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Webber CM, Riberdy Hammer A, Saha A, Marinac-Dabic D, Caños DA, Tarver ME. Integrating Patient-Generated Health Data Throughout the Total Product Life Cycle of Medical Devices. Ther Innov Regul Sci 2023:10.1007/s43441-023-00505-5. [PMID: 37294529 PMCID: PMC10400470 DOI: 10.1007/s43441-023-00505-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/24/2023] [Indexed: 06/10/2023]
Abstract
Nearly ubiquitous use of personal electronics, wearable sensors, and other types of digital health technologies, along with wireless connectivity, makes the capture of health data directly from an individual easier, enabling the use of patient-generated health data (PGHD) as a potential bridge between a patient's home and the healthcare system. This type of real-world data may be a completely new type of information, or it may be a more frequent collection of traditional information over longer time periods to form a longitudinal view of a patient's health status that can inform decision-making in clinical, medical product regulatory, and coverage and reimbursement settings. The U.S. Food and Drug Administration's Center for Devices and Radiological Health (CDRH) has been exploring and advancing the collection and use of PGHD since 2016, hosting a public meeting on the topic in May 2021. This manuscript presents highlights from various discussions at this meeting including those on the importance of stakeholder engagement, characteristics of high data quality, and PGHD in practice in patient-driven registries, as well as a look forward to some of the opportunities in the field.
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Affiliation(s)
- Christina M Webber
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA.
| | - Anne Riberdy Hammer
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Anindita Saha
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Daniel A Caños
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
| | - Michelle E Tarver
- Center for Devices and Radiological Health, U.S. Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD, 20993, USA
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Brennan JM, Wruck L, Pencina MJ, Clare RM, Lopes RD, Alexander JH, O'Brien S, Krucoff M, Rao SV, Wang TY, Curtis LH, Newby LK, Granger CB, Patel M, Mahaffey K, Ross JS, Normand SL, Eloff BC, Caños DA, Lokhnygina YV, Roe MT, Califf RM, Marinac-Dabic D, Peterson ED. Claims-based cardiovascular outcome identification for clinical research: Results from 7 large randomized cardiovascular clinical trials. Am Heart J 2019; 218:110-122. [PMID: 31726314 DOI: 10.1016/j.ahj.2019.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Medicare insurance claims may provide an efficient means to ascertain follow-up of older participants in clinical research. We sought to determine the accuracy and completeness of claims- versus site-based follow-up with clinical event committee (+CEC) adjudication of cardiovascular outcomes. METHODS We performed a retrospective study using linked Medicare and Duke Database of Clinical Trials data. Medicare claims were linked to clinical data from 7 randomized cardiovascular clinical trials. Of 52,476 trial participants, linking resulted in 5,839 (of 10,497 linkage-eligible) Medicare-linked trial participants with fee-for-service A and B coverage. Death, myocardial infarction (MI), stroke, and revascularization incidences were compared using Medicare inpatient claims only, site-reported events (+CEC) only, or a combination of the 2. Randomized treatment effects were compared as a function of whether claims-based, site-based (+CEC), or a combined system was used for event detection. RESULTS Among the 5,839 study participants, the annual event rates were similar between claims- and site-based (+CEC) follow-up: death (overall rate 5.2% vs 5.2%; adjusted κ 0.99), MI (2.2% vs 2.3%; adjusted κ 0.96), stroke (0.7% vs 0.7%; adjusted κ 0.99), and any revascularization (7.4% vs 7.9%; adjusted κ 0.95). Of events detected by claims yet not reported by CEC, a minority were reported by sites but negatively adjudicated by CEC (39% of MIs and 18% of strokes). Differences in individual case concordance led to higher event rates when claims- and site-based (+CEC) systems were combined. Randomized treatment effects were similar among the 3 approaches for each outcome of interest. CONCLUSIONS Claims- versus site-based (+CEC) follow-up identified similar overall cardiovascular event rates despite meaningful differences in the events detected. Randomized treatment effects were similar using the 2 methods, suggesting claims data could be used to support clinical research leveraging routinely collected data. This approach may lead to more effective evidence generation, synthesis, and appraisal of medical products and inform the strategic approaches toward the National Evaluation System for Health Technology.
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Affiliation(s)
| | - Lisa Wruck
- Duke University School of Medicine, Durham, NC
| | | | | | | | | | | | | | - Sunil V Rao
- Duke University School of Medicine, Durham, NC
| | | | | | | | | | | | | | | | | | - Benjamin C Eloff
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD
| | - Daniel A Caños
- Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Baltimore, MD
| | | | | | | | - Danica Marinac-Dabic
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD
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Zusterzeel R, Mishra NK, Beydoun H, Laschinger J, Wu C, Dong LM, Lin JA, Marinac-Dabic D, Strauss DG, Caños DA. Sex-Specific Outcomes After Transcatheter Aortic Valve Replacement: FDA Patient-Level Meta-Analysis of Premarket Clinical Trials. J Womens Health (Larchmt) 2018; 27:808-814. [DOI: 10.1089/jwh.2017.6760] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Hind Beydoun
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | | | - Changfu Wu
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Li Ming Dong
- U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Ja-An Lin
- U.S. Food and Drug Administration, Silver Spring, Maryland
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Zusterzeel R, O'Callaghan KM, Caños DA, Sanders WE, Marinac-Dabic D, Strauss DG. Improving the Safety and Effectiveness of Medical Device Therapy in Women. J Womens Health (Larchmt) 2016; 25:428-30. [DOI: 10.1089/jwh.2015.5605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zusterzeel R, Selzman KA, Sanders WE, O’Callaghan KM, Caños DA, Vernooy K, Prinzen FW, Gorgels APM, Strauss DG. Toward Sex-Specific Guidelines for Cardiac Resynchronization Therapy? J Cardiovasc Transl Res 2015; 9:12-22. [DOI: 10.1007/s12265-015-9663-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
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Herz ND, Engeda J, Zusterzeel R, Sanders WE, O'Callaghan KM, Strauss DG, Jacobs SB, Selzman KA, Piña IL, Caños DA. Sex differences in device therapy for heart failure: utilization, outcomes, and adverse events. J Womens Health (Larchmt) 2015; 24:261-71. [PMID: 25793483 DOI: 10.1089/jwh.2014.4980] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Multiple studies of heart failure patients demonstrated significant improvement in exercise capacity, quality of life, cardiac left ventricular function, and survival from cardiac resynchronization therapy (CRT), but the underenrollment of women in these studies is notable. Etiological and pathophysiological differences may result in different outcomes in response to this treatment by sex. The observed disproportionate representation of women suggests that many women with heart failure either do not meet current clinical criteria to receive CRT in trials or are not properly recruited and maintained in these studies. METHODS We performed a systematic literature review through May 2014 of clinical trials and registries of CRT use that stratified outcomes by sex or reported percent women included. One-hundred eighty-three studies contained sex-specific information. RESULTS Ninety percent of the studies evaluated included ≤ 35% women. Fifty-six articles included effectiveness data that reported response with regard to specific outcome parameters. When compared with men, women exhibited more dramatic improvement in specific parameters. In the studies reporting hazard ratios for hospitalization or death, women generally had greater benefit from CRT. CONCLUSIONS Our review confirms women are markedly underrepresented in CRT trials, and when a CRT device is implanted, women have a therapeutic response that is equivalent to or better than in men, while there is no difference in adverse events reported by sex.
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Affiliation(s)
- Naomi D Herz
- Center for Devices and Radiological Health, United States Food and Drug Administration , Silver Spring, Maryland
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Zusterzeel R, Spatz ES, Curtis JP, Sanders WE, Selzman KA, Piña IL, Bao H, Ponirakis A, Varosy PD, Masoudi FA, Caños DA, Strauss DG. Cardiac resynchronization therapy in women versus men: observational comparative effectiveness study from the National Cardiovascular Data Registry. Circ Cardiovasc Qual Outcomes 2015; 8:S4-11. [PMID: 25714821 DOI: 10.1161/circoutcomes.114.001548] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Women have been under-represented in trials of cardiac resynchronization therapy-defibrillators (CRT-D). Previous studies suggest that women benefit from CRT-D at shorter QRS duration than men and that there may be no benefit of CRT-D in patients without left bundle branch block (LBBB) regardless of patient sex. METHODS AND RESULTS We compared sex-specific death risk in 75 079 patients with New York Heart Association class III or IV heart failure, reduced left ventricular ejection fraction, and prolonged QRS duration (≥120 ms) receiving either CRT-D or implantable cardioverter defibrillator in subgroups according to QRS morphology and 10-ms increments in QRS duration. We applied propensity score weighting to control for differences between treatments. Among patients with LBBB, women receiving CRT-D had a lower relative death risk than those receiving an implantable cardioverter-defibrillator (absolute difference, 11%; hazard ratio=0.74 [95% confidence interval, 0.68-0.81]). In men, the lower mortality with CRT-D versus implantable cardioverter defibrillator was less pronounced (absolute difference, 9%; hazard ratio=0.84 [0.79-0.89]; sex×device interaction P=0.025). In those without LBBB, the mortality difference was modest and did not differ between women and men (absolute difference, 3%; hazard ratio=0.88 [0.79-0.97] in women and absolute difference, 2%; hazard ratio=0.95 [0.91-0.998] in men; interaction P=0.17). In subgroups according to QRS duration, CRT-D was associated with better survival in both sexes with LBBB and QRS ≥130 ms, whereas there was no clear relation between QRS duration and survival in patients without LBBB regardless of patient sex. CONCLUSIONS In a large real-world population CRT-D was associated with a lower mortality risk in both sexes with LBBB, although more pronounced among women. Only among those with LBBB, both sexes had better survival with longer QRS duration. The mortality differences in patients without LBBB were attenuated in both sexes.
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Affiliation(s)
- Robbert Zusterzeel
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Erica S Spatz
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Jeptha P Curtis
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - William E Sanders
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Kimberly A Selzman
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Ileana L Piña
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Haikun Bao
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Angelo Ponirakis
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Paul D Varosy
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Frederick A Masoudi
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - Daniel A Caños
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.)
| | - David G Strauss
- From the Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD (R.Z., W.E.S., K.A.S., I.L.P., D.A.C., D.G.S.); Yale School of Medicine, New Haven, CT (E.S.S., J.P.C., H.B.); American College of Cardiology Foundation, Washington, DC (A.P.); VA Eastern Colorado Health Care System, University of Colorado, Denver (P.D.V.); Colorado Cardiovascular Outcomes Research Group, Denver (P.D.V.); and University of Colorado Anschutz Medical Campus, Aurora (F.A.M.).
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Zusterzeel R, Caños DA, Sanders WE, Selzman KA, Ponirakis A, Varosy PD, Strauss DG. Reply. J Am Coll Cardiol 2015; 65:515. [DOI: 10.1016/j.jacc.2014.10.062] [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] [Received: 10/06/2014] [Accepted: 10/21/2014] [Indexed: 10/24/2022]
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Zusterzeel R, Curtis JP, Caños DA, Sanders WE, Selzman KA, Piña IL, Spatz ES, Bao H, Ponirakis A, Varosy PD, Masoudi FA, Strauss DG. Sex-Specific Mortality Risk by QRS Morphology and Duration in Patients Receiving CRT. J Am Coll Cardiol 2014; 64:887-94. [DOI: 10.1016/j.jacc.2014.06.1162] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 05/20/2014] [Accepted: 06/03/2014] [Indexed: 10/24/2022]
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Zusterzeel R, Selzman KA, Sanders WE, Caños DA, O'Callaghan KM, Carpenter JL, Piña IL, Strauss DG. Cardiac resynchronization therapy in women: US Food and Drug Administration meta-analysis of patient-level data. JAMA Intern Med 2014; 174:1340-8. [PMID: 25090172 DOI: 10.1001/jamainternmed.2014.2717] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [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 Women were underrepresented in cardiac resynchronization therapy (CRT) trials for heart failure (making up about 20% of enrollees). Combining individual patient data from multiple clinical trials would enable assessment of CRT benefit in women. OBJECTIVE To evaluate whether women with left bundle branch block (LBBB) benefit from CRT-defibrillators (CRT-D) at a shorter QRS duration than men with LBBB do. DESIGN, SETTING, AND PARTICIPANTS Individual patient data were pooled from 3 CRT-D vs implantable cardioverter defibrillator (ICD) trials (4076 patients) enrolling predominantly patients with New York Heart Association (NYHA) class II heart failure and follow-up to 3 years. The effect of CRT-D compared with ICD on outcomes was assessed using random effects Cox proportional hazards. MAIN OUTCOMES AND MEASURES Time to heart failure event or death (primary) and death alone (secondary). RESULTS Women benefited from CRT-D more than men. The main difference occurred in patients with LBBB and a QRS of 130 to 149 milliseconds. In this group, women had a 76% reduction in heart failure or death (absolute CRT-D to ICD difference, 23%; hazard ratio [HR], 0.24, [95% CI, 0.11-0.53]; P < .001) and a 76% reduction in death alone (absolute difference 9%; HR, 0.24, [95% CI, 0.06-0.89]; P = .03), while there was no significant benefit in men for heart failure or death (absolute difference 4%; HR, 0.85 [95% CI, 0.60-1.21]; P = .38) or death alone (absolute difference 2%; HR, 0.86 [95% CI, 0.49-1.52]; P = .60). Neither women nor men with LBBB benefited from CRT-D at QRS shorter than 130 milliseconds, while both sexes with LBBB benefited at QRS of 150 milliseconds or longer. CONCLUSIONS AND RELEVANCE In this population of patients with primarily mild heart failure, women with LBBB benefited from CRT-D at a shorter QRS duration than men with LBBB. This is important because recent guidelines limit the class I indication for CRT-D to patients with LBBB and QRS of 150 milliseconds or longer. While guidelines do give a class IIa indication to patients with LBBB and a QRS of 120 to 149 milliseconds, the present findings are important to communicate because women are less likely to receive CRT-D than men are. This study exemplifies the potential public health and regulatory science value of combining data from multiple clinical trials submitted to the FDA.
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Affiliation(s)
- Robbert Zusterzeel
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Kimberly A Selzman
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - William E Sanders
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Daniel A Caños
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Kathryn M O'Callaghan
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Jamie L Carpenter
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Ileana L Piña
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - David G Strauss
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
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Loring Z, Caños DA, Selzman K, Herz ND, Silverman H, MaCurdy TE, Worrall CM, Kelman J, Ritchey ME, Piña IL, Strauss DG. Left bundle branch block predicts better survival in women than men receiving cardiac resynchronization therapy: long-term follow-up of ∼ 145,000 patients. JACC Heart Fail 2013; 1:237-44. [PMID: 24621876 DOI: 10.1016/j.jchf.2013.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 03/04/2013] [Accepted: 03/06/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The goal of this study was to test the hypothesis that in recipients of cardiac resynchronization therapy defibrillators (CRT-D), conventional left bundle branch block (LBBB) diagnosis predicts better survival in women than in men. BACKGROUND New York Heart Association class I and II patients without LBBB do not benefit from CRT-D, and women have better survival after CRT-D than men. Separate analysis suggests that QRS duration thresholds for LBBB diagnosis differ according to sex, and conventional LBBB electrocardiographic criteria are falsely positive in men more frequently than in women. METHODS We analyzed Medicare records from 144,642 CRT-D recipients between 2002 and 2008 that were followed up for up to 90 months. Medicare billing data were used to determine age, sex, race, and comorbidities. Hazard ratios (HRs) were calculated to assess if conventional LBBB diagnosis had different prognostic significance according to sex. RESULTS In univariate analysis, LBBB was associated with a 31% reduction in death in women (HR: 0.69 [95% confidence interval (CI): 0.67 to 0.71]) but only a 16% reduction in death in men (HR: 0.84 [95% CI: 0.82 to 0.85]). In multivariable analyses controlling for comorbidities, LBBB was associated with a 26% reduction in death in women (HR: 0.74 [95% CI: 0.71 to 0.77]) and a 15% reduction in death in men (HR: 0.85 [95% CI: 0.83 to 0.87]). A significant interaction (p < 0.0001) between sex and LBBB was seen. CONCLUSIONS LBBB diagnosis is associated with greater survival in women than in men receiving CRT-D, and this discrepancy is not explained by differences in measured comorbidities. Possible explanations for this difference include that LBBB may have different prognostic significance according to sex or that LBBB diagnosis is more often false-positive in men compared with women.
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Affiliation(s)
- Zak Loring
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; Duke University School of Medicine, Durham, North Carolina
| | - Daniel A Caños
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Kimberly Selzman
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; Division of Cardiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Naomi D Herz
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | | | | | | | - Jeffrey Kelman
- Centers for Medicare & Medicaid Services, Baltimore, Maryland
| | - Mary E Ritchey
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland
| | - Ileana L Piña
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland; Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York
| | - David G Strauss
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland.
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Kim S, Apple S, Mintz GS, McMillan T, Caños DA, Maehara A, Weissman NJ. The importance of gender on coronary artery size: in-vivo assessment by intravascular ultrasound. Clin Cardiol 2004; 27:291-4. [PMID: 15188946 PMCID: PMC6654584 DOI: 10.1002/clc.4960270511] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND It remains controversial whether women have smaller coronary arteries than men because of a gender-specific trait, or whether the observed differences are primarily due to a difference in body size. Intravascular ultrasound (IVUS), with its ability to provide unique coronary images that allow precise measurement of arterial size in vivo, is ideally suited to address this issue. HYPOTHESIS Female gender, independent of body size, is associated with smaller coronary artery size as measured by intracoronary ultrasound. METHODS Intravascular ultrasound images of normal left main arteries were identified retrospectively from a single center database. Associations between demographic and clinical characteristics (including body size) and left main coronary dimensions were assessed with univariant and multivariate regression analyses. RESULTS We identified 257 completely normal left main arteries. Mean left main arterial areas were smaller in women than in men (17.2 vs. 20.6 mm2, p < 0.001), as were mean luminal areas (14.0 vs. 16.7 mm2, p < 0.001). By multiple regression analysis, the independent predictors of left main lumen were body surface area (p < 0.001) and gender (p = 0. 003). CONCLUSIONS Body surface area and gender are both independent predictors of coronary artery size, although body size has a greater influence than gender.
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Affiliation(s)
- Sang‐Gon Kim
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
| | - Sue Apple
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
| | - Gary S. Mintz
- Cardiovascular Research Foundation, New York, New York, USA
| | - Taya McMillan
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
| | - Daniel A. Caños
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
| | - Akiko Maehara
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
| | - Neil J. Weissman
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC
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Caños DA, Mintz GS, Berzingi CO, Apple S, Kotani JI, Pichard AD, Satler LF, Suddath WO, Waksman R, Lindsay J, Weissman NJ. Clinical, angiographic, and intravascular ultrasound characteristics of early saphenous vein graft failure. J Am Coll Cardiol 2004; 44:53-6. [PMID: 15234406 DOI: 10.1016/j.jacc.2004.03.045] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2003] [Revised: 03/10/2004] [Accepted: 03/16/2004] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to examine saphenous vein graft (SVG) lesions that fail within the first year after operation. BACKGROUND Saphenous vein grafts remain patent for approximately 10 years; however, up to 15% to 20% of SVGs become occluded within the first year. METHODS We studied 100 patients who underwent percutaneous coronary intervention (PCI) for early (<1 year post-implantation) SVG failure lesions and compared them with a diabetes- and hypercholesterolemia-matched cohort of late SVG failures (>1 year). Coronary angiography and intravascular ultrasound images were analyzed. RESULTS The majority of patients in both groups were males who presented with unstable angina; 36% were diabetic. Graft ages were 6.0 +/- 2.9 months and 105.4 +/- 50.8 months, respectively. The early SVG failure lesion location was more often ostial or proximal (62% vs. 42%, respectively). Early SVG failures were angiographically smaller than late failures (reference: 2.47 +/- 0.86 mm vs. 3.26 +/- 0.83 mm, p < 0.001) but had similar lesion lengths. Intravascular ultrasound showed that early failure lesions had smaller proximal and distal reference lumen areas (7.3 +/- 6.8 mm2 vs. 10.6 +/- 3.8 mm2, p = 0.026) and greater reference plaque burden than late failures (52.3% vs. 36.1%, p < 0.001). After PCI, 20.6% of early and 30.6% of late failure lesions had creatine kinase-myocardial band (CK-MB) greater than twice normal. CONCLUSIONS Early SVG failure is mostly proximal or ostial, lesions appear focal, and early SVGs appear smaller than late SVGs. Intravascular ultrasound shows significant reference segment plaque burden, suggesting more severe, diffuse SVG disease.
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Affiliation(s)
- Daniel A Caños
- Cardiovascular Research Institute, Washington Hospital Center, Washington, DC 20010, USA
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Affiliation(s)
- Shadi M Hamwi
- Department of Cardiology, Washington Hospital Center, Washington, DC 20010, USA
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