthening the VMJ pipeline: Initial experience of the Next Generation Editorial Board. Vasc Med 2023; 28:3-5. [PMID: 36759935 DOI: 10.1177/1358863x231152026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- Mary O Whipple
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Pulkit Chaudhury
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Valerie Clark
- Vascular Medicine Editorial Office, Cleveland, OH, USA
| | - Heather L Gornik
- University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
17
|
Pathangey G, Moudgal R, Lee C, Henkin S. Myocardial stunning secondary to erroneous administration of intravenous epinephrine. SAGE Open Med Case Rep 2023; 11:2050313X231159732. [PMID: 36950049 PMCID: PMC10026126 DOI: 10.1177/2050313x231159732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023] Open
Abstract
Epinephrine is a commonly used medication for emergent conditions, such as anaphylaxis, respiratory distress, and shock. However, its versatility can also lead to iatrogenic errors in dosages, concentrations, and routes of administration. In this case, a 47-year-old female experiencing anaphylaxis received an intravenous dose of 0.3 mg (1:1000) epinephrine formulated for intramuscular injection, resulting in cardiac arrest and acute heart failure due to myocardial stunning, as diagnosed by echocardiography. Management included invasive ventilation and hemodynamic support until cardiac function recovered. This case highlights the potential dangers of epinephrine overdose, and to our knowledge, is the first reported case of iatrogenic epinephrine-induced Takotsubo cardiomyopathy in a rural area. In addition, we review the literature on iatrogenic epinephrine toxicity-associated cardiomyopathy and the epidemiology of epinephrine errors. Safety measures must be considered for improving communication in emergencies, increasing awareness via training, and changing epinephrine's antiquated packaging design.
Collapse
Affiliation(s)
- Girish Pathangey
- Department of Medicine,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Rohitha Moudgal
- Department of Medicine,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Christopher Lee
- Heart and Vascular Center,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Stanislav Henkin
- Heart and Vascular Center,
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Stanislav Henkin, Heart and Vascular
Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Dr., Lebanon, NH
03766, USA.
| |
Collapse
|
18
|
Abstract
Patients undergoing major vascular surgery have an increased risk of perioperative major adverse cardiovascular events (MACE). Accordingly, in this population, it is of particular importance to appropriately risk stratify patients' risk for these complications and optimize risk factors prior to surgical intervention. Comorbidities that portend a higher risk of perioperative MACE include coronary artery disease, heart failure, left-sided valvular heart disease, and significant arrhythmic burden. In this review, we provide a current approach to risk stratification prior to major vascular surgery and describe the strengths and weaknesses of different cardiac risk indices; discuss the role of noninvasive and invasive cardiac testing; and review perioperative pharmacotherapies.
Collapse
Affiliation(s)
| | | | | | | | - Stanislav Henkin
- Stanislav Henkin, Heart and Vascular
Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at
Dartmouth, Lebanon, NH 03756, USA.
Twitter: @stanhenkin
| |
Collapse
|
19
|
Ponukumati AS, Columbo JA, Suckow BD, Stableford JA, Henkin S, Beach JM, Goodney PP, Stone DH. The financial implications of cardiac stress testing prior to abdominal aortic aneurysm repair. Vasc Med 2022; 27:469-475. [PMID: 36036487 DOI: 10.1177/1358863x221112180] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The utilization and cost-effectiveness of stress testing before abdominal aortic aneurysm (AAA) repair remains insufficiently studied. We examined the variation and financial implications of stress testing, and their association with major adverse cardiovascular events (MACE). METHODS We studied patients who underwent elective endovascular (EVAR) or open AAA repair (OAR) at Vascular Quality Initiative centers from 2015 to 2019. We grouped centers into quintiles of preoperative stress testing frequency. We calculated the risk of postoperative MACE, a composite of in-hospital myocardial infarction, heart failure, or death, for each center-quintile. We obtained charges for stress tests locally and applied these to the cohort to estimate charges per 1000 patients. RESULTS We studied 32,459 patients (EVAR: 27,978; OAR: 4481; 283 centers). Stress test utilization varied across quintiles from 13.0% to 68.6% (median: 36.8%) before EVAR and 15.9% to 85.0% (median: 59.4%) before OAR. The risk of MACE was 1.4% after EVAR and 10.2% after OAR. There was a trend towards more common MACE after EVAR among centers with higher utilization of stress testing: 0.9% among centers in the lowest quintile, versus 1.7% in the highest quintile (p-trend = 0.068). There was no association between MACE and stress testing frequency for OAR (p-trend = 0.223). The estimated financial charges for stress testing before EVAR ranged from $125,806 per 1000 patients at 1st-quintile centers, to $665,975 at 5th-quintile centers. Charges before OAR ranged from $153,861 at 1st-quintile centers, to $825,473 at 5th-quintile centers. CONCLUSION Stress test use before AAA repair is highly variable and associated with substantial cost, with an unclear association with postoperative MACE. This highlights the need for improved stress testing paradigms prior to surgery.
Collapse
Affiliation(s)
- Aravind S Ponukumati
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jesse A Columbo
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - Bjoern D Suckow
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - Jennifer A Stableford
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - Stanislav Henkin
- Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA.,Section of Cardiovascular Medicine, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jocelyn M Beach
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - Philip P Goodney
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| | - David H Stone
- Section of Vascular Surgery, Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, NH, USA
| |
Collapse
|
20
|
Henkin S, McBane RD. SVM Communications: Membership Spotlight. Vasc Med 2022; 27:418-420. [PMID: 36522856 DOI: 10.1177/1358863x221112726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
21
|
Hess CN, Szarek M, Anand SS, Bauersachs RM, Patel MR, Debus ES, Nehler MR, Capell WH, Beckman JA, Piazza G, Henkin S, Bura-Rivière A, Lawall H, Roztocil K, Hsia J, Muehlhofer E, Berkowitz SD, Haskell LP, Bonaca MP. Rivaroxaban and Risk of Venous Thromboembolism in Patients With Symptomatic Peripheral Artery Disease After Lower Extremity Revascularization. JAMA Netw Open 2022; 5:e2215580. [PMID: 35731517 PMCID: PMC9218845 DOI: 10.1001/jamanetworkopen.2022.15580] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Prior studies have observed an association between the burden of atherosclerotic vascular disease and the risk of venous thromboembolism (VTE). The association is not well described in peripheral artery disease (PAD) after lower extremity revascularization (LER). OBJECTIVE To describe the risk of, factors associated with, and outcomes after VTE, as well as the association of low-dose rivaroxaban plus antiplatelet therapy with VTE after LER. DESIGN, SETTING, AND PARTICIPANTS This global, multicenter cohort study used data from the Vascular Outcomes Study of ASA (acetylsalicylic acid) Along With Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD (VOYAGER PAD) randomized clinical trial, which enrolled patients from 2015 to 2018 with median follow-up of 28 months. Participants included patients with PAD undergoing LER. Patients with an indication for therapeutic anticoagulation were excluded. Data were analyzed from September 2020 to September 2021. EXPOSURE Randomization to rivaroxaban 2.5 mg twice daily or placebo on a background of aspirin 100 mg daily; short-term clopidogrel was used at the discretion of the treating physician. MAIN OUTCOMES AND MEASURES Symptomatic VTE was a prespecified secondary outcome and prospectively collected. RESULTS Among 6564 patients (median [IQR] age, 67 [61-73] years; 4860 [74.0%] men), 66 patients had at least 1 VTE. The 3-year rate of VTE in patients receiving placebo was 1.7%, and the pattern of risk was linear (year 1: 0.5%; year 2: 1.1%). After multivariable modeling, weight (hazard ratio [HR], 3.04; 95% CI, 1.09-8.43), hypertension (HR, 2.11; 95% CI, 0.91-4.89), prior amputation (HR, 2.07; 95% CI, 0.95-4.53), and older age (HR, 1.81; 95% CI, 1.06-3.11) were associated with increased risk of VTE. VTE was associated with risk of subsequent mortality (HR, 7.22; 95% CI, 4.66-11.19). Compared with aspirin alone, rivaroxaban plus aspirin was associated with lower VTE risk (HR, 0.61; 95% CI, 0.37-0.998; P = .047), with benefit apparent early and sustained over time. This association was not modified by use of clopidogrel at randomization (without clopidogrel: HR, 0.55; 95% CI, 0.29-1.07; with clopidogrel: HR, 0.69; 95% CI, 0.32-1.48; P for interaction = .67). CONCLUSIONS AND RELEVANCE In this cohort study, there was continuous risk for VTE after LER in patients with PAD, with greater risk in patients who were older and had obesity and those with more severe PAD, as reflected by prior amputation. Low-dose rivaroxaban plus aspirin was associated with lower VTE risk compared with aspirin alone, with benefits apparent early and continued over time. The spectrum of venous and arterial thrombotic events and overall benefits of more potent antithrombotic strategies for prevention should be considered after LER for PAD.
Collapse
Affiliation(s)
- Connie N. Hess
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
- CPC Clinical Research, Aurora, Colorado
| | - Michael Szarek
- CPC Clinical Research, Aurora, Colorado
- The State University of New York Downstate Health Sciences University, Brooklyn
| | - Sonia S. Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada
| | - Rupert M. Bauersachs
- Department of Vascular Medicine, Klinikum Darmstadt, Darmstadt, and Center for Thrombosis and Hemostasis, University of Mainz, Mainz, Germany
| | - Manesh R. Patel
- Duke Clinical Research Institute, Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - E. Sebastian Debus
- Department of Vascular Medicine, Vascular Surgery–Angiology–Endovascular Therapy, University of Hamburg-Eppendorf, Hamburg, Germany
| | - Mark R. Nehler
- CPC Clinical Research, Aurora, Colorado
- University of Colorado School of Medicine, Department of Surgery, Aurora
| | - Warren H. Capell
- CPC Clinical Research, Aurora, Colorado
- Division of Endocrinology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Joshua A. Beckman
- Cardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gregory Piazza
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Holger Lawall
- Praxis für Herzkreislaufkrankheiten und Akademie für Gefäßkrankheiten, Ettlingen, Germany
| | - Karel Roztocil
- Department of Transplantational Surgery, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Judith Hsia
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
- CPC Clinical Research, Aurora, Colorado
| | | | - Scott D. Berkowitz
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
- CPC Clinical Research, Aurora, Colorado
- Division of Hematology, Department of Medicine, University of Colorado School of Medicine, Aurora
| | | | - Marc P. Bonaca
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
- CPC Clinical Research, Aurora, Colorado
| |
Collapse
|
22
|
Grodzinsky A, Kim ES, Gornik HL, Wells BJ, Taylor AM, Lewey J, Hess CN, Henkin S, Kadian-Dodov D, Wells GL, Tam L, Vitarello C, Alkhalfan F, Chi G, Gibson M, Leon K, Naderi S, Wood M. REPRODUCTIVE HEALTH FEATURES ASSOCIATED WITH SPONTANEOUS CORONARY ARTERY DISSECTION: A REPORT OF THE ISCAD REGISTRY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
23
|
Wells BJ, Wood MJ, Grodzinsky A, Gornik HL, Kadian-Dodov D, Taylor AM, Hess CN, Lewey J, Henkin S, Wells GL, Tam L, Vitarello C, Alkhalfan F, Chi G, Gibson CM, Leon K, Naderi S, Kim SH. MIGRAINE HEADACHE IN PATIENTS WITH SPONTANEOUS CORONARY ARTERY DISSECTION: A REPORT OF THE ISCAD REGISTRY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02796-6] [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: 10/18/2022]
|
24
|
Kim SH, Naderi S, Grodzinsky A, Gornik HL, Wells BJ, Taylor A, Lewey J, Hess CN, Henkin S, Kadian-Dodov D, Wells GL, Tam L, Vitarello C, Alkhalfan F, Chi G, Gibson CM, Leon K, Wood MJ. PREVALENCE OF POTENTIAL TRIGGERS AND UNDERLYING MEDICAL CONDITIONS IN SPONTANEOUS CORONARY ARTERY DISSECTION: A REPORT OF THE ISCAD REGISTRY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01961-1] [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: 11/26/2022]
|
25
|
Altujjar M, Mhanna M, Bhuta S, Patel N, Miedema MD, Manunga J, Hennessey K, Henkin S, Andrus BW, Taub CC, Creager MA, Harris KM. THE WEEKEND EFFECT ON OUTCOMES IN PATIENTS PRESENTING WITH ACUTE AORTIC DISSECTION: A NATIONWIDE ANALYSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02733-4] [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: 11/17/2022]
|
26
|
Henkin S, Pritchard A, Sharma S, Young MN. SUBCLINICAL ATHEROSCLEROSIS AND PERI-OPERATIVE CARDIAC EVENTS IN PATIENTS UNDERGOING PERIPHERAL BYPASS SURGERY. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02761-9] [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]
|
27
|
Altujjar M, Khokher W, Sajdeya O, Hennessey KC, Henkin S, Andrus BW, Taub CC. WEEKEND EFFECT ON PATIENTS PRESENTING WITH CARDIAC ARREST: A NATIONWIDE ANALYSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)02031-9] [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]
|
28
|
Serhal M, Josephson R, Shishehbor M, Frechette K, Henkin S. SVM Communications: Supervised exercise therapy for symptomatic peripheral artery disease - A conversation with the experts. Vasc Med 2022; 27:214-216. [PMID: 35168411 DOI: 10.1177/1358863x221078886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Maya Serhal
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, MA, USA
| | - Richard Josephson
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Mehdi Shishehbor
- Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kristen Frechette
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
29
|
Ilyas S, Henkin S, Martinez-Camblor P, Suckow BD, Beach JM, Stone DH, Goodney PP, Ebinger JE, Creager MA, Columbo JA. Sex-, Race- and Ethnicity-Based Differences in Thromboembolic Events Among Adults Hospitalized With COVID-19. J Am Heart Assoc 2021; 10:e022829. [PMID: 34845920 PMCID: PMC9075407 DOI: 10.1161/jaha.121.022829] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Patients hospitalized with COVID‐19 have an increased risk of thromboembolic events. Whether sex, race or ethnicity impacts these events is unknown. We studied the association between sex, race, and ethnicity and venous and arterial thromboembolic events among adults hospitalized with COVID‐19. Methods and Results We used the American Heart Association Cardiovascular Disease COVID‐19 registry. Primary exposures were sex and race and ethnicity, as defined by the registry. Primary outcomes were venous thromboembolic events and arterial thromboembolic events. We used logistic regression for risk adjustment. We studied 21 528 adults hospitalized with COVID‐19 across 107 centers (54.1% men; 38.1% non‐Hispanic White, 25.4% Hispanic, 25.7% non‐Hispanic Black, 0.5% Native American, 4.0% Asian, 0.4% Pacific Islander, and 5.9% other race and ethnicity). The rate of venous thromboembolic events was 3.7% and was more common in men (4.2%) than women (3.2%; P<0.001), and in non‐Hispanic Black patients (4.9%) than other races and ethnicities (range, 1.3%–3.8%; P<0.001). The rate of arterial thromboembolic events was 3.9% and was more common in men (4.3%) than women (3.5%; P=0.002), and in non‐Hispanic Black patients (5.0%) than other races and ethnicities (range, 2.3%–4.7%; P<0.001). Compared with men, women were less likely to experience venous thromboembolic events (adjusted odds ratio [OR], 0.71; 95% CI, 0.61–0.83) and arterial thromboembolic events (adjusted OR, 0.76; 95% CI, 0.66–0.89). Compared with non‐Hispanic White patients, non‐Hispanic Black patients had the highest likelihood of venous thromboembolic events (adjusted OR, 1.27; 95% CI, 1.04–1.54) and arterial thromboembolic events (adjusted OR, 1.35; 95% CI, 1.11–1.65). Conclusions Men and non‐Hispanic Black adults hospitalized with COVID‐19 are more likely to have venous and arterial thromboembolic events. These subgroups may represent at‐risk patients more susceptible to thromboembolic COVID‐19 complications.
Collapse
Affiliation(s)
- Sadia Ilyas
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH
| | - Stanislav Henkin
- Section of Cardiovascular Medicine, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - Pablo Martinez-Camblor
- Department of Anesthesiology Dartmouth-Hitchcock Medical Center Lebanon NH.,Department of Biomedical Data Science Dartmouth College Hanover NH
| | - Bjoern D Suckow
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - Jocelyn M Beach
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - David H Stone
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - Philip P Goodney
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - Joseph E Ebinger
- Section of Cardiovascular Medicine Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles CA
| | - Mark A Creager
- Section of Cardiovascular Medicine, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| | - Jesse A Columbo
- Section of Vascular Surgery, Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH.,Geisel School of Medicine at Dartmouth Dartmouth College Hanover, NH
| |
Collapse
|
30
|
|
31
|
Henkin S, Creager MA. Management of Vascular Disorders in Cardiovascular Practice. Cardiol Clin 2021; 39:ix-x. [PMID: 34686270 DOI: 10.1016/j.ccl.2021.07.001] [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] [Indexed: 11/18/2022]
Affiliation(s)
- Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| | - Mark A Creager
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| |
Collapse
|
32
|
Sharma S, Henkin S, Young MN. Renovascular Disease and Mesenteric Vascular Disease. Cardiol Clin 2021; 39:527-537. [PMID: 34686265 DOI: 10.1016/j.ccl.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Renal artery stenosis is caused by atherosclerosis and fibromuscular dysplasia and is associated with ischemic nephropathy, renovascular hypertension, and accelerated cardiovascular disease. Routine screening for renal artery stenosis is not recommended but is reasonable in patients who have rapid onset of hypertension, resistant hypertension, progressive renal insufficiency, recurrent pulmonary edema, or repeat admissions for heart failure. Acute mesenteric ischemia is caused by arterial embolism or thrombosis, mesenteric venous thrombosis, or nonocclusive mesenteric ischemia, whereas chronic mesenteric ischemia is most often caused by arterial obstruction. This article reviews the epidemiology, pathophysiology, diagnosis, and management of these two conditions.
Collapse
Affiliation(s)
- Swapna Sharma
- The Elliot Hospital, 1 Elliot Way, Manchester, NH 03103, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Michael N Young
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| |
Collapse
|
33
|
Abstract
Thoracic aortic aneurysms are common. Most thoracic aortic aneurysms are degenerative. However, some are associated with connective tissue disorders, bicuspid aortic valves, or familial/genetic predisposition. Most are asymptomatic, discovered incidentally on imaging. Aortic diameter is the best predictor of the natural history and risk of complications. Treating hypertension and smoking cessation can slow their growth. Surveillance imaging and referral for prophylactic aortic repair based on absolute aneurysm diameter is the primary means to decrease mortality from thoracic aortic aneurysm. We provide a practical evidence-based summary of the pathophysiology, risk factors, associated genetic syndromes, and clinical management of thoracic aortic aneurysms.
Collapse
Affiliation(s)
- Ethan M Senser
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Shantum Misra
- Department of Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
| |
Collapse
|
34
|
Bandarage D, Stanko K, DeVries J, Henkin S, Young M. INITIAL ANTICOAGULATION STRATEGY IN PATIENTS UNDERGOING ULTRASOUND ASSISTED CATHETER-DIRECTED THROMBOLYSIS. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03145-4] [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]
|
35
|
Henkin S, McBane RD, Rooke TW, Wysokinski WE, Casanegra AI, Liedl DA, Wennberg PW. Major adverse events associated with inducible cardiac ischemia during treadmill exercise testing for peripheral artery disease. J Vasc Surg 2021; 74:1335-1342.e2. [PMID: 33887431 DOI: 10.1016/j.jvs.2021.03.041] [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] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/19/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The coexistence of coronary artery disease and peripheral artery disease (PAD) is well-established. Whether myocardial ischemia by electrocardiography during treadmill testing to evaluate PAD severity is associated with adverse cardiac and limb events has not been established. The aim of the current study is to assess the risk of major adverse cardiac events (MACE), major adverse limb events (MALE), and all-cause mortality in patients with evidence of myocardial ischemia on ECG compared with those without ischemia in patients undergoing treadmill testing for PAD evaluation. METHODS Patients undergoing treadmill exercise ankle-brachial index (ABI) evaluation (January 1, 2003, to December 31, 2006) were identified using the Mayo Clinic Gonda Vascular Laboratory database. Patients with ischemia by electrocardiogram (ECG) were age and sex matched to patients without ischemia. Outcomes were compared by ECG category. RESULTS Of 4128 patients who underwent treadmill exercise, 170 (4.1%) had inducible myocardial ischemia by ECG. These were matched with 340 patients without ischemia. The positive ECG group had a higher percentage of diabetes mellitus (31.2% vs 21.8%; P = .02), carotid artery disease (22.4% vs 13.2%; P = .009), exercise-induced angina (14.1% vs 2.9%; P < .0001), and dyspnea (60.6% vs 35.6%; P < .0001). While the resting ABI was similar, the postexercise ABI was lower in the positive ECG group (0.5 vs 0.7; P = .04). After a median follow-up of 8 years, MACE were significantly greater in the positive ECG group (62.4% vs 46.5%; P < .001). MALE were significantly less frequent (17.1% vs 23.2%; P = .02), without an increased risk of amputation. In multivariable analysis, inducible ischemia was associated with higher incidence of MACE (hazard ratio, 1.65; 95% confidence interval, 1.25-2.16; P < .001) and lower incidence of MALE (hazard ratio, 0.51; 95% confidence interval, 0.31-0.84; P < .05). CONCLUSIONS ECG monitoring during vascular treadmill testing identified a subset of patients with more frequent MACE but less MALE.
Collapse
Affiliation(s)
- Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Robert D McBane
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn.
| | - Thom W Rooke
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - Waldemar E Wysokinski
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - Ana I Casanegra
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - David A Liedl
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - Paul W Wennberg
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn
| |
Collapse
|
36
|
Columbo JA, Demsas F, Wanken ZJ, Suckow BD, Beach JM, Henkin S, Goodney PP, Stone DH. Stress testing before abdominal aortic aneurysm repair does not lead to a reduction in perioperative cardiac events. J Vasc Surg 2021; 74:694-700. [PMID: 33684471 DOI: 10.1016/j.jvs.2021.02.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/21/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Stress testing is often used before abdominal aortic aneurysm (AAA) repair. Whether stress testing leads to a reduction in cardiac events after AAA repair has remained unclear. Our objective was to study the national stress test usage rates and compare the perioperative outcomes between centers with high and low usage of stress testing. METHODS We used the Vascular Quality Initiative to study patients who had undergone elective endovascular AAA repair (EVAR) or open AAA repair (OAR). We measured the usage rates of stress testing across centers and compared the Vascular Study Group of New England cardiac risk index (VSG-CRI) among patients who had and had not undergone preoperative stress testing. We determined the rate of major adverse cardiac events (MACE), a composite of perioperative myocardial infarction, stroke, heart failure exacerbation, and death across the centers. We compared the MACE and 1-year mortality between the centers in the highest quintile of stress test usage and the lowest quintile. RESULTS We studied 43,396 EVAR patients and 8935 OAR patients across 324 centers. The median proportion of stress test usage across centers before EVAR was 35.9% and varied from 10.2% (5th percentile) to 73.7% (95th percentile), with similar variability for OAR (median, 57.9%; 5th percentile, 13.0%; 95th percentile, 86.0%). The mean VSG-CRI for the EVAR group with preoperative stress testing was 5.6 ± 2.1 compared with 5.4 ± 2.1 (P < .001) for the EVAR group without preoperative stress testing. The findings were similar for OAR, with a VSG-CRI of 5.1 ± 2.0 vs 4.8 ± 2.1 (P < .001) for those with and without preoperative stress testing, respectively. The rate of MACE was 1.8% after EVAR and 11.6% after OAR. The 1-year mortality was 4.6% for EVAR and 6.6% for OAR. The centers in the highest quintile of stress testing had a higher adjusted likelihood of MACE after both EVAR (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.37-2.30) and OAR (OR, 1.99; 95% CI, 1.53-2.59) but similar 1-year mortality (EVAR: OR, 1.18; 95% CI, 1.02-1.37; OAR: OR, 0.87; 95% CI, 0.65-1.17) compared with the centers in the lowest quintile. The VSG-CRI was not different between the high stress test centers (EVAR, 5.5 ± 2.1; OAR: 5.0 ± 2.0), and low stress test centers (EVAR, 5.5 ± 2.1; P = .403; OAR, 4.9 ± 2.0; P = .563). CONCLUSIONS Stress test usage before AAA repair varied widely across Vascular Quality Initiative centers despite similar patient risk profiles. No reduction was observed in MACE or 1-year mortality among centers with high stress test usage. The value of routine stress testing before AAA repair should be reconsidered, and stress testing should be used more selectively, given these findings and the associated costs of widespread testing.
Collapse
Affiliation(s)
- Jesse A Columbo
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH.
| | - Falen Demsas
- Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Zachary J Wanken
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Bjoern D Suckow
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Jocelyn M Beach
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Stanislav Henkin
- Geisel School of Medicine at Dartmouth, Hanover, NH; Section of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Philip P Goodney
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH
| | - David H Stone
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Geisel School of Medicine at Dartmouth, Hanover, NH
| |
Collapse
|
37
|
Abstract
Raynaud's phenomenon, which is characterized by episodic digital pallor, cyanosis and rubor upon exposure to cold environment or to stress, is relatively common, although the prevalence depends on the climate. Still, it is under-diagnosed, under-treated, and often confused with other conditions. Primary Raynaud's phenomenon (i.e., Raynaud disease) must be distinguished from secondary Raynaud's phenomenon (i.e., Raynaud syndrome) as long-term morbidity and outcomes differ vastly between the two conditions. Additionally, the practitioner must differentiate between Raynaud's phenomenon and related vascular disorders, such as acrocyanosis, pernio, and livedo reticularis. In this article, we review differences between the conditions and suggest an approach to diagnosis and treatment strategy for these disorders.
Collapse
Affiliation(s)
- Eunjung Choi
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
38
|
Henkin S, Rothstein ES, Young MN. Images in Vascular Medicine: Trapped thrombus underneath a recently placed inferior vena cava filter. Vasc Med 2020; 26:346-347. [PMID: 33175670 DOI: 10.1177/1358863x20967432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Eric S Rothstein
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Michael N Young
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| |
Collapse
|
39
|
Columbo JA, Wanken ZJ, Walsh DB, Suckow BD, Beach JM, Henkin S, Goodney PP, Stone DH. Stress Testing Before Abdominal Aortic Aneurysm Repair Does Not Prevent Postoperative Cardiac Events. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.06.033] [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: 11/25/2022]
|
40
|
Parmer C, De Sousa-Coelho AL, Cheng HS, Daher G, Burkart A, Dreyfuss JM, Pan H, Prenner JC, Keilson JM, Pande R, Henkin S, Feinberg MW, Patti ME, Creager MA. Skeletal muscle expression of adipose-specific phospholipase in peripheral artery disease. Vasc Med 2020; 25:401-410. [PMID: 32853041 DOI: 10.1177/1358863x20947467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Flow-limiting atherosclerotic lesions of arteries supplying the limbs are a cause of symptoms in patients with peripheral artery disease (PAD). Musculoskeletal metabolic factors also contribute to the pathophysiology of claudication, which is manifest as leg discomfort that impairs walking capacity. Accordingly, we conducted a case-control study to determine whether skeletal muscle metabolic gene expression is altered in PAD. Calf skeletal muscle gene expression of patients with PAD and healthy subjects was analyzed using microarrays. The top-ranking gene differentially expressed between PAD and controls (FDR < 0.001) was PLA2G16, which encodes adipose-specific phospholipase A2 (AdPLA) and is implicated in the maintenance of insulin sensitivity and regulation of lipid metabolism. Differential expression was confirmed by qRT-PCR; PLA2G16 was downregulated by 68% in patients with PAD (p < 0.001). Expression of Pla2g16 was then measured in control (db/+) and diabetic (db/db) mice that underwent unilateral femoral artery ligation. There was significantly reduced expression of Pla2g16 in the ischemic leg of both control and diabetic mice (by 51%), with significantly greater magnitude of reduction in the diabetic mice (by 79%). We conclude that AdPLA is downregulated in humans with PAD and in mice with hindlimb ischemia. Reduced AdPLA may contribute to impaired walking capacity in patients with PAD via its effects on skeletal muscle metabolism. Further studies are needed to fully characterize the role of AdPLA in PAD and to investigate its potential as a therapeutic target for alleviating symptoms of claudication.
Collapse
Affiliation(s)
- Caitlin Parmer
- Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | | | - Henry S Cheng
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Grace Daher
- Research Division, Joslin Diabetes Center, and Harvard Medical School, Boston, MA, USA
| | - Alison Burkart
- Research Division, Joslin Diabetes Center, and Harvard Medical School, Boston, MA, USA
| | - Jonathan M Dreyfuss
- Research Division, Joslin Diabetes Center, and Harvard Medical School, Boston, MA, USA
| | - Hui Pan
- Research Division, Joslin Diabetes Center, and Harvard Medical School, Boston, MA, USA
| | - Joshua C Prenner
- Department of Medicine, McGaw Medical Center of Northwestern University, Chicago, IL, USA
| | | | - Reena Pande
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Stanislav Henkin
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Mark W Feinberg
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Mary Elizabeth Patti
- Research Division, Joslin Diabetes Center, and Harvard Medical School, Boston, MA, USA
| | - Mark A Creager
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center and Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| |
Collapse
|
41
|
Henkin S, Wysokinski WE, Tweet M, Shamoun F, Naidu S, Sutkowska K, Bator K, Shields R, Greene E, Keller S, Hodge D, McBane R. Spontaneous visceral artery dissections in otherwise normal arteries: Clinical features, management, and outcomes compared with fibromuscular dysplasia. J Vasc Surg 2020; 73:516-523.e2. [PMID: 32623103 DOI: 10.1016/j.jvs.2020.05.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/22/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Visceral artery dissection with otherwise normal-appearing arteries (VADNA), diagnosed on imaging and suggestive of segmental arterial mediolysis, is a poorly understood disease entity. Study objectives were to define the clinical features, management, and outcomes of patients with VADNA compared with patients with fibromuscular dysplasia (FMD). METHODS In this single-center retrospective cohort study, consecutive patients with a diagnosis of VADNA or FMD evaluated in the Mayo Clinic Gonda Vascular Center (January 1, 2000-April 1, 2017) were identified. Patient demographics, symptom presentation, management, composite adverse arterial events (recurrent arterial dissection, stroke or transient ischemic attack, myocardial infarction, mesenteric or renal infarction, or need for revascularization), and overall survival were compared between VADNA and FMD patients. RESULTS There were 103 VADNA patients (age [mean ± standard deviation], 51.7 ± 11.0 years; 27.9% female) and 248 FMD controls (49.8 ± 8.9 years; 81.8% female) identified. The most common symptom for VADNA patients was abdominal or flank pain (80.6%). For FMD, chest pain, headache, and dizziness were more frequent presenting complaints. The median follow-up was longer for VADNA patients (42 months; interquartile range, 9-76 months) compared with FMD patients (19 months; interquartile range, 0.6-52 months; P < .001). During this time interval, there were twofold more composite arterial events in the VADNA group compared with the FMD group (17% vs 8.1%; P = .01). This difference was primarily driven by recurrent dissections. All-cause mortality was low and similar for both groups (3.8% vs 0.4%; P = .10). CONCLUSIONS VADNA patients carry a higher risk of recurrent arterial events compared with those with FMD. This difference was primarily driven by recurrent dissections.
Collapse
Affiliation(s)
- Stanislav Henkin
- Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Waldemar E Wysokinski
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - Marysia Tweet
- Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - Fadi Shamoun
- Cardiovascular Department, Mayo Clinic, Scottsdale, Ariz
| | | | | | - Kaja Bator
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn
| | - Raymond Shields
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - Eddie Greene
- Nephrology and Hypertension Division, Mayo Clinic, Rochester, Minn
| | - Shelly Keller
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn
| | - David Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Fla
| | - Robert McBane
- Gonda Vascular Center, Mayo Clinic, Rochester, Minn; Cardiovascular Department, Mayo Clinic, Rochester, Minn.
| |
Collapse
|
42
|
Columbo JA, Wanken Z, Barnes JA, Beach J, Suckow BD, Henkin S, Goodney PP, Stone D. Stress Testing Prior to Abdominal Aortic Aneurysm Repair Does Not Prevent Postoperative Cardiac Events. J Vasc Surg 2020. [DOI: 10.1016/j.jvs.2020.04.426] [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: 10/24/2022]
|
43
|
McBane RD, Wysokinski WE, Le-Rademacher JG, Zemla T, Ashrani A, Tafur A, Perepu U, Anderson D, Gundabolu K, Kuzma C, Perez Botero J, Leon Ferre RA, Henkin S, Lenz CJ, Houghton DE, Vishnu P, Loprinzi CL. Apixaban and dalteparin in active malignancy-associated venous thromboembolism: The ADAM VTE trial. J Thromb Haemost 2020; 18:411-421. [PMID: 31630479 DOI: 10.1111/jth.14662] [Citation(s) in RCA: 319] [Impact Index Per Article: 79.8] [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: 08/02/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Low-molecular-weight heparin is the guideline-endorsed treatment for cancer-associated venous thromboembolism (VTE). While apixaban is approved for the treatment of acute VTE, limited data support its use in cancer patients. OBJECTIVES The primary outcome was major bleeding. Secondary outcomes included VTE recurrence and a composite of major plus clinically relevant non-major bleeding (CRNMB). PATIENTS/METHODS Patients with cancer-associated VTE were randomly assigned to receive either apixaban 10 mg twice daily for seven days followed by 5 mg twice daily for six months or subcutaneous dalteparin (200 IU/kg for one month followed by 150 IU/kg once daily). RESULTS Of 300 patients randomized, 287 were included in the primary analysis. Metastatic disease was present in 66% of subjects; 74% were receiving concurrent chemotherapy. Major bleeding occurred in 0% of 145 patients receiving apixaban, compared with 1.4% of 142 patients receiving dalteparin [P = .138; hazard ratio (HR) not estimable because of 0 bleeding event in apixaban group]. Recurrent VTE occurred in 0.7% of apixaban, compared to 6.3% of dalteparin patients [HR 0.099, 95% confidence interval [CI], 0.013-0.780, P = .0281). Major bleeding or CRNMB rates were 6% for both groups. CONCLUSIONS Oral apixaban was associated with low major bleeding and VTE recurrence rates for the treatment of VTE in cancer patients.
Collapse
Affiliation(s)
- Robert D McBane
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota
- Hematology Division, Mayo Clinic, Rochester, Minnesota
- Cardiovascular Department, Mayo Clinic, Rochester, Minnesota
| | - Waldemar E Wysokinski
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota
- Hematology Division, Mayo Clinic, Rochester, Minnesota
- Cardiovascular Department, Mayo Clinic, Rochester, Minnesota
| | - Jennifer G Le-Rademacher
- Health Science Research Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Tyler Zemla
- Health Science Research Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Aneel Ashrani
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota
- Hematology Division, Mayo Clinic, Rochester, Minnesota
| | | | - Usha Perepu
- Medical Oncology, University of Iowa, Iowa City, Iowa
| | - Daniel Anderson
- Department of Hematology, Oncology and Transplantation, University of Minnesota, Regions Hospital, St Paul, Minnesota
| | - Krishna Gundabolu
- Department of Oncology and Hematology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Charles Kuzma
- Department of Hematology and Oncology, First Health of the Carolinas, Pinehurst, North Carolina
| | | | | | - Stanislav Henkin
- Department of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Charles J Lenz
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota
- Cardiovascular Department, Mayo Clinic, Rochester, Minnesota
| | - Damon E Houghton
- Vascular Medicine Division, Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota
- Hematology Division, Mayo Clinic, Rochester, Minnesota
- Cardiovascular Department, Mayo Clinic, Rochester, Minnesota
| | - Prakash Vishnu
- Department of Oncology and Hematology, Mayo Clinic, Jacksonville, Florida
| | | |
Collapse
|
44
|
Scantlebury DC, Kattah AG, Weissgerber TL, Agarwal S, Mielke MM, Weaver AL, Vaughan LE, Henkin S, Zimmerman K, Miller VM, White WM, Hayes SN, Garovic VD. Impact of a History of Hypertension in Pregnancy on Later Diagnosis of Atrial Fibrillation. J Am Heart Assoc 2018; 7:JAHA.117.007584. [PMID: 29755033 PMCID: PMC6015308 DOI: 10.1161/jaha.117.007584] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Atrial fibrillation/flutter (AF) produces significant morbidity in women and is typically attributed to cardiac remodeling from multiple causes, particularly hypertension. Hypertensive pregnancy disorders (HPDs) are associated with future hypertension and adverse cardiac remodeling. We evaluated whether women with AF were more likely to have experienced a HPD compared with those without. Methods and Results A nested case–control study was conducted within a cohort of 7566 women who had a live or stillbirth delivery in Olmsted County, Minnesota between 1976 and 1982. AF cases were matched (1:1) to controls based on date of birth, age at first pregnancy, and parity. AF and pregnancy history were confirmed by chart review. We identified 105 AF cases: mean age 57±8 (mean±SD) years, (controls 56±8 years), 32±8 years (controls 31±8 years) after the first pregnancy. Cases were more likely to have obesity during childbearing years, and hypertension, diabetes mellitus, dyslipidemia, coronary disease, valvular disease, and heart failure at the time of AF diagnosis. Cases were more likely to have a history of HPDs, compared with controls: 28/105 (26.7%) cases versus 12/105 (11.4%) controls, odds ratio: 2.60 (95% confidence interval, 1.21–6.04). After adjustment for hypertension and obesity, the association was attenuated and no longer statistically significant; odds ratio (95% confidence interval, 2.12 (0.92–5.23). Conclusions Women with AF are more likely to have had a HPD, a relationship at least partially mediated by associated obesity and hypertension. Given the high morbidity of AF, studies evaluating the benefit of screening for and management of cardiovascular risk factors in women with a history of HPD should be performed.
Collapse
Affiliation(s)
- Dawn C Scantlebury
- Faculty of Medical Sciences, University of the West Indies, St. Michael, Barbados
| | - Andrea G Kattah
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | - Sanket Agarwal
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Michelle M Mielke
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.,Department of Neurology Mayo Clinic, Rochester, MN
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Lisa E Vaughan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Stanislav Henkin
- Department of Cardiovascular Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Virginia M Miller
- Department of Surgery, Mayo Clinic, Rochester, MN.,Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Wendy M White
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| | | | - Vesna D Garovic
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN .,Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN
| |
Collapse
|
45
|
Simmons B, Wysokinski W, Saadiq RA, Bott-Kitslaar D, Henkin S, Casanegra A, Lenz C, Daniels P, Bjarnason H, Vargas E, Hodge D, Holton SJ, Cerhan JR, Loprinzi C, McBane R. Efficacy and safety of rivaroxaban compared to enoxaparin in treatment of cancer-associated venous thromboembolism. Eur J Haematol 2018; 101:136-142. [PMID: 29617053 DOI: 10.1111/ejh.13074] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low molecular weight heparin (LMWH) is the guideline-endorsed treatment for cancer-associated venous thromboembolism (cVTE). Study objectives were to compare the efficacy and safety of rivaroxaban and enoxaparin in cVTE. METHODS Using a cohort study design, consecutive patients with cVTE (3/1/2013-7/31/2016), enrolled in the Mayo Thrombophilia Clinic Direct Oral Anticoagulants Registry, were compared to contemporary cancer patients receiving enoxaparin. The cumulative incidence of venous thromboembolism (VTE) recurrence, major and clinically relevant non-major bleeding, and survival were assessed at 3 and 12 months. RESULTS Ninety-eight patients received rivaroxaban (51% female, mean age 63 ± 12 years) and 168 enoxaparin (34.5% female, mean age 62 ± 15 years). The most common cancers included gastrointestinal/pancreatic, genitourinary and hematologic cancers. More than half of patients had pulmonary emboli at presentation. More than half had metastases, and two-thirds were receiving chemotherapy. At 3 months, there were no differences in VTE recurrence (rivaroxaban 1.0% vs enoxaparin 4.2%; P = .15), major bleeding (rivaroxaban 5.1% vs enoxaparin 3.6%; P = .55), or all-cause mortality (rivaroxaban 4.1% vs enoxaparin 8.9%; P = .14). At 12 months, these outcomes did not differ by treatment strategy. CONCLUSION The results of this "real-world" experience with cVTE suggest that rivaroxaban may offer a safe and effective alternative to LMWH.
Collapse
Affiliation(s)
- Benjamin Simmons
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Waldemar Wysokinski
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Rayya A Saadiq
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Dalene Bott-Kitslaar
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Stanislav Henkin
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Ana Casanegra
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Charles Lenz
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Paul Daniels
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Haraldur Bjarnason
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - Emily Vargas
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - David Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Sara J Holton
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James R Cerhan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Robert McBane
- Division of Vascular Diseases, Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
46
|
McBane Ii R, Loprinzi CL, Ashrani A, Perez-Botero J, Leon Ferre RA, Henkin S, Lenz CJ, Le-Rademacher JG, Wysokinski WE. Apixaban and dalteparin in active malignancy associated venous thromboembolism. The ADAM VTE Trial. Thromb Haemost 2017; 117:1952-1961. [PMID: 28837207 DOI: 10.1160/th17-03-0193] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 06/24/2017] [Indexed: 12/13/2022]
Abstract
Currently, low molecular weight heparin (LMWH) is the guideline endorsed treatment of patients with cancer associated venous thromboembolism (VTE). While apixaban is approved for the treatment of acute VTE, there are limited data supporting its use in cancer patients. The rationale and design of this investigator initiated Phase IV, multicenter, randomized, open label, superiority trial assessing the safety of apixaban versus dalteparin for cancer associated VTE is provided (ADAM-VTE; NCT02585713). The main aim of the ADAM-VTE trial is to test the hypothesis that apixaban is associated with a significantly lower rate of major bleeding compared to dalteparin in the treatment of cancer patients with acute VTE. The primary safety outcome is rate of major bleeding. Secondary efficacy objective is to assess the rates of recurrent VTE or arterial thromboembolism. Cancer patients with acute VTE (n=300) are randomized to receive apixaban (10 mg twice daily for 7 days followed by 5 mg twice daily thereafter) or dalteparin (200 IU/Kg daily for 30 days followed by 150 IU/kg daily thereafter) for 6 months. Stratification factors used for randomization include cancer stage and cancer specific risk of venous thromboembolism using the Khorana score. Participating centers are chosen from the Academic and Community Cancer Research United (ACCRU) consortium comprised of 90 oncology practices in the United States and Canada. Based on the hypothesis to be tested, we anticipate that these trial results will provide evidence supporting apixaban as an effective treatment of cancer associated VTE at lower rates of major bleeding compared to LMWH.
Collapse
Affiliation(s)
- Robert McBane Ii
- Robert D. McBane II, MD, Gonda Vascular Center, Mayo Clinic, 200 First Street SW, Rochester, MN, USA, Tel.: +1 507 266 3964, Fax: +1 507 266 1617, E-mail:
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Henkin S, Wysokinski W, Little Y, Shamoun F, Greene E, McBane R. RISK OF RE-DISSECTION IN SEGMENTAL ARTERIAL MEDIOLYSIS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35459-1] [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: 11/29/2022]
|
48
|
Kiani S, Kurian D, Henkin S, Desai P, Brunel F, Poston R. Direct to consumer advertising of robotic heart bypass surgery: effectiveness, patient satisfaction and clinical outcomes. Int J Pharm Healthc Mark 2016; 10:358-375. [PMID: 28331538 DOI: 10.1108/ijphm-05-2015-0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Robotic coronary artery bypass (rCABG) is a relatively novel and less invasive form of surgery. A yearlong direct-to-consumer advertising (DTCA) campaign was initiated to provide the community with information regarding rCABG, increase awareness and recruit patients. To optimize information content and ensure appropriate messaging for future campaigns, this study aims to analyze the campaign effectiveness and compared service quality perceptions and clinical outcomes, following surgery across DTCA-responder and control groups.
Design/methodology/approach
The institution initiated an rCABG program and one-year DTCA campaign. The authors prospectively documented all rCABG referrals prompted by these ads (DTCA-responder group) and concurrent referrals from medical providers (controls). Groups were compared according to baseline characteristics, perioperative outcomes, patient satisfaction (HCAHPS survey) and functional capacity at three weeks (Duke Activity Status Index). At six months, both groups were surveyed for patient satisfaction and unmet expectations.
Findings
There were 103 DTCA responders and 77 controls. The subset of responders that underwent rCABG (n = 54) had similar characteristics to controls, except they were younger, less likely to have lung disease or to be scheduled as an urgent case. Both groups had similar 30-day clinical outcomes, functional capacity recovery and overall satisfaction at three weeks. Follow-up interviews at six months and four years revealed that the DTCA group reported more unmet expectations regarding the “size of the skin incisions” and “recovery time” but no concern about “expertise of their surgeon”.
Practical implications
The DTCA campaign was effective at recruiting patients. The specific focus of the ads and narrow timeframe for decision-making about CABG lends confidence that the incremental cases seen during the campaign were prompted primarily by DTCA. However, differences in unmet expectations underscore the need to better understand the impact of message content on patients recruited via DTCA campaigns.
Originality/value
This is one of the first studies to provide real-world direct empirical evidence of patients’ clinical and attitudinal outcomes for DTCA campaigns. Furthermore, the findings contradict prevailing beliefs that DTCA is ineffective for prompting surgical referrals.
Collapse
|
49
|
Starr MR, Henkin S, Greenlund LS. 77-Year-Old Man With a Painful Left Knee, Anemia, and Renal Insufficiency. Mayo Clin Proc 2016; 91:e149-e153. [PMID: 27519907 DOI: 10.1016/j.mayocp.2016.04.030] [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: 02/18/2016] [Revised: 03/26/2016] [Accepted: 04/01/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Matthew R Starr
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Stanislav Henkin
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Laura S Greenlund
- Advisor to residents and Consultant in Primary Care Internal Medicine, Rochester, MN
| |
Collapse
|
50
|
Henkin S, Chon TY, Christopherson ML, Halvorsen AJ, Worden LM, Ratelle JT. Improving nurse-physician teamwork through interprofessional bedside rounding. J Multidiscip Healthc 2016; 9:201-5. [PMID: 27194915 PMCID: PMC4859421 DOI: 10.2147/jmdh.s106644] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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] [Indexed: 11/26/2022] Open
Abstract
Background Teamwork between physicians and nurses has a positive association with patient satisfaction and outcomes, but perceptions of physician–nurse teamwork are often suboptimal. Objective To improve nurse–physician teamwork in a general medicine inpatient teaching unit by increasing face-to-face communication through interprofessional bedside rounds. Intervention From July 2013 through October 2013, physicians (attendings and residents) and nurses from four general medicine teams in a single nursing unit participated in bedside rounding, which involved the inclusion of nurses in morning rounds with the medicine teams at the patients’ bedside. Based on stakeholder analysis and feedback, a checklist for key patient care issues was created and utilized during bedside rounds. Assessment To assess the effect of bedside rounding on nurse–physician teamwork, a survey of selected items from the Safety Attitudes Questionnaire (SAQ) was administered to participants before and after the implementation of bedside rounds. The number of pages to the general medicine teams was also measured as a marker of physician–nurse communication. Results Participation rate in bedside rounds across the four medicine teams was 58%. SAQ response rates for attendings, residents, and nurses were 36/36 (100%), 73/73 (100%), and 32/73 (44%) prior to implementation of bedside rounding and 36 attendings (100%), 72 residents (100%), and 14 (19%) nurses after the implementation of bedside rounding, respectively. Prior to bedside rounding, nurses provided lower teamwork ratings (percent agree) than residents and attendings on all SAQ items; but after the intervention, the difference remained significant only on SAQ item 2 (“In this clinical area, it is not difficult to speak up if I perceive a problem with patient care”, 64% for nurses vs 79% for residents vs 94% for attendings, P=0.02). Also, resident responses improved on SAQ item 1 (“Nurse input is well received in this area”, 62% vs 82%, P=0.01). Conclusion Increasing face-to-face communication through interprofessional bedside rounding can improve the perceptions of nurse–physician teamwork, particularly among residents and nurses.
Collapse
Affiliation(s)
| | - Tony Y Chon
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Andrew J Halvorsen
- Department of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Medicine, Internal Medicine Residency Office of Educational Innovations, Mayo Clinic, Rochester, MN, USA
| | | | - John T Ratelle
- Division of Hospital Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|