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Patel K, Yadalam A, DeStefano R, Desai S, Almuwaqqat Z, Ko YA, Alras Z, Martini MA, Ejaz K, Alvi Z, Varounis C, Murtagh G, Gupta D, Book W, Quyyumi AA. High sensitivity troponin I as a biomarker for cardiac allograft vasculopathy: Evaluation of diagnostic potential and clinical utility. Clin Transplant 2024; 38:e15168. [PMID: 37882497 PMCID: PMC10841445 DOI: 10.1111/ctr.15168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Cardiac allograft vasculopathy (CAV) limits long-term survival in heart transplant (HTx) recipients. The use of biomarkers in CAV surveillance has been studied, but none are used in clinical practice. The predictive value of high-sensitivity troponin I (hsTnI) has not been extensively investigated in HTx recipients. METHODS HTx patients undergoing surveillance coronary angiograms and enrolled in the Emory Cardiovascular Biobank had plasma hsTnI measured. CAV grade was assessed using ISHLT nomenclature. Multivariable cumulative link mixed modeling was performed to determine association between hsTnI level and CAV grade. Patients were followed for adverse outcomes over a median 10-year period. Kaplan-Meier survival analysis and Cox proportional hazard modeling were performed. RESULTS Three hundred and seventy-two angiograms were analyzed in 156 patients at a median 8.9 years after transplant. hsTnI levels were positively correlated with concurrent CAV grade after adjustment for age, age at transplant, sex, BMI, hypertension, diabetes, hyperlipidemia, estimated glomerular filtration rate, and history of acute cellular rejection (p = .016). In an adjusted Cox proportional hazard model, initial hsTnI level above the median (4.9 pg/mL) remained a predictor of re-transplantation or death (hazard ratio 1.82; 95% confidence interval 1.16-2.90; p = .01). CONCLUSION An elevated hsTnI level reflects severity of CAV and is associated with poor long-term outcomes in patients with HTx.
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Affiliation(s)
- Krishan Patel
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Adithya Yadalam
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Robert DeStefano
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Shivang Desai
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Zakaria Almuwaqqat
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Zahran Alras
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Mohamed Afif Martini
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Kiran Ejaz
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Zain Alvi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | | | - Gillian Murtagh
- Diagnostics Division, Abbott Laboratories, North Chicago, IL
| | - Divya Gupta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Wendy Book
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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Shi H, Book W, Raskind-Hood C, Downing KF, Farr SL, Bell MN, Sameni R, Rodriguez FH, Kamaleswaran R. A machine learning model for predicting congenital heart defects from administrative data. Birth Defects Res 2023; 115:1693-1707. [PMID: 37681293 PMCID: PMC10841295 DOI: 10.1002/bdr2.2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION International Classification of Diseases (ICD) codes recorded in administrative data are often used to identify congenital heart defects (CHD). However, these codes may inaccurately identify true positive (TP) CHD individuals. CHD surveillance could be strengthened by accurate CHD identification in administrative records using machine learning (ML) algorithms. METHODS To identify features relevant to accurate CHD identification, traditional ML models were applied to a validated dataset of 779 patients; encounter level data, including ICD-9-CM and CPT codes, from 2011 to 2013 at four US sites were utilized. Five-fold cross-validation determined overlapping important features that best predicted TP CHD individuals. Median values and 95% confidence intervals (CIs) of area under the receiver operating curve, positive predictive value (PPV), negative predictive value, sensitivity, specificity, and F1-score were compared across four ML models: Logistic Regression, Gaussian Naive Bayes, Random Forest, and eXtreme Gradient Boosting (XGBoost). RESULTS Baseline PPV was 76.5% from expert clinician validation of ICD-9-CM CHD-related codes. Feature selection for ML decreased 7138 features to 10 that best predicted TP CHD cases. During training and testing, XGBoost performed the best in median accuracy (F1-score) and PPV, 0.84 (95% CI: 0.76, 0.91) and 0.94 (95% CI: 0.91, 0.96), respectively. When applied to the entire dataset, XGBoost revealed a median PPV of 0.94 (95% CI: 0.94, 0.95). CONCLUSIONS Applying ML algorithms improved the accuracy of identifying TP CHD cases in comparison to ICD codes alone. Use of this technique to identify CHD cases would improve generalizability of results obtained from large datasets to the CHD patient population, enhancing public health surveillance efforts.
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Affiliation(s)
- Haoming Shi
- Department of Biomedical Engineering, Georgia Institute Technology, Atlanta, Georgia, USA
| | - Wendy Book
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Cheryl Raskind-Hood
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Karrie F. Downing
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sherry L. Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary N. Bell
- Department of Biomedical Engineering, Georgia Institute Technology, Atlanta, Georgia, USA
| | - Reza Sameni
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Fred H. Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Rishikesan Kamaleswaran
- Department of Biomedical Engineering, Georgia Institute Technology, Atlanta, Georgia, USA
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
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Patel K, Yadalam A, DeStefano R, Almuwaqqat Z, Desai S, Alkhoder A, Ejaz K, Alvi Z, Book W, Gupta D, Quyyumi A. Lipoprotein(a) Levels Predict Development of Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.060] [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: 04/05/2023] Open
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Rea KE, Cushman GK, Quast LF, George RP, Basu A, Ford R, Book W, Blount RL. Initial attendance and retention in adult healthcare as criteria for transition success among organ transplant recipients. Pediatr Transplant 2022; 26:e14280. [PMID: 35388604 DOI: 10.1111/petr.14280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 03/15/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) solid organ transplant recipients experience worsening medical outcomes during transition to adult healthcare. Current understanding and definitions of transition success emphasize first initiation of appointment attendance in adult healthcare; however, declines in attendance over time after transfer remain possible, particularly as AYAs are further removed from their pediatric provider and assume greater independence in their care. METHODS The current study assessed health-care utilization, medical outcomes, and transition success among 49 AYA heart, kidney, or liver recipients recently transferred to adult healthcare. Differences in outcomes were examined along two transition success criteria: (1) initial engagement in adult healthcare within 6 or 12 months of last pediatric appointment and (2) retention in adult healthcare over 3 years following last pediatric appointment. Growth curve modeling examined change in attendance over time. RESULTS Successful retention in adult healthcare was significantly related to more improved clinical outcomes, including decreased number and duration of hospitalizations and greater medication adherence, as compared to initial engagement. Significant declines in appointment attendance over 3 years were noted, and individual differences in declines were not accounted for by age at transfer or time since transplant. CONCLUSIONS Findings underscore support for AYAs after transfer, as significant declines in attendance were noted after initiating adult care. Clinical care teams should examine transition success longitudinally to address changes in health-care utilization and medical outcomes. Attention to interventions and administrative support aimed at maintaining or increasing attendance and identifying risk factors and intervention for unsuccessful transition is warranted.
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Affiliation(s)
- Kelly E Rea
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Grace K Cushman
- Department of Psychology, University of Georgia, Athens, Georgia, USA.,Alpert Medical School of Brown University, Bradley/Hasbro Children's Research Center, Providence, USA
| | - Lauren F Quast
- Department of Psychology, University of Georgia, Athens, Georgia, USA
| | - Roshan P George
- Department of Pediatrics, Emory University School of Medicine, Athens, Georgia, USA
| | - Arpita Basu
- Emory Transplant Center, Emory University School of Medicine, Athens, Georgia, USA
| | - Ryan Ford
- Emory Transplant Center, Emory University School of Medicine, Athens, Georgia, USA
| | - Wendy Book
- Emory Transplant Center, Emory University School of Medicine, Athens, Georgia, USA
| | - Ronald L Blount
- Department of Psychology, University of Georgia, Athens, Georgia, USA
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5
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Chang JW, Rubenstein JH, Mellinger JL, Kodroff E, Strobel MJ, Scott M, Mack D, Book W, Sable K, Kyle S, Paliana A, Dellon ES. Motivations, Barriers, and Outcomes of Patient-Reported Shared Decision Making in Eosinophilic Esophagitis. Dig Dis Sci 2021; 66:1808-1817. [PMID: 32621259 PMCID: PMC9110111 DOI: 10.1007/s10620-020-06438-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Little is known about patient choice in treatment of eosinophilic esophagitis (EoE). AIM Determine motivators and barriers to using common EoE therapies and describe patient-reported shared decision making (SDM) and satisfaction with treatment. METHODS We developed and administered a Web-based survey on factors influencing EoE treatment choice, SDM, and satisfaction. Adults with EoE and adult caregivers of pediatric EoE patients were recruited via patient advocacy groups and at two centers. Descriptive statistics of multiple response questions and multivariable logistic regression were performed to identify predictors of SDM and satisfaction with treatment. RESULTS A total of 243 adults (mean age 38.7 years) and 270 adult caregivers of children (mean age 9.5 years) completed the survey. Preventing worsening disease was the most common motivator to treat EoE. Barriers to topical steroids were potential side effects, cost, and preferring a medication-free approach. Inconvenience and quality of life were barriers to diet. Potential adverse events, discomfort, and cost were barriers to dilation. Nearly half (42%) of patients experienced low SDM, but those followed by gastroenterologists were more likely to experience greater SDM compared to non-specialists (OR 1.81; 95% CI 1.03-3.15). Patients receiving more SDM were more satisfied with treatment, regardless of provider or treatment type (OR 2.62, 95% CI 1.76-3.92). CONCLUSIONS Patients with EoE pursue treatment mostly to prevent worsening disease. Common barriers to treatment are inconvenience and financial costs. SDM is practiced most by gastroenterologists, but nearly half of patients do not experience SDM, indicating a substantial area of need in EoE.
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Affiliation(s)
- Joy W. Chang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Drive, SPC 5362, Ann Arbor, MI 48109, USA
| | - Joel H. Rubenstein
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Drive, SPC 5362, Ann Arbor, MI 48109, USA,Veterans Affairs Center for Clinical Management Research, Ann Arbor VA Medical Center, Ann Arbor, MI, USA
| | - Jessica L. Mellinger
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, 3912 Taubman Center, 1500 E. Medical Center Drive, SPC 5362, Ann Arbor, MI 48109, USA
| | - Ellyn Kodroff
- Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, IL, USA
| | - Mary J. Strobel
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | | | - Denise Mack
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Wendy Book
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Kathleen Sable
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Scholeigh Kyle
- Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, IL, USA
| | - Allisa Paliana
- Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, IL, USA
| | - Evan S. Dellon
- Division of Gastroenterology, Center for Esophageal and Swallowing Disorders, University of North Carolina, Chapel‑Hill, NC, USA
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Rink D, Book W, Raskind-Hood C, Kancherla V, Hoffman T, Rodriguez F. ASSOCIATION BETWEEN COMBINED ANATOMIC AND PHYSIOLOGIC CLASSIFICATION OF ADULTS WITH CONGENITAL HEART DISEASE (ACHD) AND SELECTED HEALTHCARE UTILIZATION AND CLINICAL OUTCOMES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01806-4] [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]
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7
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Alam Z, Raskind-Hood C, Hoffman T, Kancherla V, Book W. THE RISK OF CEREBROVASCULAR ACCIDENT AMONG PATIENTS WITH CONGENITAL HEART DISEASE. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01825-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Saraf A, Book W. Reply to the Letter to the Editor: "GDF-15 - A matter of the heart or the kidney?". Int J Cardiol 2020; 313:46. [PMID: 32517964 PMCID: PMC11059139 DOI: 10.1016/j.ijcard.2020.04.008] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/02/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Anita Saraf
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America.
| | - Wendy Book
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
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9
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Gaydos LM, Sommerhalter K, Raskind-Hood C, Fapo O, Lui G, Hsu D, Van Zutphen A, Glidewell J, Farr S, Rodriguez FH, Hoffman T, Book W. Health Care Transition Perceptions Among Parents of Adolescents with Congenital Heart Defects in Georgia and New York. Pediatr Cardiol 2020; 41:1220-1230. [PMID: 32500288 PMCID: PMC9109153 DOI: 10.1007/s00246-020-02378-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Abstract
With increasing survival trends for children and adolescents with congenital heart defects (CHD), there is a growing need to focus on transition from pediatric to adult specialty cardiac care. To better understand parental perspectives on the transition process, a survey was distributed to 451 parents of adolescents with CHD who had recent contact with the healthcare system in Georgia (GA) and New York (NY). Among respondents, 90.7% reported excellent, very good or good health-related quality of life (HRQoL) for their adolescent. While the majority of parents (77.8%) had been told by a provider about their adolescent's need to transition to adult specialty cardiac care, most reported concerns about transitioning to adult care. Parents were most commonly concerned with replacing the strong relationship with pediatric providers (60.7%), locating an appropriate adult provider (48.7%), and accessing adult health insurance coverage (43.6%). These findings may offer insights into transition planning for adolescents with CHD.
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Affiliation(s)
- Laura M Gaydos
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | | | | | - Olushola Fapo
- New York State Department of Health, Albany, NY, USA
| | - George Lui
- Division of Cardiovascular Medicine and Pediatric Cardiology, Stanford School of Medicine, Stanford, CA, USA
| | - Daphne Hsu
- Division of Pediatric Cardiology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Alissa Van Zutphen
- New York State Department of Health, Albany, NY, USA
- University at Albany School of Public Health, Rensselaer, NY, USA
| | - Jill Glidewell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sherry Farr
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Trenton Hoffman
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Wendy Book
- Emory University School of Medicine, Atlanta, GA, USA
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Xie JX, Kobashigawa JA, Kennedy KF, Henry TD, Tabak SW, Krebbs R, Shaw L, Abbott JD, Book W, Rab ST, Spertus JA, Goyal A. Omission of Heart Transplant Recipients From the Appropriate Use Criteria for Revascularization and the Ramifications on Heart Transplant Centers. JAMA Cardiol 2020; 5:669-676. [PMID: 32267466 DOI: 10.1001/jamacardio.2020.0586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Guidelines endorse routine coronary angiography and percutaneous coronary intervention (PCI) to screen for and treat cardiac allograft vasculopathy in heart transplant recipients. However, the current Appropriate Use Criteria for Revascularization (AUC-R) do not recognize prior heart transplant as a unique PCI indication. Whether this affects rates of rarely appropriate (RA) PCIs is unknown. Objective To assess the rate of RA PCI procedures in heart transplant recipients and how it pertains to hospital PCI appropriateness metrics and pay-for-performance scorecards. Design, Setting, and Participants This observational study used National Cardiovascular Data Registry CathPCI Registry data on all patients undergoing elective PCIs from 96 Medicare-approved heart transplant centers from quarter 3 of 2009 to quarter 2 of 2017. The data were analyzed in July 2018. Exposures Prior heart transplant. Main Outcomes and Measures Rates of RA elective PCIs in heart transplant recipients compared with nonrecipients and hospital rates of RA PCI before vs after exclusion of heart transplant recipients using paired t tests. In a subset of heart transplant centers participating in the Anthem Blue Cross and Blue Shield's Quality-In-Sights Hospital Incentive Program (Q-HIP), we compared the change in Q-HIP scorecards before vs after excluding heart transplant recipients. Results Of 168 802 participants, 123 124 (72.9%) were men, 137 457 were white, and the mean (SD) age was 66.3 (11.4) years. Of 168 802 elective PCIs performed in heart transplant centers, 1854 (1.1%) were for heart transplant recipients. Heart transplant recipients were less likely to have ischemic symptoms (14.6% vs 61.4%, P < .001), had lower rates of antecedent stress testing (15.0% vs 58.4%, P < .001), and had higher RA PCI rates (66.0% vs 16.9%, P < .001) compared with nonrecipients. In heart transplant centers, the absolute difference in RA rates (before vs after excluding transplant recipients) was directly associated with the proportion of PCIs performed in heart transplant recipients (r = 0.91; P < .001). In the subset of heart transplant centers participating in Q-HIP during the 2016 and 2017 calendar years, 8 of 20 (40%) and 8 of 16 centers (50%), respectively, could have benefited from a change in their Q-HIP scorecards if their RA PCI rates excluded transplant recipients. Conclusions and Relevance Two-thirds of PCIs in heart transplant recipients were deemed RA by the AUC-R. The failure of the AUC-R to consider prior heart transplant as a unique PCI indication may lead to inflated RA PCI rates with the potential for affecting quality reporting and pay-for-performance metrics in heart transplant centers.
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Affiliation(s)
- Joe X Xie
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Kevin F Kennedy
- St Luke's Mid-America Heart Institute, University of Missouri-Kansas City, Kansas City
| | | | - Steven W Tabak
- Cedars-Sinai Smidt Heart Institute, Los Angeles, California
| | | | - Leslee Shaw
- Weill Cornell Medical Center, New York, New York
| | - J Dawn Abbott
- Brown University School of Medicine, Providence, Rhode Island
| | - Wendy Book
- Emory University School of Medicine, Atlanta, Georgia
| | - S Tanveer Rab
- Emory University School of Medicine, Atlanta, Georgia
| | - John A Spertus
- St Luke's Mid-America Heart Institute, University of Missouri-Kansas City, Kansas City
| | - Abhinav Goyal
- Emory University School of Medicine, Atlanta, Georgia
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Lewis MJ, Reardon L, Aboulhosn JA, Haeffele C, Chen S, Kim Y, Book W, Rodriguez F, Valente AM, Carazo M, Krieger E, Angiulo J, Egbe A, Cedars AM, Ko J, Jacobson R, Earing M, Ermis P, Broda C, Cramer JW, Nugaeva N, Ross HJ, Krasuski RA, Rosenbaum M. MORBIDITY AND MORTALITY IN ADULT FONTAN PATIENTS AFTER HEART OR COMBINED HEART LIVER TRANSPLANT: A REPORT FROM THE FOSTER STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31280-8] [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: 10/24/2022]
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12
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Glidewell J, Farr S, Downing K, Khanna A, Raskind-Hood C, Book W, Botto L, Feldkamp M, Riehle-Colarusso T, Sommerhalter K, Soim A, D'Ottavio A, Li J, Crume T. PREVALENCE OF CONGENITAL HEART DEFECTS AMONG 1- TO 64- YEAR-OLDS RECEIVING HEALTHCARE AT FIVE U.S. SITES, 2011-2013. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31228-6] [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: 11/28/2022]
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13
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Lewis MJ, Haeffele C, Chen S, Reardon L, Aboulhosn JA, Nugaeva N, Ross HJ, Kim Y, Krasuski RA, Valente AM, Carazo M, Krieger E, Angiulo J, Book W, Rodriguez F, Egbe A, Jacobson R, Earing M, Cramer JW, Cedars AM, Ko J, Broda C, Ermis P, Rosenbaum M. MORBIDITY AND MORTALITY IN ADULT FONTAN PATIENTS REFERRED FOR TRANSPLANT: A REPORT FROM THE FOSTER STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31173-6] [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: 11/16/2022]
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14
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Saraf A, De Staercke C, Everitt I, Haouzi A, Ko YA, Jennings S, Kim JH, Rodriguez FH, Kalogeropoulos AP, Quyyumi A, Book W. Biomarker profile in stable Fontan patients. Int J Cardiol 2020; 305:56-62. [PMID: 31959411 DOI: 10.1016/j.ijcard.2020.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 11/21/2019] [Accepted: 01/08/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND As the population of adults with congenital heart disease (CHD) grows, cardiologists continue to encounter patients with complex anatomies that challenge the standard treatment of care. Single ventricle Fontan palliated patients are the most complex within CHD, with a high morbidity and mortality burden. Factors driving this early demise are largely unknown. METHODS AND RESULTS We analyzed biomarker expression in 44 stable Fontan outpatients (29.2 ± 10.7 years, 68.2% female) seen in the outpatient Emory Adult Congenital Heart Center and compared them to 32 age, gender and race matched controls. In comparison to controls, Fontan patients had elevated levels of multiple cytokines within the inflammatory pathway including Tumor Necrosis Factor-α (TNF-α) (p < 0.001), Interleukin-6 (IL-6) (p < 0.011), Growth Derived Factor-15 (GDF-15) (p < 0.0001), β2-macroglobulin, (p = 0.0006), stem cell mobilization: Stromal Derived Factor-1∝ (SDF-1α) (p = 0.006), extracellular matrix turnover: Collagen IV (p < 0.0001), neurohormonal activation: Renin (p < 0.0001), renal dysfunction: Cystatin C (p < 0.0001) and Urokinase Receptor (uPAR) (p = 0.022), cardiac injury: Troponin-I (p < 0.0004) and metabolism: Adiponectin (p = 0.0037). Within 1 year of enrollment 50% of Fontan patients had hospitalizations, arrhythmias or worsening hepatic function. GDF-15 was significantly increased in Fontan patients with clinical events (p < 0.0001). In addition, GDF-15 moderately correlated with longer duration of Fontan (r = 0.55, p = 0.01) and was elevated in atriopulmonary (AP) Fontan circulation. Finally, in a multivariate model, VEGF-D and Collagen IV levels were found to be associated with a change in MELDXI, a marker of liver dysfunction. CONCLUSION Multiple clinical and molecular biomarkers are upregulated in Fontan patients, suggesting a state of chronic systemic dysregulation.
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Affiliation(s)
- Anita Saraf
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America.
| | - Christine De Staercke
- Hemostasis Laboratory Branch, Division of Blood Disorders, Centers for Disease Control and Prevention, Atlanta, GA 30329, United States of America
| | - Ian Everitt
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
| | - Alice Haouzi
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, GA 30322, United States of America
| | - Staci Jennings
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
| | - Jonathan H Kim
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
| | - Fred H Rodriguez
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America; Sibley Heart Center Cardiology, Atlanta, GA 30341, United States of America
| | | | - Arshed Quyyumi
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
| | - Wendy Book
- Division of Cardiology, Department of Medicine, Emory University Department of Medicine, Atlanta, GA 30322, United States of America
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Kamioka N, Lisko J, Maidman S, Kim D, Sahu A, Dong A, Shashidharan S, Jokhadar M, Rodriguez F, Book W, Gleason P, Block P, Babaliaros V. TCT-770 Outcomes After Endograft Facilitated Transcatheter Pulmonary Valve Replacement for Failed Repair: Surgical vs. Transcatheter Procedures. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.911] [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: 10/25/2022]
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16
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Lui GK, McGarry C, Bhatt A, Book W, Riehle-Colarusso TJ, Dunn JE, Glidewell J, Gurvitz M, Hoffman T, Hogue CJ, Hsu D, Obenhaus S, Raskind-Hood C, Rodriguez FH, Zaidi A, Van Zutphen AR. Surveillance of Congenital Heart Defects among Adolescents at Three U.S. Sites. Am J Cardiol 2019; 124:137-143. [PMID: 31030970 DOI: 10.1016/j.amjcard.2019.03.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
The prevalence, co-morbidities, and healthcare utilization in adolescents with congenital heart defects (CHDs) is not well understood. Adolescents (11 to 19 years old) with a healthcare encounter between January 1, 2008 (January 1, 2009 for MA) and December 31, 2010 with a CHD diagnosis code were identified from multiple administrative data sources compiled at 3 US sites: Emory University, Atlanta, Georgia (EU); Massachusetts Department of Public Health (MA); and New York State Department of Health (NY). The estimated prevalence for any CHD was 4.77 (EU), 17.29 (MA), and 4.22 (NY) and for severe CHDs was 1.34 (EU), 3.04 (MA), and 0.88 (NY) per 1,000 adolescents. Private or commercial insurance was the most common insurance type for EU and NY, and Medicaid for MA. Inpatient encounters were more frequent in severe CHDs. Cardiac co-morbidities included rhythm and conduction disorders at 20% (EU), 46% (MA), and 9% (NY) as well as heart failure at 3% (EU), 15% (MA), and 2% (NY). Leading noncardiac co-morbidities were respiratory/pulmonary (22% EU, 34% MA, 16% NY), infectious disease (17% EU, 22% MA, 20% NY), non-CHD birth defects (12% EU, 23% MA, 14% NY), gastrointestinal (10% EU, 28% MA, 13% NY), musculoskeletal (10% EU, 32% MA, 11% NY), and mental health (9% EU, 30% MA, 11% NY). In conclusion, this study used a novel approach of uniform CHD definition and variable selection across administrative data sources in 3 sites for the first population-based CHD surveillance of adolescents in the United States. High resource utilization and co-morbidities illustrate ongoing significant burden of disease in this vulnerable population.
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17
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Gerardin J, Raskind-Hood C, Rodriguez FH, Hoffman T, Kalogeropoulos A, Hogue C, Book W. Lost in the system? Transfer to adult congenital heart disease care-Challenges and solutions. CONGENIT HEART DIS 2019; 14:541-548. [PMID: 31066199 DOI: 10.1111/chd.12780] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/03/2019] [Accepted: 04/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Transfer of congenital heart disease care from the pediatric to adult setting has been identified as a priority and is associated with better outcomes. Our objective is to determine what percentage of patients with congenital heart disease transferred to adult congenital cardiac care. DESIGN A retrospective cohort study. SETTING Referrals to a tertiary referral center for adult congenital heart disease patients from its pediatric referral base. PATIENTS This resulted in 1514 patients age 16-30, seen at least once in three pediatric Georgia health care systems during 2008-2010. INTERVENTIONS We analyzed for protective factors associated with age-appropriate care, including distance from referral center, age, timing of transfer, gender, severity of adult congenital heart disease, and comorbidities. OUTCOME MEASURES We analyzed initial care by age among patients under pediatric care from 2008 to 2010 and if patients under pediatric care subsequently transferred to an adult congenital cardiologist in this separate pediatric and adult health system during 2008-2015. RESULTS Among 1514 initial patients (39% severe complexity), 24% were beyond the recommended transfer age of 21 years. Overall, only 12.1% transferred care to the referral affiliated adult hospital. 90% of these adults that successfully transferred were seen by an adult congenital cardiologist, with an average of 33.9 months between last pediatric visit and first adult visit. Distance to referral center contributed to delayed transfer to adult care. Those with severe congenital heart disease were more likely to transfer (18.7% vs 6.2% for not severe). CONCLUSION Patients with severe disease are more likely to transfer to adult congenital heart disease care than nonsevere disease. Most congenital heart disease patients do not transfer to adult congenital cardiology care with distance to referral center being a contributing factor. Both pediatric and adult care providers need to understand and address barriers in order to improve successful transfer.
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Affiliation(s)
- Jennifer Gerardin
- Division of Cardiology, Department of Pediatrics, Medical College of Wisconsin, Wauwatosa, Wisconsin
| | - Cheryl Raskind-Hood
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Fred H Rodriguez
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Sibley Heart Center, Atlanta, Georgia
| | - Trenton Hoffman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Carol Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Wendy Book
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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18
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Xie J, Kobashigawa J, Kennedy K, Henry T, Tabak S, Krebbs R, Shaw L, Abbott JD, Book W, Rab ST, Spertus J, Goyal A. Abstract 196: Omission of Heart Transplant Recipients from the Appropriate Use Criteria for Revascularization and Impact on High-Volume Heart Transplant Centers. Circ Cardiovasc Qual Outcomes 2019. [DOI: 10.1161/hcq.12.suppl_1.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
For heart transplant recipients, guidelines endorse routine coronary angiography and percutaneous coronary intervention (PCI) to screen for and treat cardiac allograft vasculopathy (CAV). However, current Appropriate Use Criteria for Revascularization (AUC-R) do not recognize CAV as a unique PCI indication, and thus PCI for CAV is often labeled “rarely appropriate (RA).” The AUC-R’s omission of CAV patients, and its impact on RA PCI rates and hospital pay-for-performance reimbursement have never been described.
Methods:
Using NCDR CathPCI Registry data, we identified all elective PCIs from 96 Medicare-approved heart transplant centers between 2009Q3 and 2017Q2. NCDR-reported rates of RA elective PCI were compared before and after exclusion of CAV patients using paired t-tests. The annual pay-for-performance financial incentives potentially lost by heart transplant centers were estimated based on AUC-R performance thresholds published by Anthem Blue Cross and Blue Shield’s Quality-In-Sights®: Hospital Incentive Program (Q-HIP®).
Results:
Of 168,802 elective PCIs performed in heart transplant centers, 1,854 (1.1%) were for CAV. CAV patients, compared with non-heart transplant recipients, were more frequently asymptomatic (81.9% vs. 33.4%, p<0.001) and had lower rates of prior stress testing (15.0% vs. 58.4%, p<0.001), resulting in higher RA PCI rates (66.0% vs 16.9%, p<0.001). In transplant centers, the absolute difference in RA rates (before vs. after exclusion of CAV patients) was directly associated with the proportion of total PCIs performed in CAV patients (p<0.001,
Figure
). In a sample of 16 heart transplant centers participating in Q-HIP® during the 2017 calendar year measurement period, 2 (13%) centers could have each observed reimbursement increases estimated at ~$90,000 dollars if their Q-HIP® scorecards were re-scored after excluding CAV patients.
Conclusion:
Two-thirds of PCI cases in CAV patients are deemed RA by the AUC-R. The failure of the AUC-R to recognize CAV as a unique PCI indication may lead to inflated RA PCI rates and has the potential for substantial negative pay-for-performance implications in heart transplant centers. The AUC-R should recognize CAV as a unique PCI indication so that heart transplant centers are not penalized for performing PCI for CAV.
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19
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Everitt I, Hoffman T, Raskind-Hood C, Saraf A, Rodriguez F, Hogue C, Book W. WHO WILL BOUNCE BACK? PREDICTING REHOSPITALIZATION AFTER CONGENITAL HEART SURGERY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31249-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Raskind-Hood C, Hogue C, Overwyk KJ, Book W. Estimates of adolescent and adult congenital heart defect prevalence in metropolitan Atlanta, 2010, using capture-recapture applied to administrative records. Ann Epidemiol 2018; 32:72-77.e2. [PMID: 30602414 DOI: 10.1016/j.annepidem.2018.11.012] [Citation(s) in RCA: 6] [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: 09/11/2018] [Revised: 11/14/2018] [Accepted: 11/29/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Although congenital heart defects (CHD) are one of the most common types of birth defects in the United States, subnational prevalence estimates beyond early childhood are limited. METHODS We used capture-recapture methodology and logistic regression to estimate CHD prevalence per 1000 residents as of January 1, 2010, separately for adolescents and adults treated and living within five metropolitan Atlanta, Georgia counties, during 2008-2010. RESULTS Data sources differed by age. Adolescents (n = 1621, aged 11-20 years) and adults (n = 3176, aged 21-64 years) were captured from at least one source. We estimated CHD prevalence to be 7.85 per 1000 adolescents (estimated n = 3718 [95% CI: 3471-4004]) and 6.08 per 1000 adults (estimated n = 12,969 [95% CI: 13,873-18,915]). When we included persons found in age-inappropriate sources, prevalence estimates increased to 11 per 1000 adolescents and 6.5 per 1000 adults. CONCLUSIONS This method for obtaining subnational prevalence estimates provided reasonable prevalence results and identified needs for service improvement. Only one half of adolescents and one-quarter of adults with CHD were in health care within a 3-year time frame, suggesting need for better access to health insurance, transition care, and an increased number of physicians specializing in CHD care.
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Affiliation(s)
| | - Carol Hogue
- Emory University Rollins School of Public Health, Atlanta, GA
| | | | - Wendy Book
- Emory University School of Medicine, Atlanta, GA
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21
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Diallo AO, Krishnaswamy A, Shapira SK, Oster ME, George MG, Adams JC, Walker ER, Weiss P, Ali MK, Book W. Detecting moderate or complex congenital heart defects in adults from an electronic health records system. J Am Med Inform Assoc 2018; 25:1634-1642. [DOI: 10.1093/jamia/ocy127] [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] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 09/10/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The prevalence of moderate or complex (moderate-complex) congenital heart defects (CHDs) among adults is increasing due to improved survival, but many patients experience lapses in specialty care or their CHDs are undocumented in the medical system. There is, to date, no efficient approach to identify this population.
Objective
To develop and assess the performance of a risk score to identify adults aged 20-60 years with undocumented specific moderate-complex CHDs from electronic health records (EHR).
Methods
We used a case-control study (596 adults with specific moderate-complex CHDs and 2384 controls). We extracted age, race/ethnicity, electrocardiogram (EKG), and blood tests from routine outpatient visits (1/2009 through 12/2012). We used multivariable logistic regression models and a split-sample (4: 1 ratio) approach to develop and internally validate the risk score, respectively. We generated receiver operating characteristic (ROC) c-statistics and Brier scores to assess the ability of models to predict the presence of specific moderate-complex CHDs.
Results
Out of six models, the non-blood biomarker model that included age, sex, and EKG parameters offered a high ROC c-statistic of 0.96 [95% confidence interval: 0.95, 0.97] and low Brier score (0.05) relative to the other models. The adult moderate-complex congenital heart defect risk score demonstrated good accuracy with 96.4% sensitivity and 80.0% specificity at a threshold score of 10.
Conclusions
A simple risk score based on age, sex, and EKG parameters offers early proof of concept and may help accurately identify adults with specific moderate-complex CHDs from routine EHR systems who may benefit from specialty care.
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Affiliation(s)
- Alpha Oumar Diallo
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Asha Krishnaswamy
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stuart K Shapira
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew E Oster
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Sibley Heart Center Cardiology, Children’s Healthcare of Atlanta, Atlanta, GA, USA
- Emory University School of Medicine, Atlanta, GA, USA
| | - Mary G George
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jenna C Adams
- Emory University School of Medicine, Atlanta, GA, USA
| | | | - Paul Weiss
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mohammed K Ali
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Wendy Book
- Emory University School of Medicine, Atlanta, GA, USA
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22
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Glidewell J, Book W, Raskind-Hood C, Hogue C, Dunn JE, Gurvitz M, Ozonoff A, McGarry C, Van Zutphen A, Lui G, Downing K, Riehle-Colarusso T. Population-based surveillance of congenital heart defects among adolescents and adults: surveillance methodology. Birth Defects Res 2018; 110:1395-1403. [PMID: 30394691 DOI: 10.1002/bdr2.1400] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 06/13/2018] [Revised: 08/14/2018] [Accepted: 08/27/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Improved treatment of congenital heart defects (CHDs) has increased survival of persons with CHDs; however, no U.S. population-based systems exist to assess prevalence, healthcare utilization, or longer-term outcomes among adolescents and adults with CHDs. METHODS Novel approaches identified individuals aged 11-64 years who received healthcare with ICD-9-CM codes for CHDs at three sites: Emory University in Atlanta, Georgia (EU), Massachusetts Department of Public Health (MA), New York State Department of Health (NY) between January 1, 2008 (2009 for MA) and December 31, 2010. Case-finding sources included outpatient clinics; Medicaid and other claims data; and hospital inpatient, outpatient, and emergency visit data. Supplemental information came from state vital records (EU, MA), and birth defects registries (EU, NY). Demographics and diagnostic and procedural codes were linked, de-duplicated, and shared in a de-identified dataset. Cases were categorized into one of five mutually exclusive CHD severity groups; non-cardiac comorbidity codes were grouped into broad categories. RESULTS 73,112 individuals with CHD codes in healthcare encounters were identified. Primary data source type varied: clinics (EU, NY for adolescents), claims (MA), hospital (NY for adults). There was a high rate of missing data for some variables and data varied in format and quality. Some diagnostic codes had poor specificity for CHD ascertainment. CONCLUSIONS To our knowledge, this is the first population-based, multi-site CHD surveillance among adolescents and adults in the U.S. Identification of people living with CHDs through healthcare encounters using multiple data sources was feasible, though data quality varied and linkage/de-duplication was labor-intensive.
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Affiliation(s)
- Jill Glidewell
- Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
| | | | | | | | - Julie E Dunn
- Massachusetts Department of Public Health, Boston, Massachusetts
| | | | - Al Ozonoff
- Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | | | - Alissa Van Zutphen
- New York State Department of Health, Albany, New York.,University at Albany School of Public Health, Rensselaer, New York
| | - George Lui
- Stanford University School of Medicine, Stanford, California
| | - Karrie Downing
- Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Tiffany Riehle-Colarusso
- Centers for Disease Control and Prevention (CDC), National Center on Birth Defects and Developmental Disabilities, Atlanta, Georgia
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23
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Menachem JN, Lindenfeld J, Schlendorf K, Shah AS, Bichell DP, Book W, Brinkley DM, Danter M, Frischhertz B, Keebler M, Kogon B, Mettler B, Rossano J, Sacks SB, Young T, Wigger M, Zalawadiya S. Center volume and post-transplant survival among adults with congenital heart disease. J Heart Lung Transplant 2018; 37:1351-1360. [DOI: 10.1016/j.healun.2018.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/25/2018] [Accepted: 07/05/2018] [Indexed: 12/18/2022] Open
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24
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Hiremath G, Kodroff E, Strobel MJ, Scott M, Book W, Reidy C, Kyle S, Mack D, Sable K, Abonia P, Spergel J, Gupta SK, Furuta TG, Rothenberg ME, Dellon ES. Individuals affected by eosinophilic gastrointestinal disorders have complex unmet needs and frequently experience unique barriers to care. Clin Res Hepatol Gastroenterol 2018; 42:483-493. [PMID: 29615329 PMCID: PMC6167209 DOI: 10.1016/j.clinre.2018.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/08/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Eosinophilic gastrointestinal disorders (EGIDs) are a rare but emerging healthcare problem. Patient advocacy groups (PAGs) have an important role in representing the EGID community, and serve as valuable research partners. By leveraging the partnership between medical researchers and PAGs, we examined the unmet needs and barriers to care perceived by individuals affected by EGIDs. Next, we examined if these varied between adult EGID patients and adult caregivers of children with EGID. METHODS Adult EGID patients and adult caregivers of children (<18 years) with EGIDs participated in this study. PAGs conducted focus groups comprised of individuals affected by EGIDs to identify domains and questions meaningful to the EGID community and this information was used to develop an online REDCap survey. The survey consisted of 58 questions across medical, healthcare, social, and emotional impact domains. It was distributed via the PAGs' web-based platforms. Demographic data, and responses to questions on a six-point Likert scale were collected and analyzed. RESULTS Of the 361 responses analyzed, 90 (25%) were from adult EGID patients and 271 (75%) were from adult caregivers. Of the applicable responses, in the medical domain only 19% of participants indicated that repeated endoscopies to monitor response to treatment was convenient. In the healthcare domain, 67% indicated that lack of insurance coverage for elemental formula was a barrier. In the social domain, only 5% of respondents reported adequate awareness of EGIDs in schools. In the emotional domain, 64% had experienced significant stress due to EGID related out-of-pocket costs. Multivariate logistic regression revealed that some of these responses varied between adult EGID patients and adult caregivers of children with EGID. The respondents indicated highest priority for improvement in the medical domain compared to other domains. CONCLUSIONS Individuals affected by EGIDs have a constellation of complex unmet needs and perceived barriers across medical, healthcare, social and emotional domains. Addressing unmet needs in the medical domain is relatively more important for the EGID community. Understanding unmet needs and barriers will likely help design improved patient-centered EGID care paradigms.
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Affiliation(s)
- Girish Hiremath
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Monroe Carell Jr Children's Hospital at Vanderbilt, DOT Suite 10226, 2200 Children's Way, Nashville, TN 37232, USA.
| | - Ellyn Kodroff
- Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, IL, USA
| | - Mary J Strobel
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | | | - Wendy Book
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Cathy Reidy
- Eosinophilic Family Coalition, Cincinnati, OH, USA
| | - Shay Kyle
- Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, IL, USA
| | - Denise Mack
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Kathleen Sable
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Pablo Abonia
- Division of Allergy and Immunology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Jonathan Spergel
- Division of Allergy and Immunology, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Illinois College of Medicine, Peoria, IL, USA
| | - T Glenn Furuta
- Digestive Health Institute, Gastrointestinal Eosinophilic Diseases Program, Children's Hospital Colorado, Aurora, CO, USA
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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25
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Spergel JM, Aceves SS, Kliewer K, Gonsalves N, Chehade M, Wechsler JB, Groetch M, Friedlander J, Dellon ES, Book W, Hirano I, Muir AB, Cianferoni A, Spencer L, Liacouras CA, Cheng E, Kottyan L, Wen T, Platts-Mills T, Rothenberg ME. New developments in patients with eosinophilic gastrointestinal diseases presented at the CEGIR/TIGERS Symposium at the 2018 American Academy of Allergy, Asthma & Immunology Meeting. J Allergy Clin Immunol 2018; 142:48-53. [PMID: 29803797 PMCID: PMC6129859 DOI: 10.1016/j.jaci.2018.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 12/28/2022]
Abstract
The Consortium of Eosinophilic Gastrointestinal Diseases and the International Gastrointestinal Eosinophil Researchers organized a day-long symposium at the recent 2018 Annual Meeting of the American Academy of Allergy, Asthma & Immunology, which was coupled for the first time with the World Allergy Organization meeting to create an international platform. The symposium featured experts in many facets of eosinophilic gastrointestinal diseases, including allergy, immunology, gastroenterology, pathology, and nutrition, and was a well-attended event. The basic science, genetics, cellular immunology, and clinical features of the diseases, with a focus on epithelial, eosinophil, and mast cell responses, as well as current and emerging treatment options, were reviewed. Here we briefly review some of the highlights of the material presented at the meeting.
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Affiliation(s)
- Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Seema S Aceves
- Division of Allergy, Immunology, Departments of Pediatrics and Medicine, University of California, San Diego, Rady Children's Hospital, San Diego, La Jolla, Calif
| | - Kara Kliewer
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Nirmala Gonsalves
- Division of Gastroenterology and Hepatology, Northwestern University-Feinberg School of Medicine, Chicago, Ill
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua B Wechsler
- Eosinophilic Gastrointestinal Diseases Program, Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Marion Groetch
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Friedlander
- Digestive Health Institute, Children's Hospital Colorado, and the Aerodigestive Program, University of Colorado School of Medicine, Aurora, Colo
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Wendy Book
- American Partnership for Eosinophilic Disorders, Atlanta, Ga
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Northwestern University-Feinberg School of Medicine, Chicago, Ill
| | - Amanda B Muir
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Antonella Cianferoni
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | | | - Chris A Liacouras
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; Division of Gastroenterology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Edaire Cheng
- Departments of Pediatrics and Internal Medicine, Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Leah Kottyan
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Ting Wen
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Thomas Platts-Mills
- Division of Asthma, Allergy, and Immunology, University of Virginia, Charlottesville, Va
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
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Cole RT, Gandhi J, Bray RA, Gebel HM, Yin M, Shekiladze N, Young A, Grant A, Mahoney I, Laskar SR, Gupta D, Bhatt K, Book W, Smith A, Nguyen D, Vega JD, Morris AA. Racial differences in the development of de-novo donor-specific antibodies and treated antibody-mediated rejection after heart transplantation. J Heart Lung Transplant 2018; 37:503-512. [DOI: 10.1016/j.healun.2017.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/01/2017] [Accepted: 11/01/2017] [Indexed: 11/29/2022] Open
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Kendsersky P, Book W, Rodriguez F, Lloyd M. CLINICAL OUTCOMES OF NOVEL ANTICOAGULANT VERSUS VITAMIN K ANTAGONIST USE IN ADULTS WITH FONTAN CIRCULATION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31079-9] [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: 11/29/2022]
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28
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Saraf A, De Stearcke C, Gerardin J, Pernetz M, Ephrem G, Adjei S, Jennings S, Abdelhadi N, Kim J, Rodriguez F, Book W. FONTAN PHENOTYPES HAVE SIGNATURE BIOMARKER EXPRESSION PROFILES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31168-9] [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: 10/17/2022]
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Rodriguez FH, Ephrem G, Gerardin JF, Raskind-Hood C, Hogue C, Book W. The 745.5 issue in code-based, adult congenital heart disease population studies: Relevance to current and future ICD-9-CM and ICD-10-CM studies. CONGENIT HEART DIS 2017; 13:59-64. [PMID: 29266726 DOI: 10.1111/chd.12563] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although the ICD-9-CM code 745.5 is widely used to indicate the presence of a secundum atrial septal defect (ASD), it is also used for patent foramen ovale (PFO) which is a normal variant and for "rule-out" congenital heart disease (CHD). The ICD-10-CM code Q21.1 perpetuates this issue. The objective of this study was to assess whether code 745.5 in isolation or in combination with unspecified CHD codes 746.9 or 746.89 miscodes for CHD, and if true CHD positives decrease with age. DESIGN Echocardiograms of patients with an ICD-9-CM code of 745.5 in isolation or in combination with unspecified CHD codes 746.9 or 746.89 were reviewed to validate the true incidence of an ASD. This observational, cross-sectional record review included patients between 11 and 64 years of age. RESULTS Medical charts and echocardiograms of 190 patients (47.9% males) were reviewed. The number of falsely coded patients with 745.5 (no ASD) was high (76.3%). Forty-five (23.7%) patients had a true ASD. Among the 145 patients without an ASD, 100 (52.6%) were classified as having a PFO, 37 (19.5%) had a normal non-CHD echocardiogram, and 8 (4.2%) had some other CHD anomaly. The likelihood that 745.5 coded for a true ASD was higher in children aged 11-20 (64.3%) than adults aged 21-64 years (20.6%). CONCLUSIONS This validation study demonstrates that 745.5 performed poorly across all ages. As 745.5 is widely used in population-level investigations and ICD-10-CM perpetuates the problem, future analyses utilizing CHD codes should consider separate analysis of those identified only through code 745.5.
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Affiliation(s)
- Fred H Rodriguez
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA.,Sibley Heart Center Cardiology, Atlanta, Georgia, USA
| | - Georges Ephrem
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jennifer F Gerardin
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Cheryl Raskind-Hood
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Carol Hogue
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Wendy Book
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Daniels CJ, Bradley EA, Landzberg MJ, Aboulhosn J, Beekman RH, Book W, Gurvitz M, John A, John B, Marelli A, Marino BS, Minich LL, Poterucha JJ, Rand EB, Veldtman GR. Fontan-Associated Liver Disease. J Am Coll Cardiol 2017; 70:3173-3194. [DOI: 10.1016/j.jacc.2017.10.045] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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31
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Jessup M, Drazner MH, Book W, Cleveland JC, Dauber I, Farkas S, Ginwalla M, Katz JN, Kirkwood P, Kittleson MM, Marine JE, Mather P, Morris AA, Polk DM, Sakr A, Schlendorf KH, Vorovich EE. 2017 ACC/AHA/HFSA/ISHLT/ACP Advanced Training Statement on Advanced Heart Failure and Transplant Cardiology (Revision of the ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant): A Report of the ACC Competency Management Committee. Circ Heart Fail 2017; 10:HHF.0000000000000021. [DOI: 10.1161/hhf.0000000000000021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
| | | | | | - Joseph C. Cleveland
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | - Ira Dauber
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | | | - Mahazarin Ginwalla
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | - Jason N. Katz
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | | | | | | | - Paul Mather
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | - Alanna A. Morris
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
| | | | | | - Kelly H. Schlendorf
- Official International Society for Heart & Lung Transplantation Representative. Official Heart Failure Society of America Representative. Official American College of Physicians Representative. Official American Heart Association Representative
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Jessup M, Drazner MH, Book W, Cleveland JC, Dauber I, Farkas S, Ginwalla M, Katz JN, Kirkwood P, Kittleson MM, Marine JE, Mather P, Morris AA, Polk DM, Sakr A, Schlendorf KH, Vorovich EE. 2017 ACC/AHA/HFSA/ISHLT/ACP Advanced Training Statement on Advanced Heart Failure and Transplant Cardiology (Revision of the ACCF/AHA/ACP/HFSA/ISHLT 2010 Clinical Competence Statement on Management of Patients With Advanced Heart Failure and Cardiac Transplant): A Report of the ACC Competency Management Committee. J Card Fail 2017; 23:492-511. [PMID: 28454730 DOI: 10.1016/j.cardfail.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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33
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Cole RT, Gandhi J, Bray RA, Gebel HM, Morris A, McCue A, Yin M, Laskar SR, Book W, Jokhadar M, Smith A, Nguyen D, Vega JD, Gupta D. De novo DQ donor-specific antibodies are associated with worse outcomes compared to non-DQ de novo donor-specific antibodies following heart transplantation. Clin Transplant 2017; 31. [DOI: 10.1111/ctr.12924] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Robert Townsend Cole
- Emory University Center for Heart Failure Therapy and Transplantation; Atlanta GA USA
| | | | - Robert A. Bray
- Emory University Department of Pathology and Laboratory Medicine; Atlanta GA USA
| | - Howard M. Gebel
- Emory University Department of Pathology and Laboratory Medicine; Atlanta GA USA
| | - Alanna Morris
- Emory University Center for Heart Failure Therapy and Transplantation; Atlanta GA USA
| | - Andrew McCue
- Emory University Department of Medicine; Atlanta GA USA
| | - Michael Yin
- Emory University Department of Medicine; Atlanta GA USA
| | - S. Raja Laskar
- Emory University Center for Heart Failure Therapy and Transplantation; Atlanta GA USA
| | - Wendy Book
- Emory University Center for Heart Failure Therapy and Transplantation; Atlanta GA USA
| | - Maan Jokhadar
- Emory University Center for Heart Failure Therapy and Transplantation; Atlanta GA USA
| | - Andrew Smith
- Emory University Center for Heart Failure Therapy and Transplantation; Atlanta GA USA
| | - Duc Nguyen
- Emory University Center for Heart Failure Therapy and Transplantation; Atlanta GA USA
| | - J. David Vega
- Emory University Center for Heart Failure Therapy and Transplantation; Atlanta GA USA
| | - Divya Gupta
- Emory University Center for Heart Failure Therapy and Transplantation; Atlanta GA USA
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34
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Saraf A, Staercke CD, Rodriguez F, Kalogeropoulos A, Knezevic A, Gerardin J, Ephrem G, Hayek S, Jennings S, Katabarwa A, Quyyumi A, Book W. BIOMARKER PROFILE IN ADULTS WITH FONTAN CIRCULATION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34039-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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]
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35
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Ephrem G, Esmaeeli A, Gerardin J, Saraf A, Hayek S, Jennings S, Katabarwa A, Rodriguez F, Quyyumi A, Book W. RED BLOOD CELL DISTRIBUTION WIDTH AND OUTCOMES IN FONTAN PATIENTS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33949-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kalogeropoulos AP, Savvoulidis P, Saraf A, Rodriguez F, Hoffman T, Raskind-Hood C, Hogue C, Book W. PREVALENCE AND INCIDENCE OF HEART FAILURE IN ADOLESCENTS AND ADULTS WITH REPAIRED TETRALOGY OF FALLOT. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)33952-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kogon B, Rosenblum J, Alsoufi B, Shashidharan S, Book W. The Evolution of an Adult Congenital Heart Surgery Program: The Emory System. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2017; 20:28-32. [PMID: 28007061 DOI: 10.1053/j.pcsu.2016.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 06/06/2023]
Abstract
The Emory Adult Congenital Heart (Emory University, Atlanta, GA) program was founded in 2001. In 2004, the surgical component transitioned from a pediatric facility to an adult facility. The aim of this article is characterize the program as a whole, outline changes in the program, and discuss the challenges of the transition process. Between 2001 and 2015, changes in program structure and personnel were evaluated. There has been significant growth of the program between 2001 and 2015. There are currently 19 half-day clinics per week, with 2,700 clinic visits per year. There are six cardiologists, three congenital cardiac surgeons, two sonographers, one advanced practice provider, and one social worker dedicated to the program. There are Accreditation Council for Graduate Medical Education-accredited adult congenital cardiology and congenital cardiac surgery fellowships. One thousand forty-four operations were performed between 2001 and 2015. There were 828 open-heart operations, of which 581 (70%) were re-operations. Over the study period, the number of yearly operations increased from 30 to 119, and the mean age at surgery increased from 22 to 35 years. Over time, more of the operations were performed at the adult hospital: increasing from 3% in 2001 to 82% in 2015, and more of the operations were performed by congenital cardiac surgeons: 87% (114 of 131) before the 2004 transition to 97% (881 of 913) afterward. The Emory Adult Congenital Heart program has undergone significant growth and change, including transition of the surgical component from the pediatric to the adult facility. While numerous obstacles have been overcome and great progress has been made, additional challenges remain.
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Affiliation(s)
- Brian Kogon
- Department of Cardiothoracic Surgery, Emory University, Atlanta, GA.
| | - Joshua Rosenblum
- Department of Cardiothoracic Surgery, Emory University, Atlanta, GA
| | | | | | - Wendy Book
- Division of Cardiology, Emory University, Atlanta, GA
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38
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Ilardi D, Ono KE, McCartney R, Book W, Stringer AY. Neurocognitive functioning in adults with congenital heart disease. CONGENIT HEART DIS 2016; 12:166-173. [DOI: 10.1111/chd.12434] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 08/12/2016] [Accepted: 09/16/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Dawn Ilardi
- Department of Neuropsychology, Children's Healthcare of Atlanta; Atlanta Georgia USA
- Department of Rehabilitation Medicine, Emory University; Atlanta Georgia USA
| | - Kim E. Ono
- Department of Neuropsychology, Children's Healthcare of Atlanta; Atlanta Georgia USA
- Department of Rehabilitation Medicine, Emory University; Atlanta Georgia USA
| | - Rebecca McCartney
- Behavioral Health, Southeast Permanente Medical Group; Tucker Georgia USA
| | - Wendy Book
- Department of Internal Medicine, Division of Cardiology, Emory University; Atlanta Georgia USA
| | - Anthony Y. Stringer
- Department of Rehabilitation Medicine, Emory University; Atlanta Georgia USA
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Hebson C, Book W, Elder RW, Ford R, Jokhadar M, Kanter K, Kogon B, Kovacs AH, Levit RD, Lloyd M, Maher K, Reshamwala P, Rodriguez F, Romero R, Tejada T, Marie Valente A, Veldtman G, McConnell M. “Frontiers in Fontan failure: A summary of conference proceedings”. CONGENIT HEART DIS 2016; 12:6-16. [DOI: 10.1111/chd.12407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/24/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Camden Hebson
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
- Division of Pediatric Cardiology; Department of Pediatrics, Emory University; Atlanta GA
| | - Wendy Book
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
| | - Robert W. Elder
- Division of Cardiology; Department of Medicine, Yale University; New Haven CT
| | - Ryan Ford
- Division of Gastroenterology; Department of Medicine, Emory University; Atlanta GA
| | - Maan Jokhadar
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
| | - Kirk Kanter
- Division of Cardiothoracic Surgery; Department of Surgery, Emory University; Atlanta GA
| | - Brian Kogon
- Division of Cardiothoracic Surgery; Department of Surgery, Emory University; Atlanta GA
| | - Adrienne H. Kovacs
- Division of Cardiology; Department of Medicine, Oregon Health and Science University; Portland OR
| | - Rebecca D. Levit
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
| | - Michael Lloyd
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
| | - Kevin Maher
- Division of Pediatric Cardiology; Department of Pediatrics, Emory University; Atlanta GA
| | - Preeti Reshamwala
- Division of Gastroenterology; Department of Medicine, Emory University; Atlanta GA
| | - Fred Rodriguez
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
- Division of Pediatric Cardiology; Department of Pediatrics, Emory University; Atlanta GA
| | - Rene Romero
- Division of Pediatric Gastroenterology; Department of Pediatrics, Emory University; Atlanta GA
| | - Thor Tejada
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
| | - Anne Marie Valente
- Division of Cardiology; Department of Medicine, Harvard University; Boston MA
| | - Gruschen Veldtman
- Division of Pediatric Cardiology; Department of Pediatrics, University of Cincinnati; Cincinnati OH
| | - Michael McConnell
- Division of Cardiology; Department of Medicine, Emory University; Atlanta GA
- Division of Pediatric Cardiology; Department of Pediatrics, Emory University; Atlanta GA
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McCabe N, Dunbar SB, Butler J, Higgins M, Book W, Reilly C. Antecedents of self-care in adults with congenital heart defects. Int J Cardiol 2015; 201:610-5. [PMID: 26340127 DOI: 10.1016/j.ijcard.2015.08.125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/13/2015] [Accepted: 08/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adults with congenital heart defects (ACHD) face long-term complications related to prior surgery, abnormal anatomy, and acquired cardiovascular conditions. Although self-care is an important part of chronic illness management, few studies have explored self-care in the ACHD population. The purpose of this study is to describe self-care and its antecedents in the ACHD population. METHODS Persons with moderate or severe ACHD (N=132) were recruited from a single ACHD center. Self-care (health maintenance behaviors, monitoring and management of symptoms), and potential antecedents including sociodemographic and clinical characteristics, ACHD knowledge, behavioral characteristics (depressive symptoms and self-efficacy), and family-related factors (parental overprotection and perceived family support) were collected via self-report and chart review. Multiple regression was used to identify antecedents of self-care maintenance, monitoring, and management. RESULTS Only 44.7%, 27.3%, and 23.3% of participants performed adequate levels of self-care maintenance, monitoring and management, respectively. In multiple regression analysis, self-efficacy, education, gender, perceived family support, and comorbidities explained 25% of the variance in self-care maintenance (R(2)=.248, F(5, 123)=9.44, p<.001). Age, depressive symptoms, self-efficacy, and NYHA Class explained 23% of the variance in self-care monitoring (R(2)=.232, F(2, 124)=10.66, p<.001). Self-efficacy and NYHA Class explained 9% of the variance in self-care management (R(2)=.094, F(2, 80)=5.27, p=.007). CONCLUSIONS Low levels of self-care are common among persons with ACHD. Multiple factors, including modifiable factors of self-efficacy, depressive symptoms, and perceived family support, are associated with self-care and should be considered in designing future interventions to improve outcomes in the ACHD population.
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Affiliation(s)
- Nancy McCabe
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States.
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Javed Butler
- Cardiology Division, School of Medicine, Stony Brook University, Stony Brook, NY, United States
| | - Melinda Higgins
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Wendy Book
- Cardiology Division, School of Medicine, Emory University, Atlanta, GA, United States
| | - Carolyn Reilly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
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Mori M, Shioda K, Pernetz M, Elder R, Rangosch A, Book W, Rodriguez F, Sahu A, Kogon B, McConnell M, Hebson C, Jokhadar M. DIASTOLIC DYSFUNCTION BY DOPPLER ECHOCARDIOGRAM IS ASSOCIATED WITH MAJOR ADVERSE EVENTS IN ADULT FONTAN PATIENTS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60520-4] [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: 10/23/2022]
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Mori M, Hebson C, Shioda K, Elder R, Rodriguez F, Jokhadar M, McCabe N, Kogon B, McConnell M, Sahu A, Book W. CATHETER-MEASURED HEMODYNAMICS OF ADULT FONTAN CIRCULATION: ASSOCIATION WITH MAJOR ADVERSE EVENT. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60537-x] [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]
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Abstract
In this article, we review both acute and chronic liver diseases that occur as a result of heart or circulatory system failure. Ischemic hepatitis, congestive hepatopathy, cardiac cirrhosis, and Fontan liver disease are reviewed. We review clinical presentation, diagnostic data, prognosis, and available therapeutic strategies for these entities. We aim to increase awareness about cardio-hepatic disease as the prevalence of this disorder in adults is increasing. Due to advances in medical and surgical care, patients with heart disease are living longer and thus exposing long-term effects on the liver that are clinically relevant. There may be a role for dual organ transplantation in some cases, but this is a very challenging endeavor, and newer ideas about treatment or prevention are needed.
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Affiliation(s)
- Ryan M Ford
- Department of Digestive Diseases, Emory Transplant Center, Emory University, Atlanta, GA, USA.
| | - Wendy Book
- Department of Cardiology, Director of Adult Congenital Heart Disease, Emory University, Atlanta, GA, USA
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Cole RT, Patel A, Butler J, Smith A, Book W, Morris A, Gupta D. Elevated PVR Is Associated with Improved 6-Month Survival in Patients on Continuous Milrinone Infusion as Destination Therapy. J Card Fail 2014. [DOI: 10.1016/j.cardfail.2014.06.323] [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: 11/16/2022]
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Kogon BE, Daniel W, Fay K, Book W. Is the liberal use of preoperative 3-dimensional imaging and presternotomy femoral cutdown beneficial in reoperative adult congenital heart surgery? J Thorac Cardiovasc Surg 2014; 147:1799-804. [DOI: 10.1016/j.jtcvs.2013.07.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 07/04/2013] [Accepted: 07/26/2013] [Indexed: 11/28/2022]
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46
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Mori M, Jokhadar M, Shioda K, Sahu A, Elder R, Hebson C, McCabe N, Kogon B, Book W. REDUCED HEPATIC VENOUS FLOW IS A MARKER OF ADVERSE OUTCOMES IN PATIENTS WITH FONTAN CIRCULATION. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)60566-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Morris AA, Veledar E, Cole RT, Gupta D, Sims DB, Book W, Smith AL, Butler J. Wait List Mortality Is Higher for Female Heart Transplant Candidates. J Card Fail 2013. [DOI: 10.1016/j.cardfail.2013.06.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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48
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Kella D, Merchant F, Book W, Langberg J, Lloyd MS. OUTCOMES OF CARDIAC RESYNCHRONIZATION THERAPY IN ADULT PATIENTS WITH SURGICALLY REPAIRED TETRALOGY OF FALLOT AND LEFT VENTRICULAR SYSTOLIC DYSFUNCTION. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60553-7] [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: 11/30/2022]
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49
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Elder RW, McCabe N, Veledar E, Sahu A, Jokhadar M, Kogon B, McConnell M, Book W. TRANSPLANT-FREE SURVIVAL AND HOSPITALIZATIONS LATE AFTER THE FONTAN PALLIATION. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60428-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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]
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Kogon B, Grudziak J, Sahu A, Jokhadar M, McConnell M, Book W, Oster M. Surgery in adults with congenital heart disease: risk factors for morbidity and mortality. Ann Thorac Surg 2013; 95:1377-82; discussion 1382. [PMID: 23462261 DOI: 10.1016/j.athoracsur.2012.11.076] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [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: 09/29/2012] [Revised: 11/11/2012] [Accepted: 11/19/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with congenital heart disease are frequently surviving into adulthood, and many of them will require surgery. Unfortunately, outcome data in this patient population are limited. We aimed to identify risk factors associated with adverse events in adults with congenital heart disease undergoing cardiac surgery and establish long-term survival data. METHODS We retrospectively studied 458 adult patients who underwent cardiac surgery for congenital heart disease between 2000 and 2010. We constructed logistic models to assess risk factors for mortality, major adverse event (stroke, renal failure, prolonged ventilation, prolonged coma, deep sternal infection, reoperation, and operative mortality), and prolonged length of stay (>7 days). Long-term, all-cause mortality was also measured. RESULTS Sixteen patients died (3.49%). Risk factors for mortality included a history of cerebrovascular disease (odds ratio [OR]: 4.51), New York Heart Association (NYHA) class 3 or 4 (OR: 8.88), and surgery on the aorta or the aortic valve (OR: 5.74). Ninety-four patients suffered a major adverse event (20.5%). Significant risk factors were male gender (OR: 2.28), NYHA class of 3 or 4 (OR 2.58), 2 concomitant major operations (OR: 2.15), and cardiopulmonary bypass time of greater than 100 minutes (OR: 3.18). Last, 90 patients (19.7%) remained in the hospital longer than 7 days. Significant risk factors for a prolonged length of stay included chronic lung disease (OR: 3.05), NYHA class of 3 or 4 (OR: 3.69), surgery by an adult cardiac surgeon (OR 2.58), 2 concomitant major operations (OR: 3.28), and cardiopulmonary bypass time of greater than 100 minutes (OR: 2.41). Survival at 1, 5, and 10 years was 97.6%, 95.2%, and 93.4%, respectively. CONCLUSIONS Surgery in adults with congenital heart disease can be performed with low morbidity and mortality. Nonetheless, there remain important risk factors for adverse events. Awareness and modification of risk factors may help improve outcomes.
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Affiliation(s)
- Brian Kogon
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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