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Allen KJ, Chiavaroli N, Reid KJ. Successful return to work in anaesthesia after maternity leave: a qualitative study. Anaesthesia 2024. [PMID: 38177064 DOI: 10.1111/anae.16231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/06/2024]
Abstract
Returning to work after maternity leave poses significant challenges, with potential long-term implications including decreased engagement or attrition of clinicians. Many quantitative studies have identified challenges and supports for women during pregnancy, maternity leave and re-entry to clinical practice. This qualitative study explored the experiences of anaesthetists returning to clinical work after maternity leave, to identify influential factors with the aim of providing a framework to assist planning re-entry. We conducted semi-structured interviews with 15 anaesthetists. Attendees of a re-entry programme were invited to participate, with purposive sampling and snowball recruitment to provide diversity of location and training stage, until data saturation was reached at 13 interviews. Five themes were identified: leave duration; planning re-entry; workplace culture; career impact and emotional impact. Leave duration was influenced by concerns about deskilling, but shorter periods of leave had logistical challenges, including fatigue. Most participants started planning to return to work with few or no formal processes in the workplace. Workplace culture, including support for breastfeeding, was identified as valuable, but variable. Participants also experienced negative attitudes on re-entry, including difficulty accessing permanent work, with potential career impacts. Many participants identified changes to professional and personal identity influencing the experience with emotional sequelae. This research describes factors which may be considered to assist clinicians returning to work after maternity leave and identifies challenges, including negative attitudes, which may pose significant barriers to women practising in anaesthesia and may contribute to lack of female leadership in some workplaces.
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Affiliation(s)
- K J Allen
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - N Chiavaroli
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
- Australian Council for Educational Research, Melbourne, Australia
| | - K J Reid
- Department of Medical Education, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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Bhamidipati CM, Tohill BC, Robe C, Reid KJ, Eglitis NC, Farber MA, Jordan WD. Physiologic risk stratification is important to long-term mortality, complications, and readmission in thoracic endovascular aortic repair. J Vasc Surg Cases Innov Tech 2023; 9:101174. [PMID: 37334158 PMCID: PMC10275962 DOI: 10.1016/j.jvscit.2023.101174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/15/2023] [Indexed: 06/20/2023] Open
Abstract
Use of the American Society of Anesthesiologists (ASA) physical status classification is important for periprocedural risk stratification. However, the collective effect after adjustment for the Society for Vascular Surgery (SVS) medical comorbidity grading system on long-term all-cause mortality, complications, and discharge disposition is unknown. We examined these associations in patients after thoracic endograft placement. Data from three thoracic endovascular aortic repair (TEVAR) trials through 5 years of follow-up were included. Patients with acute complicated type B dissection (n = 50), traumatic transection (n = 101), or descending thoracic aneurysm (n = 66) were analyzed. The patients were stratified into three groups according to the ASA class: I-II, III, and IV. Multivariable proportional hazards regression models were used to examine the effect of ASA class on 5-year mortality, complications, and rehospitalizations after adjustment for SVS risk score and potential confounders. The largest proportion of patients treated by TEVAR across the ASA groups (n = 217) was ASA IV (n = 97; 44.7%; P < .001), followed by ASA III (n = 83; 38.2%) and ASA I-II (n = 37; 17.1%). Among the ASA groups, the ASA I-II patients were, on average, 6 years younger than those with ASA III and 3 years older than those with ASA IV (ASA I-II: age, 54.3 ± 22.0 years; ASA III: age, 60.0 ± 19.7 years; ASA IV: age, 51.0 ± 18.4 years; P = .009). Multivariable adjusted 5-year outcome models showed that ASA class IV, independent of the SVS score, conferred an increased risk of mortality (hazard ratio [HR], 3.83; 95% confidence interval [CI], 1.19-12.25; P = .0239) and complications (HR, 4.53; 95% CI, 1.69-12.13; P = .0027) but not rehospitalization (HR, 1.84; 95% CI, 0.93-3.68; P = .0817) compared with ASA class I-II. Procedural ASA class is associated with long-term outcomes among post-TEVAR patients, independent of the SVS score. The ASA class and SVS score remain important to patient counseling and postoperative outcomes beyond the index operation.
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Affiliation(s)
- Castigliano M. Bhamidipati
- Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, OR
| | | | | | | | - Nicholas C. Eglitis
- Division of Cardiac Anesthesia and Critical Care, Oregon Health & Science University, Portland, OR
| | - Mark A. Farber
- Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC
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Boschert EN, Stubblefield CE, Reid KJ, Schwend RM. Twenty-two Years of Pediatric Musculoskeletal Firearm Injuries: Adverse Outcomes for the Very Young. J Pediatr Orthop 2021; 41:e153-e160. [PMID: 33055517 DOI: 10.1097/bpo.0000000000001682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Firearm injuries are a significant cause of morbidity and mortality for children in the United States. The purpose of this study is to investigate the 22-year experience of pediatric firearm-related musculoskeletal injuries at a major pediatric level 1 hospital and to analyze the risk of adverse outcomes in children under 10 years of age. METHODS An institutional review board-approved, retrospective cohort analysis was conducted on pediatric firearm-related musculoskeletal injuries at our institution from 1995 to 2017. A total of 189 children aged 0 to 18 years were identified using International Classification of Diseases, 9th Revision/10th Revision codes, focusing on musculoskeletal injuries by firearms. Exclusion criteria were primary treatment at an outside hospital, isolated nonmusculoskeletal injuries (eg, traumatic brain injury), and death before orthopaedic intervention. Two cohorts were included: age below 10 years and age 10 years and above. Primary outcome measure was a serious adverse outcome (death, growth disturbance, amputation, or impairment). Standard statistical analysis was used for demographic data, along with linear mixed models and multivariable logistic regression for adverse outcome. RESULTS Of the 189 children, 46 (24.3%) were below 10 years of age and 143 (75.7%) were 10 years and above. Fifty-two (27.5%) of the total group had an adverse outcome, with 19 (41.3%) aged below 10 years and 33 (23.1%) aged 10 years and above (P=0.016). Adverse outcomes were 3 deaths, 17 growth disturbances, 7 amputations, and 44 impairments. For those below 10 years of age, rural location (P=0.024), need for surgical treatment (P=0.041), femur injury (P=0.032), peripheral nerve injury (P=0.006), and number of surgeries (P=0.022) were associated with an adverse outcome. CONCLUSIONS Over one fourth of survivors of musculoskeletal firearm injuries had an adverse outcome. Children 10 years and above represent the majority of firearm injuries in our population; however, when injured, those below 10 years are more likely to have an adverse outcome. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
| | - Connor E Stubblefield
- Children's Mercy Hospital, Kansas City, MO
- University of Kansas School of Medicine, Kansas City, KS
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Reid KJ, Kräuchi K, Grimaldi D, Sbarboro J, Attarian H, Zee PC. 0015 Manipulating Body Temperature: Effects on Sleep in Postmenopausal Women. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.014] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
A decline in sleep quality and reduction in slow wave sleep (SWS) and slow wave activity (SWA) are common in older adults. Prior studies have shown that manipulating body temperature during sleep can increase SWS/SWA. The aim of this study was to determine the effects of manipulation of body temperatures during sleep, using a high heat capacity mattress, on SWS/SWA and heart rate variability in post-menopausal women.
Methods
Twenty-four healthy postmenopausal women between 40–75 years of age (mean age 62.4 ± 8.2 years, mean BMI 25.4 ± 3.5 kg/m2) were randomized in a single-blind, counterbalanced, cross-over manner to sleep on either a high heat capacity mattress (HHCM) or a low heat capacity mattress(LHCM) a week apart. Sleep was recorded using polysomnography during an 8-hour sleep opportunity. Core and peripheral temperatures were recorded using Equivital and ibutton respectively.
Results
In comparison to the LHCM, sleep on HHCM exhibited a selective increase in SWS (average increase in Stage N3 of 9.6 minutes (2.1%), p = 0.04) and in slow oscillatory activity (0.5-1Hz) in the first NREM/REM cycle (p=0.04). In addition, the HHCM induced a greater reduction in core body temperature (p=0.002), and delayed the increase in mattress surface temperature (maximal difference LHCM-HHCM: 4.66±0.17°C). Average heart rate was 2.7 beats/minute lower across the night on the HHCM compared to the LHCM (p=0.001).
Conclusion
The results of this study indicate that manipulation of body temperature during sleep may be a useful approach to enhance SWS sleep and cardiovascular function in postmenopausal women.
Support
Technogel
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Affiliation(s)
- K J Reid
- Northwestern University, Center for Circadian and Sleep Medicine, Chicago, IL
| | - K Kräuchi
- Psychiatric University Clinics, Basel, SWITZERLAND
| | - D Grimaldi
- Northwestern University, Center for Circadian and Sleep Medicine, Chicago, IL
| | - J Sbarboro
- Northwestern University, Center for Circadian and Sleep Medicine, Chicago, IL
| | - H Attarian
- Northwestern University, Center for Circadian and Sleep Medicine, Chicago, IL
| | - P C Zee
- Northwestern University, Center for Circadian and Sleep Medicine, Chicago, IL
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Panchangam C, White DA, Goudar S, Birnbaum B, Malloy-Walton L, Gross-Toalson J, Reid KJ, Shirali G, Parthiban A. Translation of the Frailty Paradigm from Older Adults to Children with Cardiac Disease. Pediatr Cardiol 2020; 41:1031-1041. [PMID: 32377892 PMCID: PMC7223568 DOI: 10.1007/s00246-020-02354-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 04/23/2020] [Indexed: 12/20/2022]
Abstract
Children and adolescents with cardiac disease (CCD) have significant morbidity and lower quality of life. However, there are no broadly applicable tools similar to the frailty score as described in the elderly, to define functional phenotype in terms of physical capability and psychosocial wellbeing in CCD. The purpose of this study is to investigate the domains of the frailty in CCD. We prospectively recruited CCD (8-17.5 years old, 70% single ventricle, 27% heart failure, 12% pulmonary hypertension; NYHA classes I, II and III) and age and gender matched healthy controls (total n = 56; CCD n = 34, controls n = 22; age 12.6 ± 2.6 years; 39.3% female). We measured the five domains of frailty: slowness, weakness, exhaustion, body composition and physical activity using developmentally appropriate methods. Age and gender-based population norms were used to obtain Z scores and percentiles for each measurement. Two-tailed t-tests were used to compare the two groups. The CCD group performed significantly worse in all five domains of frailty compared to healthy controls. Slowness: 6-min walk test with Z score -3.9 ± 1.3 vs -1.4 ± 1.3, p < 0.001; weakness: handgrip strength percentile 18.9 ± 20.9 vs 57.9 ± 26.0, p < 0.001; exhaustion: multidimensional fatigue scale percentile 63.7 ± 13.5 vs 83.3 ± 14.4, p < 0.001; body composition: height percentile 43.4 ± 29.5 vs 71.4 ± 25.2, p < 0.001, weight percentile 46.0 ± 36.0 vs 70.9 ± 24.3, p = 0.006, BMI percentile 48.4 ± 35.5 vs 66.9 ± 24.2, p = 0.04, triceps skinfold thickness 41.0 ± 24.0 vs 54.4 ± 22.1, p = 0.04; physical activity: pediatric activity questionnaire score 2 ± 0.6 vs 2.7 ± 0.6, p < 0.001. The domains of frailty can be quantified in children using developmentally appropriate methods. CCD differ significantly from controls in all five domains, supporting the concept of quantifying the domains of frailty. Larger longitudinal studies are needed to study frailty in CCD and examine if it predicts adverse health outcomes.Clinical Trial Registration: The ClinicalTrials.gov identification number is NCT02999438. https://clinicaltrials.gov/ct2/show/NCT02999438.
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Affiliation(s)
- Chaitanya Panchangam
- Department of Child Health, University of Missouri Health Care, Columbia, MO, USA. .,University of Missouri-Columbia, 500 N Keene St, Suite 207, Columbia, MO, 65201, USA.
| | - David A. White
- grid.239559.10000 0004 0415 5050The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO USA ,grid.266756.60000 0001 2179 926XUMKC School of Medicine, Kansas City, MO USA
| | - Suma Goudar
- grid.239559.10000 0004 0415 5050The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO USA ,grid.266756.60000 0001 2179 926XUMKC School of Medicine, Kansas City, MO USA
| | - Brian Birnbaum
- grid.239559.10000 0004 0415 5050The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO USA ,grid.266756.60000 0001 2179 926XUMKC School of Medicine, Kansas City, MO USA
| | - Lindsey Malloy-Walton
- grid.239559.10000 0004 0415 5050The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO USA ,grid.266756.60000 0001 2179 926XUMKC School of Medicine, Kansas City, MO USA
| | - Jami Gross-Toalson
- grid.239559.10000 0004 0415 5050The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO USA
| | - Kimberly J. Reid
- grid.239559.10000 0004 0415 5050The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO USA
| | - Girish Shirali
- grid.239559.10000 0004 0415 5050The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO USA ,grid.266756.60000 0001 2179 926XUMKC School of Medicine, Kansas City, MO USA
| | - Anitha Parthiban
- grid.239559.10000 0004 0415 5050The Ward Family Heart Center, Children’s Mercy Hospital, Kansas City, MO USA ,grid.266756.60000 0001 2179 926XUMKC School of Medicine, Kansas City, MO USA
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Skaria PE, Ahmed AA, Yin H, Nicol K, Reid KJ, Singh V. Expression of HBME-1 and CD56 in follicular variant of papillary carcinoma in children: An immunohistochemical study and their diagnostic utility. Pathol Res Pract 2019; 215:880-884. [PMID: 30711197 DOI: 10.1016/j.prp.2019.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/05/2019] [Accepted: 01/25/2019] [Indexed: 11/27/2022]
Abstract
Papillary thyroid carcinoma (PTC) is the most common differentiated thyroid cancer in children; and the follicular variant is the second most common variant after the classic subtype. The histological appearance of follicular variant of papillary thyroid cancer (FVPTC), can be mimicked by benign follicular nodules. Pediatric pathologists encountering such lesions with FVPTC-like appearance may err on diagnosing the benign lesions as malignant. In adult patients, several immunohistochemical markers have emerged recently as a useful adjunct to distinguish differentiated thyroid carcinomas from benign follicular lesions. We undertook an inter-institutional retrospective study to establish the diagnostic utility of immunohistochemical staining for HBME-1, Galectin-3 and CD56 in differentiating FVPTC from its benign mimics, follicular adenoma and adenomatoid nodules, in children. Our specific aim of the project was to define the sensitivity and specificity of the three antibodies in FVPTC. Based on institutional diagnoses, a total of 66 cases were obtained: 32 FVPTC and 34 benign follicular nodules that comprised of 23 follicular adenoma and 11 adenomatoid nodules. Five investigators, who were blinded to the original diagnoses, independently reviewed the slides following pre-determined criteria and semi-quantitatively scoring the immunohistochemical staining. The immunohistochemical staining revealed that a combination of positive HBME-1 and negative CD56 result gave 100% specificity and positive predictive value in distinguishing FVPTC from benign follicular nodules. However, the antibody combination suffered from a lower sensitivity (50%). We used a cutoff of 25% positivity of tumor cells in determining positivity of tumor cells to an antibody. In conclusion, our study found a very high specificity and strong positive predictive value for the combination of HBME-1 and CD56 immunohistochemical stains in distinguishing FVPTC from benign follicular lesions.
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Affiliation(s)
- Priya E Skaria
- University of Missouri - Department of Pathology, Kansas City, MO, 64108, United States
| | - Atif A Ahmed
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, United States
| | - Hong Yin
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Kathleen Nicol
- Nationwide Children's Hospital, Columbus, OH, United States
| | - Kimberly J Reid
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, United States
| | - Vivekanand Singh
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, United States.
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Masonbrink AR, Stancil S, Reid KJ, Goggin K, Hunt JA, Mermelstein SJ, Shafii T, Lehmann AG, Harhara H, Miller MK. Adolescent Reproductive Health Care: Views and Practices of Pediatric Hospitalists. Hosp Pediatr 2019; 9:100-106. [PMID: 30622112 DOI: 10.1542/hpeds.2018-0051] [Citation(s) in RCA: 12] [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: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Many hospitalized adolescents are at increased risk for pregnancy complications due to an underlying medical condition, however sexual risk assessment is not consistently performed in this setting. While adolescents and their parents are supportive of sexual health discussion in the inpatient setting, a thorough understanding of factors that influence provision of this care among pediatric hospital physicians is lacking. This formative information is needed to facilitate efforts to improve and standardize clinical care provision. Our objective is to assess the frequency and factors that influence the provision of adolescent sexual and reproductive care by pediatric hospitalists. METHODS We performed a cross-sectional computerized survey of hospitalists at 5 pediatric hospitals who cared for ≥1 adolescent (14-21 years old) in the past year. Sexual and reproductive care practices were assessed by using a 76-item novel survey informed by the theory of planned behavior. We used descriptive statistics to summarize the data. RESULTS Sixty-eight pediatric hospitalists participated (49% response rate): 78% were women and 65% were aged <40 years. Most (69%) reported treating >46 adolescents annually, including many who are at an increased risk for pregnancy complications due to teratogenic medication use or a comorbid condition. A majority felt that sexual and reproductive services are appropriate, although many endorsed barriers, including concern about follow-up after emergency contraception (63%) and time constraints (53%). Most reported insufficient knowledge regarding contraception (59%), desired contraception education (57%), and were likely to increase contraceptive provision if provided education (63%). Hospitalists rarely provided condoms or referral for an intrauterine device. CONCLUSIONS Pediatric hospitalists frequently care for adolescents who are at risk for pregnancy complications and generally agree that reproductive care is appropriate in the inpatient setting. With these findings, we highlight the critical need for effective comprehensive reproductive health service interventions that are tailored to address the numerous actionable barriers identified in this study.
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Affiliation(s)
- Abbey R Masonbrink
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri; .,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Stephani Stancil
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
| | | | - Kathy Goggin
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri.,Division of Health Services and Outcomes Research and
| | - Jane Alyce Hunt
- Department of Pediatrics, St Louis Children's Hospital and School of Medicine, Washington University, St Louis, Missouri
| | - Sarah J Mermelstein
- Department of Pediatrics, St Louis Children's Hospital and School of Medicine, Washington University, St Louis, Missouri
| | - Taraneh Shafii
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
| | - Amber G Lehmann
- Department of Pediatrics, East Carolina University, Greenville, North Carolina; and
| | - Haleema Harhara
- Department of Pediatrics, Children's Hospital of San Antonio, San Antonio, Texas
| | - Melissa K Miller
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri.,School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
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Qayum O, Alshami N, Ibezim CF, Reid KJ, Noel-MacDonnell JR, Raghuveer G. Lipoprotein (a): Examination of Cardiovascular Risk in a Pediatric Referral Population. Pediatr Cardiol 2018; 39:1540-1546. [PMID: 29948030 DOI: 10.1007/s00246-018-1927-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 02/23/2018] [Accepted: 06/06/2018] [Indexed: 11/29/2022]
Abstract
Atherosclerotic cardiovascular disease (CVD), a leading cause of death globally, has origins in childhood. Major risk factors include family history of premature CVD, dyslipidemia, diabetes mellitus, and hypertension. Lipoprotein (a) [Lp(a)], an inherited lipoprotein, is associated with premature CVD, but its impact on cardiovascular health during childhood is less understood. The objective of the study was to examine the relationship between Lp(a), family history of premature CVD, dyslipidemia, and vascular function and structure in a high-risk pediatric population. This is a single-center, cross-sectional study of 257 children referred to a preventive cardiology clinic. The independent variable, Lp(a), separated children into high-Lp(a) [Lp(a) ≥ 30 mg/dL] and normal-Lp(a) groups [Lp(a) < 30 mg/dL]. Dependent variables included family history of premature CVD; dyslipidemia, defined as low-density lipoprotein cholesterol > 130 mg/dL, high-density lipoprotein cholesterol (HDL-C) < 45 mg/dL, triglycerides (TG) > 100 mg/dL; and vascular changes suggesting early atherosclerosis, as measured by carotid-femoral pulse wave velocity (PWV) and carotid artery intima-media thickness (CIMT). Of the 257 children, 110 (42.8%) had high Lp(a) and 147 (57.2%) had normal Lp(a). There was a higher prevalence of African-American children in the high-Lp(a) group (19.3%) compared to the normal-Lp(a) group (2.1%) (p < 0.001). High Lp(a) was associated with positive family history of premature CVD (p = 0.03), higher-than-optimal HDL-C (p = 0.02), and lower TG (p < 0.001). There was no difference in PWV or CIMT between groups. High Lp(a) in children is associated with family history of premature CVD and is prevalent in African-American children. In children with high Lp(a), promotion of intensive lifestyle modifications is prudent to decrease premature CVD-related morbidity.
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Affiliation(s)
- Omar Qayum
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, 64108, USA.
| | - Noor Alshami
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, 64108, USA
| | - Chizitam F Ibezim
- University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, 64108, USA
| | - Kimberly J Reid
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | | | - Geetha Raghuveer
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO, 64108, USA
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Bingler M, Erickson LA, Reid KJ, Lee B, O'Brien J, Apperson J, Goggin K, Shirali G. Interstage Outcomes in Infants With Single Ventricle Heart Disease Comparing Home Monitoring Technology to Three-Ring Binder Documentation: A Randomized Crossover Study. World J Pediatr Congenit Heart Surg 2018; 9:305-314. [PMID: 29692236 DOI: 10.1177/2150135118762401] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interstage outcomes for infants with single ventricle remain suboptimal. We have previously described a tablet PC-based platform Cardiac High Acuity Monitoring Program (CHAMP) for remote monitoring which provides immediate access to data, videos, and instant alerts to our single ventricle care team. METHODS This study compares traditional three-ring binder monitoring (Binder) to CHAMP using a randomized crossover design to evaluate mortality, resource utilization, and caregiver experience. At discharge, all single ventricle infants were monitored using Binder and randomized to receive CHAMP at either one or two months postdischarge. One month after randomization, caregivers could choose either Binder or CHAMP for the remainder of the interstage period. Caregivers experience was recorded using surveys. RESULTS Enrollment included 31 single ventricle infants from May 2014 to June 2015. There was no interstage mortality over 4,911 total interstage days (median: 144/patient). Of 73 readmissions, 45 were unplanned. Of the initial 23 unplanned readmissions, 13 were found to have been based on data obtained exclusively through CHAMP (as instant alerts or based on data review) rather than caregiver concerns. Due to concerns regarding patient safety, additional enrollment was stopped. The CHAMP use was associated with significantly fewer unplanned intensive care unit days/100 interstage days, shorter delays in care, lower resource utilization at readmissions, and lower incidence of interstage growth failure and was preferred by a majority of caregivers. CONCLUSIONS These findings suggest that CHAMP may offer benefits over Binder (improved interstage outcomes, delays in care, and caregiver experience). These findings should be tested across multiple centers in larger populations.
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Affiliation(s)
| | | | | | - Brian Lee
- 2 Children's Mercy Kansas City, Kansas City, MO, USA
| | - James O'Brien
- 2 Children's Mercy Kansas City, Kansas City, MO, USA
| | | | - Kathy Goggin
- 2 Children's Mercy Kansas City, Kansas City, MO, USA
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Ulrich TJB, Hansen TP, Reid KJ, Bingler MA, Olsen SL. Post-ligation cardiac syndrome is associated with increased morbidity in preterm infants. J Perinatol 2018; 38:537-542. [PMID: 29453434 DOI: 10.1038/s41372-018-0056-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/14/2017] [Accepted: 01/12/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The influence of post-ligation cardiac syndrome (PLCS), a complication of patent ductus arteriosus (PDA) ligations, on neonatal outcomes is unknown. The purpose of this study was to determine the risks of PLCS on severe pulmonary morbidity and severe retinopathy of prematurity (ROP). STUDY DESIGN Retrospective cohort study of infants who underwent a PDA ligation between 2006 and 2015. Data were collected on patients with and without PLCS. The primary outcome was the difference in severe bronchopulmonary dysplasia (BPD) between groups. Secondary outcomes included discharge with home oxygen and severe ROP. RESULT A total of 100 infants that underwent PDA ligation during the study period were included in the study; 31 (31%) neonates developed PLCS. In adjusted analysis, PLCS was associated with increased risk for severe BPD (RR 1.67, 95% CI: 1.15-2.42) and home oxygen therapy (RR: 1.47, 95% CI: 1.09-1.99) only. No association with severe ROP was seen (RR: 1.48; 95% CI: 0.87-2.52). CONCLUSION PLCS is associated with severe neonatal pulmonary morbidity, but not with severe ROP. Further investigation is warranted to validate these results.
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Affiliation(s)
- Timothy J B Ulrich
- Department of pediatrics, Children's Mercy Hospital, Kansas City, MO, USA.
| | - Taylor P Hansen
- Department of pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - Kimberly J Reid
- Department of Health Services and Outcomes Research, Children's Mercy Hospital, Kansas City, MO, USA
| | | | - Steven L Olsen
- Department of pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
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Papalambros NA, Grimaldi D, Reid KJ, Abbott SM, Malkani RG, Santostasi G, Gendy M, Ritger A, Braun R, Sanchez D, Paller KA, Zee PC. 0083 Acoustically Induced Changes In Sleep Spindle And Autonomic Activity Predict Memory Consolidation. Sleep 2018. [DOI: 10.1093/sleep/zsy061.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - K J Reid
- Northwestern University, Chicago, IL
| | | | | | | | - M Gendy
- Northwestern University, Chicago, IL
| | - A Ritger
- Northwestern University, Chicago, IL
| | - R Braun
- Northwestern University, Chicago, IL
| | - D Sanchez
- Northwestern University, Evanston, IL
| | | | - P C Zee
- Northwestern University, Chicago, IL
- SRI International, Menlo Park, CA
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Affiliation(s)
- I Mason
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, IL
| | - D Grimaldi
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, IL
| | - R G Malkani
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, IL
| | - K J Reid
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, IL
| | - P C Zee
- Northwestern University, Feinberg School of Medicine, Department of Neurology, Chicago, IL
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13
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Grimaldi D, Papalambros NA, Reid KJ, Abbott SM, Malkani RG, Santostasi G, Sanchez DJ, Paller KA, Zee PC. 0116 Autonomic And Sleep Interaction During Acoustic Enhancement Of Sleep. Sleep 2018. [DOI: 10.1093/sleep/zsy061.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - K J Reid
- Northwestern University, Chicago, IL
| | | | | | | | | | | | - P C Zee
- Northwestern University, Chicago, IL
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14
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Ogilvie RP, Simonelli G, Sotres-Alvarez D, St-Onge M, Mossavar-Rahmani Y, Perreira K, Petrov M, Kim Y, Balkin T, Wallace D, Reid KJ, Daviglus M, Zee PC, Patel SR. 0152 Caffeine Use And Sleep In U.S. Hispanic/Latinos: Findings From HCHS/SOL Sueño Ancillary Study. Sleep 2018. [DOI: 10.1093/sleep/zsy061.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - G Simonelli
- Walter Reed Army Institute of Research, Silver Spring, MD
| | | | | | | | - K Perreira
- University of North Carolina, Chapel Hill, NC
| | - M Petrov
- Arizona State University, Phoenix, AZ
| | - Y Kim
- University of Miami, Miami, FL
| | - T Balkin
- Walter Reed Army Institute of Research, Silver Spring, MD
| | - D Wallace
- University of Miami Miller School of Medicine, Miami, FL
| | - K J Reid
- Northwestern University, Chicago, IL
| | - M Daviglus
- University of Illinois at Chicago, Chicago, IL
| | - P C Zee
- Northwestern University, Chicago, IL
| | - S R Patel
- University of Pittsburgh, Pittsburgh, PA
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Baron K, Bardsley L, Reid KJ, Wolfe LF, Buman M, Toledo M, Zee PC. 0060 Role Of Circadian Timing and Alignment In The Timing And Intensity Of Physical Activity. Sleep 2018. [DOI: 10.1093/sleep/zsy061.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Baron
- Rush University Medical Center, Chicago, IL
| | - L Bardsley
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - K J Reid
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - L F Wolfe
- Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - M Buman
- Arizona State University, Phoenix, AZ
| | - M Toledo
- Arizona State University, Phoenix, AZ
| | - P C Zee
- Feinberg School of Medicine, Northwestern University, Chicago, IL
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16
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Reddivalla N, Robinson AL, Reid KJ, Radhi MA, Dalal J, Opfer EK, Chan SS. Using liver elastography to diagnose sinusoidal obstruction syndrome in pediatric patients undergoing hematopoetic stem cell transplant. Bone Marrow Transplant 2018; 55:523-530. [PMID: 29335626 DOI: 10.1038/s41409-017-0064-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 09/15/2017] [Accepted: 10/30/2017] [Indexed: 12/16/2022]
Abstract
Sinusoidal obstruction syndrome (SOS) is a potentially fatal complication of hematopoietic stem cell transplantation (HSCT). Traditional ultrasound (US) has poor sensitivity and specificity. US shear wave elastography (SWE) is a newer technology that measures liver stiffness. This is a single-institution, prospective cohort study evaluating SWE in patients younger than 21 years who received HSCT from December 2015 through June 2017. SOS was defined using the modified Seattle criteria. Subjects had US with SWE at three scheduled time points. t-tests were used to assess for difference between the groups and ROC curves were generated. Twenty-five patients were included. Five subjects developed SOS. At day +5 HSCT, SOS patients had SWE velocities that increased by 0.25 ± 0.21 m/s compared to 0.02 ± 0.18 in patients without SOS (p = 0.020). At day +14, SOS patients had SWE velocities that significantly increased by 0.91 m/s ± 1.14 m/s compared to 0.03 m/s ± 0.23 m/s in patients without SOS (p = 0.010). SWE SOS diagnosis occurred on average 9 and 11 days before clinical and conventional US diagnosis, respectively. Patients who develop SOS have increased liver stiffness compared to patients who do not develop SOS. SWE changes occur before other imaging and clinical findings of SOS.
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Affiliation(s)
| | | | | | - Mohamed A Radhi
- Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri at Kansas City, Kansas City, MO, USA
| | - Jignesh Dalal
- UH Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Erin K Opfer
- Children's Mercy Hospital, Kansas City, MO, USA.,University of Missouri at Kansas City, Kansas City, MO, USA
| | - Sherwin S Chan
- Children's Mercy Hospital, Kansas City, MO, USA. .,University of Missouri at Kansas City, Kansas City, MO, USA.
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17
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White DA, Willis EA, Reid KJ. Physical Activity Bout Patterns From Childhood Through Adolescence. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000517286.35002.e5] [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: 11/21/2022]
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18
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Dudley KA, Johnson DA, Weng J, Wallace DM, Alcantara C, Wallace M, Ramos AR, Mossavar-Rahmani Y, Perreira K, Zee PC, Salazar ZU, Redline S, Reid KJ, Sotres-Alvarez D, Patel SR. 0838 ACCULTURATION AND SLEEP PATTERNS IN U.S. HISPANIC/LATINOS: THE HISPANIC COMMUNITY HEALTH STUDY/STUDY OF LATINOS (HCHS/SOL) SUEÑO ANCILLARY STUDY. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.837] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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19
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Baron KG, Reid KJ, Kim T, Van Horn L, Attarian H, Wolfe L, Siddique J, Santostasi G, Zee PC. Circadian timing and alignment in healthy adults: associations with BMI, body fat, caloric intake and physical activity. Int J Obes (Lond) 2016; 41:203-209. [PMID: 27795550 PMCID: PMC5296236 DOI: 10.1038/ijo.2016.194] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/29/2016] [Accepted: 09/23/2016] [Indexed: 01/01/2023]
Abstract
Introduction Disruption of circadian rhythms is one of the proposed mechanisms linking late sleep timing to obesity risk but few studies have evaluated biological markers outside of the laboratory. The goal of this study was to determine the relationship between the timing and alignment of melatonin and sleep onset (phase angle) with BMI, body fat and obesity related behaviors. We hypothesized that circadian alignment (relationship of melatonin to sleep timing) rather than circadian (melatonin) timing would be associated with higher BMI, body fat, dietary intake and lower physical activity. Subjects/Methods Adults with sleep duration ≥6.5 hours completed 7 days of wrist actigraphy, food diaries and SenseWear arm band monitoring. Circadian timing, measured by dim light melatonin onset (DLMO) was measured in the clinical research unit. Circadian alignment was calculated as the duration between dim light melatonin onset and average sleep onset time in the prior week (phase angle). Body fat was evaluated using dual-energy absorptiometry (DXA). Data were analyzed using bivariate correlations and multivariable regression analyses controlling for age, sex, sleep duration and evening light exposure. Results Participants included 97 adults (61 F, age 26.8 ± 7.3 years) with average sleep duration 443.7 (SD= 50.4) minutes. Average phase angle was 2.2 hours (SD= 1.5). Circadian alignment was associated with circadian timing (p<0.001) and sleep duration (p=.005). In multivariable analyses, later circadian timing was associated with lower BMI (p=.04). Among males only, circadian alignment was associated with percent body fat (p=.02) and higher android/gynoid fat ratio (p=0.04). Circadian alignment was associated with caloric intake (p=0.049) carbohydrate intake (p=0.04) and meal frequency (p=0.03) among both males and females. Conclusion Circadian timing and alignment were not associated with increased BMI or body fat, among healthy adults with ≥6.5 hours of sleep, but circadian alignment was associated with dietary intake. There may be sex differences in the relationship between circadian alignment and body fat.
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Affiliation(s)
- K G Baron
- Department of Behavioral Sciences, Section of Sleep Disorders and Sleep Research, Rush University Medical Center, Chicago, IL, USA
| | - K J Reid
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Kim
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L Van Horn
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - H Attarian
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - L Wolfe
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Siddique
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - G Santostasi
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - P C Zee
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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20
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Goudar SP, Baker GH, Chowdhury SM, Reid KJ, Shirali G, Scheurer MA. Interpreting measurements of cardiac function using vendor-independent speckle tracking echocardiography in children: a prospective, blinded comparison with catheter-derived measurements. Echocardiography 2016; 33:1903-1910. [PMID: 27739163 DOI: 10.1111/echo.13347] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Adult studies demonstrate that echocardiographic measurements of cardiac function using speckle tracking correlate with invasive measurements, but such data in the pediatric population are sparse. Our aim was to compare speckle-derived measures of cardiac function to measurements routinely obtained by cardiac catheterization in children. METHODS Echocardiograms were performed on the day of cardiac catheterization. Using Tomtec 2D Cardiac Performance Analysis, longitudinal strain (LS), longitudinal strain rate (LSR), early diastolic LSR, and ejection fraction (EF) for the right and left ventricle (RV and LV) were calculated via speckle tracking. Global LS and LSR were calculated for the LV. These results were compared to cardiac index, maximum ventricular dp/dt (max dp/dt), ventricular end-diastolic pressure (EDP), and pulmonary capillary wedge pressure (PCWP) obtained by fluid-filled catheters. A blinded observer performed all echo measurements. RESULTS Fifty studies were performed on 28 patients ages 4 months to 20 years old. Their diagnoses included cardiac transplant (48 studies), repaired AV septal defect (1), and dilated cardiomyopathy (1). RVEDP ranged from 2 to 22 mm Hg (median=6) and PCWP ranged from 6 to 32 mmHg (median 10). LV global LS and LV 2-chamber LSR by speckle-tracking negatively correlated with LV max dp/dt (LV global LS R=-.83, P=.001; LV 2-chamber LSR R=-.69, P=.009). RV LS weakly correlated with max dp/dt (R=.363, P=.002). Early diastolic strain rate did not correlate with EDP in either ventricle. CONCLUSION Speckle-derived measurements of function in the LV have stronger correlation than the RV to catheter-derived measures. LV global LS has the strongest correlation with invasive function measures in children.
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Affiliation(s)
- Suma P Goudar
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - G Hamilton Baker
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Shahryar M Chowdhury
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Kimberly J Reid
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Girish Shirali
- Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Mark A Scheurer
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina
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21
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Benloucif S, Guico MJ, Reid KJ, Wolfe LF, L'hermite-Balériaux M, Zee PC. Stability of Melatonin and Temperature as Circadian Phase Markers and Their Relation to Sleep Times in Humans. J Biol Rhythms 2016; 20:178-88. [PMID: 15834114 DOI: 10.1177/0748730404273983] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Circadian rhythms of core body temperature and melatonin are commonly used as phase markers of the circadian clock. Melatonin is a more stable marker of circadian phase when measured under constant routine conditions. However, little is known about the variability of these phase markers under less controlled conditions. Moreover, there is little consensus about the preferred method of analysis. The objective of this study was to assess various methods of calculating melatonin and temperature phase in subjects with regular sleep schedules living in their natural environment. Baseline data were analyzed from 42 healthy young subjects who were studied on at least two occasions. Each hospital admission was separated by at least 3 weeks. Subjects were instructedto maintain a regular sleep schedule, which was monitored for 1 week before admission by sleep logs and actigraphy. Subjects spent one habituation night under controlled conditions prior to collecting baseline temperature and melatonin measurements. The phase of the melatonin rhythm was assessed by 9 different methods. The temperature nadir (Tmin) was estimated using both Cleveland and Cosine curve fitting procedures, with and without demasking. Variability between admissions was assessed by correlation analysis and by the mean absolute difference in timing of the phase estimates. The relationship to sleep times was assessed by correlation of sleep onset or sleep offset with the various phase markers. Melatonin phase markers were more stable and more highly correlated with the timing of sleep than estimates of Tmin. Of the methods for estimating Tmin, simple cosine analysis was the least variable. In addition, sleep offset was more strongly correlated with the various phase markers than sleep onset. The relative measures of melatonin offset had the highest correlation coefficients, the lowest study-to-study variability, and were more strongly associated with sleep timing than melatonin onsets. Concordance of the methods of analysis suggests a tendency for the declining phase of the melatonin profile to be more stable and reliable than either markers of melatonin onset or measures of the termination of melatonin synthesis.
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Affiliation(s)
- S Benloucif
- Center for Sleep and Circadian Biology, Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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22
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Reid KJ, Aguilar KM, Thompson E, Miller RM. Value-Based Benefit Design to Improve Medication Adherence for Employees with Anxiety or Depression. Am Health Drug Benefits 2015; 8:263-71. [PMID: 26380032 PMCID: PMC4567057] [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] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/02/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Through reduced out-of-pocket costs and wellness offerings, value-based benefit design (VBBD) is a promising strategy to improve medication adherence and other health-related outcomes across populations. There is limited evidence, however, of the effectiveness of these policy-level changes among individuals with anxiety or depression. OBJECTIVES To assess the impact of a multifaceted VBBD policy that incorporates waived copayments, wellness offerings, and on-site services on medication adherence among plan members with anxiety or depression, and to explore how this intervention and its resulting improved adherence affects other health-related outcomes. METHODS A retrospective longitudinal pre/post design was utilized to measure outcomes before and after the VBBD policy change. Repeated measures statistical regression models with correlated error terms were utilized to evaluate outcomes among employees of a self-insured global health company and their spouses (N = 529) who had anxiety or depression after the VBBD policy change. A multivariable linear regression model was chosen as the best fit to evaluate a change in medication possession ratio (MPR) after comparing parameters for several distributions. The repeated measures multivariable regression models were adjusted for baseline MPR and potential confounders, including continuous age, sex, continuous modified Charlson Comorbidity Index, and the continuous number of prescriptions filled that year. The outcomes were assessed for the 1 year before the policy change (January 1, 2011, through December 31, 2011) and for 2 years after the change (January 1, 2012, through December 31, 2013). The primary outcome was a change in MPR. The secondary outcomes included healthcare utilization, medical or pharmacy costs, the initiation of medication, generic medication use, and employee absenteeism (the total number of sick days). RESULTS The implementation of the VBBD strategy was associated with a significant increase in average MPR (0.65 vs 0.61 in the pre-VBBD period; P = .004), the initiation of new medications for anxiety or depression (31.4% vs 29.5%, respectively; P = .033), and the filling of generic medications for anxiety or depression (85.1% vs 80.5%, respectively; P <.001). A multivariable adjusted analysis revealed a 0.05 increase in MPR after the benefit enhancement (P = .002). Healthcare utilization, costs, and absenteeism were not statistically different before and after the VBBD policy change. CONCLUSION The VBBD strategy was associated with improved medication adherence and cost-conscious medication use. Future analyses should explore whether these trends persist over time, and if they can further impact healthcare utilization, cost, and absenteeism.
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Affiliation(s)
- Kimberly J Reid
- Biostatistician, Cerner Population Health Services, Kansas City, MO
| | | | - Eric Thompson
- Director of Business Intelligence and Analytics, KaMMCO Health Solutions, Topeka, KS, and Senior Financial Analyst II, Children's Mercy Hospital, Topeka, KS
| | - Ross M Miller
- Medical Director, Population Health Services, Cerner Health Connections, Culver City, CA
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23
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Goldsweig AM, Reid KJ, Gosch K, Tang F, Fang MC, Maddox TM, Chan PS, Cohen DJ, Chen J. Contemporary use of dual antiplatelet therapy for preventing cardiovascular events. Am J Manag Care 2014; 20:659-665. [PMID: 25295680 PMCID: PMC4539274] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES CHARISMA was a landmark randomized clinical trial that failed to demonstrate a benefit of dual antiplatelet therapy (DAPT) over aspirin alone for preventing cardiovascular events. However, subgroup analyses of the trial found fewer major adverse cardiovascular events (MACEs) for patients with established cardiovascular disease but more MACEs for patients with multiple risk factors without established cardiovascular disease. Our objective was to examine DAPT use in contemporary clinical practice after publication of CHARISMA results. STUDY DESIGN Retrospective analysis of a large clinical registry of outpatient cardiovascular visits to over 1000 physicians that collected data on patient clinical history, symptoms, vital signs, and medications. METHODS Clinical characteristics and prescription rates of aspirin and clopidogrel were compared for patients with established cardiovascular disease and for patients with only multiple cardiovascular risk factors. Prescription of DAPT by calendar quarter was evaluated from 2008 to 2011 using multivariable Poisson regression models. RESULTS Of 167,839 patients with established cardiovascular disease, 20.5% were prescribed both aspirin and clopidogrel. Of 20,478 patients with multiple risk factors but no known cardiovascular disease, 3.5% were prescribed both aspirin and clopidogrel. Across 14 calendar quarters, prescription rates of DAPT did not change significantly for patients with established CVD but decreased for patients with multiple risk factors with an incidence rate ratio of 0.77. CONCLUSIONS Use of DAPT is modest in patients with established cardiovascular disease, for whom the CHARISMA trial suggested decreased MACEs, and prescription rates have remained stable over time. Use of DAPT in patients with multiple risk factors only, for whom CHARISMA suggested that DAPT may lead to increased MACE, was low and decreased over time.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jersey Chen
- Kaiser Permanente, Mid-Atlantic Permanente Research Institute, 2101 East Jefferson St, 3 West, Rockville, MD 20852. E-mail:
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Salisbury AC, Reid KJ, Marso SP, Amin AP, Alexander KP, Wang TY, Spertus JA, Kosiborod M. Blood Transfusion During Acute Myocardial Infarction. J Am Coll Cardiol 2014; 64:811-9. [DOI: 10.1016/j.jacc.2014.05.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 04/10/2014] [Accepted: 05/01/2014] [Indexed: 01/20/2023]
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25
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Salisbury AC, Reid KJ, Amin AP, Spertus JA, Kosiborod M. Variation in the incidence of hospital-acquired anemia during hospitalization with acute myocardial infarction (data from 57 US hospitals). Am J Cardiol 2014; 113:1130-6. [PMID: 24485696 DOI: 10.1016/j.amjcard.2013.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/16/2013] [Accepted: 12/16/2013] [Indexed: 11/17/2022]
Abstract
Development of hospital-acquired anemia (HAA) during acute myocardial infarction may be related to processes of care and is associated with poor outcomes. Little is known about variation in the incidence of HAA across hospitals or the hospital characteristics associated with HAA. We studied 17,676 patients with acute myocardial infarction without anemia at admission, defining HAA as a hemoglobin decline below anemia diagnostic thresholds and moderate-to-severe HAA as a hemoglobin decline to <11 g/dl. We calculated median rate ratios (MRRs), the median value of the relative risk (RR) for HAA for 2 patients with identical characteristics presenting to 2 randomly selected hospitals, to identify variation in HAA adjusting for patient characteristics. Separate models were fit to test the association between hospital characteristics and HAA. HAA (57.5%) and moderate-to-severe HAA (20.1%) were common. The incidence of HAA varied substantially across hospitals and remained significant after multivariable adjustment (any HAA: MRR 1.09, 95% confidence interval (CI) 1.07 to 1.13; moderate-to-severe HAA: MRR 1.27, 95% CI 1.19 to 1.39). Adjusting for patient characteristics, teaching status (RR 0.91, 95% CI 0.84 to 0.97 vs nonteaching status), and region (Northeast vs Midwest: RR 1.10, 95% CI 1.01 to 1.19; West vs Midwest: RR 1.19, 95% CI 1.06 to 1.33, respectively) was associated with risk of HAA. Teaching status (RR 0.7, 95% CI 0.6 to 0.9 vs nonteaching status) and region (South vs Midwest: RR 1.3, 95% CI 1.0 to 1.5) were independently associated with moderate-to-severe HAA. In conclusion, we observed significant variability in the incidence of HAA across hospitals and found a lower risk of HAA at teaching centers, suggesting that qualitative studies of the relation between HAA and processes of care are needed to identify targets for quality improvement.
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Affiliation(s)
- Adam C Salisbury
- Department of Cardiovascular Disease, Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Department of Cardiovascular Disease, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri.
| | - Kimberly J Reid
- Department of Cardiovascular Disease, Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Department of Cardiovascular Disease, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Amit P Amin
- Department of Internal Medicine, Division of Cardiovascular Disease, Washington University School of Medicine, Saint Louis, Missouri
| | - John A Spertus
- Department of Cardiovascular Disease, Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Department of Cardiovascular Disease, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Mikhail Kosiborod
- Department of Cardiovascular Disease, Saint Luke's Mid-America Heart Institute, Kansas City, Missouri; Department of Cardiovascular Disease, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
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26
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Parashar S, Kella D, Reid KJ, Spertus JA, Tang F, Langberg J, Vaccarino V, Kontos MC, Lopes RD, Lloyd MS. New-onset atrial fibrillation after acute myocardial infarction and its relation to admission biomarkers (from the TRIUMPH registry). Am J Cardiol 2013; 112:1390-5. [PMID: 24135301 DOI: 10.1016/j.amjcard.2013.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 11/16/2022]
Abstract
Atrial fibrillation (AF) is an independent predictor of mortality after acute myocardial infarction (AMI). We analyzed the relation between biomarkers linked to myocardial stretch (NT-pro-brain natriuretic peptide [NT-proBNP]), myocardial damage (Troponin-T [TnT]), and inflammation (high-sensitivity C-reactive protein [hs-CRP]) and new-onset AF during AMI to identify patients at high risk for AF. In a prospective multicenter registry of AMI patients (from the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status registry), we measured NT-proBNP, TnT, and hs-CRP in patients without a history of AF (n = 2,370). New-onset AF was defined as AF that occurred during the index hospitalization. Hierarchical multivariate logistic regression models were used to determine the association of biomarkers with new-onset AF, after adjusting for other covariates. New-onset AF was documented in 114 patients with AMI (4.8%; mean age 58 years; 32% women). For each twofold increase in NT-proBNP, there was an 18% increase in the rate of AF (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.03 to 1.35; p <0.02). Similarly, for every twofold increase in hs-CRP, there was a 15% increase in the rate of AF (OR 1.15, 95% CI 1.02 to 1.30; p = 0.02). TnT was not independently associated with new-onset AF (OR 0.96, 95% CI 0.85 to 1.07; p = 0.3). NT-proBNP and hs-CRP were independently associated with new in-hospital AF after MI, in both men and women, irrespective of race. Our study suggests that markers of myocardial stretch and inflammation, but not the amount of myocardial necrosis, are important determinants of AF in the setting of AMI.
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Affiliation(s)
- Susmita Parashar
- Division of Cardiology, Department of Medicine, Emory University, Atlanta, Georgia.
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Payvar S, Spertus JA, Miller AB, Casscells SW, Pang PS, Zannad F, Swedberg K, Maggioni AP, Reid KJ, Gheorghiade M. Association of low body temperature and poor outcomes in patients admitted with worsening heart failure: a substudy of the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial. Eur J Heart Fail 2013; 15:1382-9. [PMID: 23858000 DOI: 10.1093/eurjhf/hft113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Risk stratification in patients admitted with worsening heart failure (HF) is essential for tailoring therapy and counselling. Risk models are available but rarely used, in part because many require laboratory and imaging results that are not routinely available. Body temperature is associated with prognosis in other illnesses, and we hypothesized that low body temperature would be associated with worse outcomes in patients admitted with worsening HF. METHODS AND RESULTS The Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial was an event-driven, randomized, double-blind, placebo-controlled study of tolvaptan in 4133 patients hospitalized for worsening HF with an EF <40%. Co-primary endpoints were all-cause mortality and cardiovascular (CV) death or HF rehospitalization. Body temperature was measured orally at randomization and entered in analyses both as a continuous variable and categorized into three groups (<36 °C, 36-36.5 °C, and >36.5 °C) using Cox regression models. The composite of CV death or HF rehospitalization occurred in 1544 patients within 1 year. For every 1 °C decrease in body temperature, the risk of adverse outcomes increased by 16% [hazard raio (HR) 1.16, 95% confidence interval (CI) 1.04-1.28], after adjustment for age, gender, race, systolic blood pressure, EF, blood urea nitrogen, and serum sodium. In fully adjusted analysis, the risk of adverse outcomes in the lowest body temperature group (<36 °C) was 51% higher than that of the index group (>36.5 °C) (HR 1.35, 95% CI 1.15-1.58). CONCLUSIONS Low body temperature is an independent marker of poor cardiovascular outcomes in patients admitted with worsening HF and reduced EF.
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Affiliation(s)
- Saeed Payvar
- University of Florida College of Medicine, Jacksonville, FL, USA
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28
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Leifheit-Limson EC, Spertus JA, Reid KJ, Jones SB, Vaccarino V, Krumholz HM, Lichtman JH. Prevalence of traditional cardiac risk factors and secondary prevention among patients hospitalized for acute myocardial infarction (AMI): variation by age, sex, and race. J Womens Health (Larchmt) 2013; 22:659-66. [PMID: 23841468 DOI: 10.1089/jwh.2012.3962] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Modification of traditional cardiac risk factors is an important goal for patients after an acute myocardial infarction (AMI). Risk factor prevalence and secondary prevention efforts at discharge are well characterized among older patients; however, research is limited for younger and minority AMI populations, particularly among women. METHODS Among 2369 AMI patients enrolled in a 19-center prospective study, we compared the prevalence and cumulative number of five cardiac risk factors (hypertension, hypercholesterolemia, current smoking, diabetes, obesity) by age, sex, and race. We also compared secondary prevention strategies at discharge for these risk factors, including prescription of antihypertensive or lipid-lowering medications and counseling on preventive behaviors (smoking cessation, diabetes management, diet/weight management). RESULTS Approximately 93% of patients had ≥1 risk factor, 72% had ≥2 factors, and 40% had ≥3 factors. The prevalence of multiple risk factors was markedly higher for blacks than for whites within each age-sex group; black women had the greatest risk factor burden of any subgroup (60% of older black women and 54% of younger black women had ≥3 risk factors). Secondary prevention efforts for smoking cessation were less common for black compared with white patients, and younger black patients were less often prescribed antihypertensive and lipid-lowering medications compared with younger white patients. CONCLUSIONS Multiple cardiac risk factors are highly prevalent in AMI patients, particularly among black women. Secondary prevention efforts, however, are less common for blacks compared to whites, especially among younger patients. Our findings highlight the need for improved risk factor modification efforts in these high-risk subgroups.
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Affiliation(s)
- Erica C Leifheit-Limson
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut 06519, USA.
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29
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Amin AP, Bachuwar A, Reid KJ, Chhatriwalla AK, Salisbury AC, Yeh RW, Kosiborod M, Wang TY, Alexander KP, Gosch K, Cohen DJ, Spertus JA, Bach RG. Nuisance bleeding with prolonged dual antiplatelet therapy after acute myocardial infarction and its impact on health status. J Am Coll Cardiol 2013; 61:2130-8. [PMID: 23541975 DOI: 10.1016/j.jacc.2013.02.044] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [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: 09/25/2012] [Revised: 01/11/2013] [Accepted: 02/14/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The purpose of this study was to examine the incidence of nuisance bleeding after AMI and its impact on QOL. BACKGROUND Prolonged dual antiplatelet therapy (DAPT) is recommended after acute myocardial infarction (AMI) to reduce ischemic events, but it is associated with increased rates of major and minor bleeding. The incidence of even lesser degrees of post-discharge "nuisance" bleeding with DAPT and its impact on quality of life (QOL) are unknown. METHODS Data from the 24-center TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status) study of 3,560 patients, who were interviewed at 1, 6, and 12 months after AMI, were used to investigate the incidence of nuisance bleeding (defined as Bleeding Academic Research Consortium type 1). Baseline characteristics associated with "nuisance" bleeding and its association with QOL, as measured by the EuroQol 5 Dimension visual analog scale, and subsequent re-hospitalization were examined. RESULTS Nuisance (Bleeding Academic Research Consortium type 1) bleeding occurred in 1,335 patients (37.5%) over the 12 months after AMI. After adjusting for baseline bleeding and mortality risk, ongoing DAPT was the strongest predictor of nuisance bleeding (rate ratio [RR]: 1.44, 95% confidence interval [CI]: 1.17 to 1.76 at 1 month; RR: 1.89, 95% CI: 1.35 to 2.65 at 6 months; and RR: 1.39, 95% CI: 1.08 to 1.79 at 12 months; p < 0.01 for all comparisons). Nuisance bleeding at 1 month was independently associated with a decrement in QOL at 1 month (-2.81 points on EuroQol 5 Dimension visual analog scale; 95% CI: 1.09 to 5.64) and nonsignificantly toward higher re-hospitalization (hazard ratio: 1.20; 95% CI: 0.95 to 1.52). CONCLUSIONS Nuisance bleeding is common in the year after AMI, associated with ongoing use of DAPT, and independently associated with worse QOL. Improved selection of patients for prolonged DAPT may help minimize the incidence and adverse consequences of nuisance bleeding.
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Affiliation(s)
- Amit P Amin
- Cardiovascular Division, Washington University School of Medicine, St. Louis, Missouri; Barnes-Jewish Hospital, St. Louis, Missouri, USA
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Shah SJ, Krumholz HM, Reid KJ, Rathore SS, Mandawat A, Spertus JA, Ross JS. Financial stress and outcomes after acute myocardial infarction. PLoS One 2012; 7:e47420. [PMID: 23112814 PMCID: PMC3480393 DOI: 10.1371/journal.pone.0047420] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 09/14/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Little is known about the association between financial stress and health care outcomes. Our objective was to examine the association between self-reported financial stress during initial hospitalization and long-term outcomes after acute myocardial infarction (AMI). MATERIALS AND METHODS We used prospective registry evaluating myocardial infarction: Event and Recovery (PREMIER) data, an observational, multicenter US study of AMI patients discharged between January 2003 and June 2004. Primary outcomes were disease-specific and generic health status outcomes at 1 year (symptoms, function, and quality of life (QoL)), assessed by the Seattle Angina Questionnaire [SAQ] and Short Form [SF]-12. Secondary outcomes included 1-year rehospitalization and 4-year mortality. Hierarchical regression models accounted for patient socio-demographic, clinical, and quality of care characteristics, and access and barriers to care. RESULTS Among 2344 AMI patients, 1241 (52.9%) reported no financial stress, 735 (31.4%) reported low financial stress, and 368 (15.7%) reported high financial stress. When comparing individuals reporting low financial stress to no financial stress, there were no significant differences in post-AMI outcomes. In contrast, individuals reporting high financial stress were more likely to have worse physical health (SF-12 PCS mean difference -3.24, 95% Confidence Interval [CI]: -4.82, -1.66), mental health (SF-12 MCS mean difference: -2.44, 95% CI: -3.83, -1.05), disease-specific QoL (SAQ QoL mean difference: -6.99, 95% CI: -9.59, -4.40), and be experiencing angina (SAQ Angina Relative Risk = 1.66, 95%CI: 1.19, 2.32) at 1 year post-AMI. While 1-year readmission rates were increased (Hazard Ratio = 1.50; 95%CI: 1.20, 1.86), 4-year mortality was no different. CONCLUSIONS High financial stress is common and an important risk factor for worse long-term outcomes post-AMI, independent of access and barriers to care.
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Affiliation(s)
- Sachin J. Shah
- Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Harlan M. Krumholz
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Section of Health Policy and Administration, Department of Epidemiology and Public Health and Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America
| | - Kimberly J. Reid
- Department of Cardiology, Mid America Heart Institute of St. Luke’s Hospital, Kansas City, Missouri, United States of America
| | - Saif S. Rathore
- Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Aditya Mandawat
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - John A. Spertus
- Department of Cardiology, Mid America Heart Institute of St. Luke’s Hospital, Kansas City, Missouri, United States of America
- Department of Cardiology, University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Joseph S. Ross
- Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut, United States of America
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31
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Bucholz EM, Rathore SS, Reid KJ, Jones PG, Chan PS, Rich MW, Spertus JA, Krumholz HM. Body mass index and mortality in acute myocardial infarction patients. Am J Med 2012; 125:796-803. [PMID: 22483510 PMCID: PMC3408565 DOI: 10.1016/j.amjmed.2012.01.018] [Citation(s) in RCA: 103] [Impact Index Per Article: 8.6] [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: 12/21/2011] [Revised: 01/04/2012] [Accepted: 01/05/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Previous studies have described an "obesity paradox" with heart failure, whereby higher body mass index (BMI) is associated with lower mortality. However, little is known about the impact of obesity on survival after acute myocardial infarction. METHODS Data from 2 registries of patients hospitalized in the US with acute myocardial infarction between 2003-2004 (PREMIER) and 2005-2008 (TRIUMPH) were used to examine the association of BMI with mortality. Patients (n=6359) were categorized into BMI groups (kg/m(2)) using baseline measurements. Two sets of analyses were performed using Cox proportional hazards regression with fractional polynomials to model BMI as categorical and continuous variables. To assess the independent association of BMI with mortality, analyses were repeated, adjusting for 7 domains of patient and clinical characteristics. RESULTS Median BMI was 28.6. BMI was inversely associated with crude 1-year mortality (normal, 9.2%; overweight, 6.1%; obese, 4.7%; morbidly obese; 4.6%; P <.001), which persisted after multivariable adjustment. When BMI was examined as a continuous variable, the hazards curve declined with increasing BMI and then increased above a BMI of 40. Compared with patients with a BMI of 18.5, patients with higher BMIs had a 20% to 68% lower mortality at 1 year. No interactions between age (P=.37), sex (P=.87), or diabetes mellitus (P=.55) were observed. CONCLUSIONS There appears to be an "obesity paradox" among patients after acute myocardial infarction such that higher BMI is associated with lower mortality, an effect that was not modified by patient characteristics and was comparable across age, sex, and diabetes subgroups.
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Affiliation(s)
- Emily M Bucholz
- Yale University School of Medicine, New Haven, CT 06510, USA
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32
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Zucker ML, Hagedorn CH, Murphy CA, Stanley S, Reid KJ, Skikne BS. Mechanism of thrombocytopenia in chronic hepatitis C as evaluated by the immature platelet fraction. Int J Lab Hematol 2012; 34:525-32. [PMID: 22708981 DOI: 10.1111/j.1751-553x.2012.01429.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Thrombocytopenia occurs frequently in chronic hepatitis C. The mechanism of this association was investigated utilizing the immature platelet fraction (IPF%) as an index of platelet production together with assay of thrombopoietin (TPO). METHODS In a cross-sectional study, 47 patients with chronic hepatitis C were studied, 29 with thrombocytopenia and 18 without thrombocytopenia (six patients in each group were on interferon therapy). RESULTS IPF% was elevated in the thrombocytopenic compared with the nonthrombocytopenic group (9.0 ± 4.8% vs. 4.7 ± 2.4%, P < 0.001), and an increase in IPF% was significantly associated with thrombocytopenia on multivariable analysis (P < 0.05). Splenomegaly was more common in thrombocytopenic than in nonthrombocytopenic subjects (66% vs. 6%, P < 0.001), and on multivariable analysis, splenomegaly was the factor associated with the highest relative risk of thrombocytopenia (RR = 1.9, P < 0.05). IPF% values were elevated in a similar proportion of thrombocytopenic patients with and without splenomegaly (58% and 60%, respectively). There was no difference in TPO levels between thrombocytopenic and nonthrombocytopenic patients, and TPO levels were not related to the risk of thrombocytopenia on multivariable analysis. Significantly more thrombocytopenic than nonthrombocytopenic subjects had abnormal liver function tests, cirrhosis, and portal hypertension, and a decrease in serum albumin was significantly associated with thrombocytopenia (P < 0.005) on multivariable analysis. CONCLUSIONS Factors associated with liver disease in general are associated with thrombocytopenia in chronic hepatitis C. Peripheral platelet destruction or sequestration is the major mechanism for thrombocytopenia, with hypersplenism being an important cause. Low TPO levels were not related to the occurrence of thrombocytopenia in this study.
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Affiliation(s)
- M L Zucker
- Department of Pathology, Kansas University Medical Center, Kansas City, KS, USA.
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33
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Dodson JA, Arnold SV, Reid KJ, Gill TM, Rich MW, Masoudi FA, Spertus JA, Krumholz HM, Alexander KP. Physical function and independence 1 year after myocardial infarction: observations from the Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status registry. Am Heart J 2012; 163:790-6. [PMID: 22607856 PMCID: PMC3359897 DOI: 10.1016/j.ahj.2012.02.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 02/27/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) may contribute to health status declines including "independence loss" and "physical function decline." Despite the importance of these outcomes for prognosis and quality of life, their incidence and predictors have not been well described. METHODS We studied 2,002 patients with AMI enrolled across 24 sites in the TRIUMPH registry who completed assessments of independence and physical function at the time of AMI and 1 year later. Independence was evaluated by the EuroQol-5D (mobility, self-care, and usual activities), and physical function was assessed with the Short Form-12 physical component score. Declines in ≥1 level on EuroQol-5D and >5 points in PCS were considered clinically significant changes. Hierarchical, multivariable, modified Poisson regression models accounting for within-site variability were used to identify predictors of independence loss and physical function decline. RESULTS One-year post AMI, 43.0% of patients experienced health status declines: 12.8% independence loss alone, 15.2% physical function decline alone, and 15.0% both. After adjustment, variables that predicted independence loss included female sex, nonwhite race, unmarried status, uninsured status, end-stage renal disease, and depression. Variables that predicted physical function decline were uninsured status, lack of cardiac rehabilitation referral, and absence of pre-AMI angina. Age was not predictive of either outcome after adjustment. CONCLUSIONS >40% of patients experience independence loss or physical function decline 1 year after AMI. These changes are distinct but can occur simultaneously. Although some risk factors are not modifiable, others suggest potential targets for strategies to preserve patients' health status.
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Affiliation(s)
- John A Dodson
- Department of Internal Medicine, Section of Cardiology, Yale University School of Medicine, New Haven, CT 06520, USA.
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34
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Salisbury AC, Amin AP, Reid KJ, Wang TY, Alexander KP, Chan PS, Masoudi FA, Spertus JA, Kosiborod M. Red blood cell indices and development of hospital-acquired anemia during acute myocardial infarction. Am J Cardiol 2012; 109:1104-10. [PMID: 22264598 DOI: 10.1016/j.amjcard.2011.11.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Revised: 11/14/2011] [Accepted: 11/14/2011] [Indexed: 10/14/2022]
Abstract
Hospital-acquired anemia (HAA) is common, often develops in the absence of bleeding, and is associated with poor outcomes in patients with acute myocardial infarction (AMI). It is unknown whether red cell distribution width (RDW) and mean corpuscular volume (MCV), which are routinely available markers of iron deficiency, are associated with development of HAA during AMI. We studied 15,133 patients with AMI without anemia at admission. HAA was defined by nadir hemoglobin levels below age-, gender-, and race-specific thresholds and moderate-severe HAA was defined as nadir hemoglobin ≤11 g/dl. We examined the association between low MCV (<80 fL) and/or increased RDW (>15%) on patients' initial complete blood cell count and moderate-severe HAA using multivariable modified Poisson regression. Moderate-severe HAA was more common in patients with high RDW and low MCV (45.5%), high RDW and MCV ≥80 fL (33.0%), and normal RDW and low MCV (28.0%) than in those with normal RDW and MCV (18.3%, p <0.001). Compared to patients with normal RDW and MCV, those with increased RDW and low MCV (relative risk 1.72, 95% confidence interval 1.57 to 1.87), increased RDW and MCV ≥80 fL (relative risk 1.28, 95% confidence interval 1.16 to 1.42), or normal RDW and low MCV (relative risk 1.34, 95% confidence interval 1.08 to 1.65) were independently more likely to develop moderate-severe HAA. In conclusion, increased RDW and low MCV were independent predictors of moderate-severe HAA.
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35
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Salisbury AC, Harris WS, Amin AP, Reid KJ, O'Keefe JH, Spertus JA. Relation between red blood cell omega-3 fatty acid index and bleeding during acute myocardial infarction. Am J Cardiol 2012; 109:13-8. [PMID: 21944672 DOI: 10.1016/j.amjcard.2011.07.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 07/29/2011] [Accepted: 07/29/2011] [Indexed: 11/18/2022]
Abstract
Omega-3 fatty acids have multiple cardiovascular benefits but may also inhibit platelet aggregation and increase bleeding risk. If this platelet inhibition is clinically meaningful, patients with the highest omega-3 indexes (red blood cell eicosapentaenoic acid plus docosahexaenoic acid), which reflect long-term omega-3 fatty acid intake, should be at the risk for bleeding. In this study, 1,523 patients from 24 United States centers who had their omega-3 indexes assessed at the time of acute myocardial infarction were studied. The rates of serious bleeding (Thrombolysis In Myocardial Infarction [TIMI] major or minor) and mild to moderate bleeding (TIMI minimal) were identified in patients with low (<4%), intermediate (4% to 8%), and high (>8%) omega-3 indices. There were no differences in bleeding across omega-3 index categories. After multivariate adjustment, there remained no association between the omega-3 index and either serious (per 2% increase, relative risk 1.03, 95% confidence interval 0.90 to 1.19) or mild to moderate bleeding (per 2% increase, relative risk 1.02, 95% confidence interval 0.85 to 1.23). In conclusion, no relation was found between the omega-3 index and bleeding in this large, multicenter cohort of patients with acute myocardial infarction, suggesting that concerns about bleeding should not preclude the use of omega-3 supplements or increased fish consumption when clinically indicated.
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Affiliation(s)
- Adam C Salisbury
- Saint Luke's Mid America Heart and Vascular Institute, Kansas City, Missouri, USA.
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Frame MW, Uphold CR, Shehan CL, Reid KJ. Effects of Spirituality on Health-Related Quality of Life in Men With HIV/AIDS: Implications for Counseling. Counseling and Values 2011. [DOI: 10.1002/j.2161-007x.2005.tb00037.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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37
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Leifheit-Limson EC, Reid KJ, Kasl SV, Lin H, Jones PG, Buchanan DM, Peterson PN, Parashar S, Spertus JA, Lichtman JH. Abstract P206: Changes in Social Support Within the Early Recovery Period and Outcomes After Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_1.ap206] [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:
Baseline social support is associated with outcomes after AMI. However, little is known about changes in social support during the early AMI recovery period and whether changes influence outcomes over the first year.
Methods:
Using data from 1951 AMI patients enrolled in the 19-center PREMIER study, we longitudinally examined whether changes in social support between baseline (index hospitalization) and 1 month post-AMI were associated with health status and depressive symptom outcomes. Using 5 items from the ENRICHD Social Support Inventory, we categorized patients into low (score <=18) and high (score >18) support and examined changes between these categories during the first month of recovery. Health status and depressive symptoms were assessed at baseline, 6, and 12 months using the Seattle Angina Questionnaire (SAQ), Short Form-12 (SF-12), and the Patient Health Questionnaire-9 (PHQ-9). Associations were evaluated using hierarchical repeated-measures regression, adjusting for site, baseline health status, depressive symptoms, and other sociodemographic and clinical factors.
Results:
During the first month of recovery, 5.6% of patients had persistently low support, 6.4% had worsened support, 8.1% had improved support, and 80.0% had persistently high support. In risk-adjusted analyses, patients with persistently low or worsened support (versus those with persistently high support) had greater risk of angina, worse SAQ quality of life (QOL), worse SF-12 mental component summary (MCS), and more PHQ-9 depressive symptoms (
table
). Patients with improved support had outcomes consistent with those of patients with persistently high support (
table
). Similarly, patients with worsened support had outcomes comparable to patients with persistently low support (p>0.50 for all comparisons).
Conclusion:
Changes in social support within the early recovery period are not uncommon and are important for predicting patient-centered outcomes.
Outcome
Social Support Status at 1 Month
Persistently Low
Worsened
Improved
Persistently High
SAQ Angina
*
1.39 (1.09, 1.78)
1.46 (1.08, 1.97)
1.13 (0.89, 1.43)
reference
SAQ QoL
†
-7.63 (-10.96, -4.30)
-7.44 (-10.54, -4.34)
-0.85 (-3.49, 1.80)
reference
SF-12 PCS
†
-0.14 (-2.20, 1.91)
-0.20 (-2.14, 1.73)
-0.44 (-2.07, 1.18)
reference
SF-12 MCS
†
-5.63 (-7.33, -3.92)
-4.82 (-6.42, -3.22)
-1.54 (-2.88, -0.20)
reference
PHQ-9
†
2.29 (1.51, 3.06)
1.94 (1.22, 2.66)
0.81 (0.19, 1.43)
reference
*
Estimates correspond to relative risks (95% confidence intervals) of any angina (SAQ Angina Score <100).
†
Estimates correspond to beta values (95% confidence intervals).
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Affiliation(s)
| | | | | | | | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | | | | | | | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO
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Charlap E, Reid KJ, Taub C, Srinivas V. Abstract P176: Does Family History of Coronary Artery Disease Affect Prognosis in Hospital Survivors of a First Acute Myocardial Infarction? Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_1.ap176] [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:
Family history (FH) of Coronary Artery Disease (CAD), a well known risk factor for development of CAD, is often elicited in patients presenting with acute myocardial infarction (MI). However, whether a positive FH determines prognosis following MI is unknown.
Methods:
In a prospective 24-center registry of AMI (Translational Research Investigating Underlying disparities in recovery from acute Myocardial infarction: Patients' Health status [TRIUMPH]), all hospital survivors of a first MI, aged <= 70 years were categorized either with a positive FH of CAD (N=800) or not (N=1993). Positive FH was defined as CAD in a father or brother <55 years of age or a mother or sister <65. Multivariable site-stratified proportional hazards regression, adjusting for GRACE risk score, tested the independent association of a FH of CAD with one year mortality. A subset analysis was performed of those patients who themselves presented with premature CAD (men<55 and women<65).
Results:
Patients with a FH of CAD were younger (53.2 vs. 54.9, p<.001), more were women (35.5% vs. 28%, p<.001), and white (69.8% vs. 65.9%, p<.01). They had a higher prevalence of dyslipidemia (46.5% vs. 41.2%, p<0.02) and were more likely to have prior angina (9.0% vs. 6.7%, p<0.05). They had lower baseline SF-12 Physical & Mental Component scores (p<.04) and lower Angina Quality of Life scores (p<.03). However, there were no differences in multivariable adjusted one year mortality observed in those with and without a positive FH of CAD (Hazard Ratio [HR] 1.34; 95% Confidence Interval [CI] 0.86-2.10). Similarly, there were no differences in one-year mortality when patients presenting with premature CAD were separated by FH status (HR 1.39; 95% CI 0.77-2.51).
Conclusion:
Although a positive FH of CAD is a predictor for developing CAD, it is not associated with prognosis after an initial MI. Therefore, the usefulness of including a FH of CAD in stratifying the post-MI population is unclear.
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Gharacholou SM, Reid KJ, Arnold SV, Spertus J, Rich MW, Pellikka PA, Singh M, Holsinger T, Krumholz HM, Peterson ED, Alexander KP. Cognitive impairment and outcomes in older adult survivors of acute myocardial infarction: findings from the translational research investigating underlying disparities in acute myocardial infarction patients' health status registry. Am Heart J 2011; 162:860-869.e1. [PMID: 22093202 DOI: 10.1016/j.ahj.2011.08.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Accepted: 08/16/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive impairment without dementia (CIND) and acute myocardial infarction (AMI) are prevalent in older adults; however, the association of CIND with outcomes after AMI is unknown. METHODS We used a multicenter registry to study 772 patients ≥65 years with AMI, enrolled between April 2005 and December 2008, who underwent cognitive function assessment with the Telephone Interview for Cognitive Status-modified (TICS-m) 1 month after AMI. Patients were categorized by cognitive status to describe characteristics and in-hospital treatment, including quality of life and survival 1 year after AMI. RESULTS Mean age was 73.2 ± 6.3 years; 58.5% were men, and 78.2% were white. Normal cognitive function (TICS-m >22) was present in 44.4%; mild CIND (TICS-m 19-22) in 29.8%; and moderate/severe CIND (TICS-m <19) in 25.8% of patients. Rates of hypertension (72.6%, 77.4%, and 81.9%), cerebrovascular accidents (3.5%, 7.0%, and 9.0%), and myocardial infarction (20.1%, 22.2%, and 29.6%) were higher in those with lower TICS-m scores (P < .05 for comparisons). AMI medications were similar by cognitive status; however, CIND was associated with lower cardiac catheterization rates (P = .002) and cardiac rehabilitation referrals (P < .001). Patients with moderate/severe CIND had higher risk-adjusted 1-year mortality that was nonstatistically significant (adjusted hazard ratio 1.97, 95% CI 0.99-3.94, P = .054; referent normal, TICS-m >22). Quality of life across cognitive status was similar at 1 year. CONCLUSIONS Most older patients surviving AMI have measurable CIND. Cognitive impairment without dementia was associated with less invasive care, less referral and participation in cardiac rehabilitation, and worse risk-adjusted 1-year survival in those with moderate/severe CIND, making it an important condition to consider in optimizing AMI care.
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Leifheit-Limson EC, Reid KJ, Kasl SV, Lin H, Jones PG, Buchanan DM, Peterson PN, Parashar S, Spertus JA, Lichtman JH. Abstract P73: Social Support and Adherence to Cardiac Risk Factor Management Instructions during the First Year after Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_1.ap73] [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:
Adherence to risk factor management (RFM) instructions after AMI can promote recovery. The prognostic importance of social support for adherence is not well understood. We examined the relationship between baseline social support and post-AMI RFM adherence, and tested whether depression moderates this association.
Methods:
Using data from 2202 AMI patients enrolled in the 19-site PREMIER study, we longitudinally examined whether low baseline social support (index hospitalization; score <=18 on 5 items from ENRICHD Social Support Inventory) is associated with poor adherence to 13 RFM instructions (medication adherence, warfarin use, follow-up plan/appointments, whom to call, cholesterol monitoring and therapy, diabetes management, weight monitoring and loss, smoking cessation, diet, exercise, cardiac rehabilitation) within the first year of recovery. Patients were asked at 1, 6, and 12 months if they received any of the RFM instructions since their last interview. Poor adherence was defined
a priori
as adhering “very carefully” to less than 50% of the patient-appropriate instructions. Hierarchical repeated-measures Poisson regression evaluated the association between support and adherence, with adjustment for site, sociodemographics, clinical history and presentation, hospital and outpatient care, and depression. Whether depression (PHQ-9 score >=10) modified the association was evaluated by stratifying the risk-adjusted model by depression status and including a support*depression interaction term.
Results:
Patients with low social support had greater unadjusted risk of poor adherence than patients with high social support (RR 1.46, 95% CI 1.27-1.67). This association did not vary with time and remained significant after full risk adjustment (RR 1.24, 95% CI 1.05-1.47). In depression-stratified analyses, the risk-adjusted association of low support with poor adherence was significant among nondepressed (RR 1.44, 95% CI 1.26-1.66) but not depressed (RR 1.03, 95% CI 0.79-1.33) patients (p<0.001 for support*depression interaction).
Conclusion:
Good social support may improve adherence among nondepressed AMI patients, but more research is needed to understand the role of social support among depressed patients.
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Affiliation(s)
| | | | | | | | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, MO
| | | | | | | | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO
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Salisbury AC, Alexander KP, Reid KJ, Masoudi FA, Spertus JA, Kosiborod M. Abstract P106: Variation in the Incidence of Hospital-Acquired Anemia During Admission with Acute Myocardial Infarction Across 57 US Hospitals. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_2.ap106] [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:
New onset, hospital-acquired anemia (HAA) during acute myocardial infarction (AMI) may be related to hospital-based processes of care. HAA is associated with poor outcomes, but little is known about the extent of hospital variation in the incidence of HAA or the hospital characteristics associated with HAA.
Methods:
We studied 17,676 AMI patients not anemic at admission, defining moderate-severe HAA as a hemoglobin decline to < 11 g/dl. Shrinkage estimates of moderate-severe HAA incidence were generated to account for low volume sites. Multivariable models were used to identify adjusted variation in moderate-severe HAA across hospitals, using median rate ratios (MRR - median value of the relative risk of moderate-severe HAA for two identical patients presenting to two randomly selected hospitals) and fit a separate model to test the association between hospital characteristics (# beds, region, urban/rural, teaching status) and moderate-severe HAA adjusting for patient factors.
Results:
Overall, 3,551 (20%) developed moderate-severe HAA. The incidence of moderate-severe HAA varied substantially across sites (Figure) and was significant after multivariable adjustment (MRR 1.3 [1.2-1.4]). The only site factors independently associated with moderate-severe HAA were teaching status (RR 0.7 [0.6-0.9] vs. non-teaching) and region (South vs. Midwest: RR 1.3 [1.0-1.5]).
Conclusions:
We found significant variation in the incidence of moderate-severe HAA and a lower risk of HAA in teaching hospitals. Further study of the relationship between HAA and specific processes of care is needed to identify actionable targets for quality improvement.
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Affiliation(s)
- Adam C Salisbury
- Saint Luke's Mid America Heart and Vascular Inst, Kansas City, MO
| | | | - Kimberly J Reid
- Saint Luke's Mid America Heart and Vascular Inst, Kansas City, MO
| | | | - John A Spertus
- Saint Luke's Mid America Heart and Vascular Inst, Kansas City, MO
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Salisbury AC, Alexander KP, Reid KJ, Spertus JA, Masoudi FA, Rathore SS, Wang TY, Bach RG, Marso SP, Charlap E, Kosiborod M. Abstract 4: Acute, Hospital-Acquired Anemia is Associated With Increased Mortality and Worse Health Status in Patients With Acute Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2011. [DOI: 10.1161/circoutcomes.4.suppl_1.a4] [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:
While the association between chronic anemia and poor prognosis after AMI is well established, some patients develop new anemia during hospitalization. This hospital-acquired anemia (HAA) often occurs in the absence of bleeding, and is potentially preventable, but whether it has implications for mortality and health status after AMI is unknown.
Methods:
Using the 24-center TRIUMPH registry of AMI patients, we defined HAA as normal hemoglobin (Hgb) on admission but anemia at discharge, (see Figure footnote for criteria). Mortality and health status over 12 months were compared between those with moderate/severe HAA (discharge Hgb < 11.0 g/dl, n=348), mild HAA (discharge Hgb 11.0 to lower limit of normal; n=973), chronic anemia (present on admission, n=950) and no anemia (n=1588). We used Cox models to evaluate the relationship between HAA and 12-month mortality, and repeated measures models (1, 6 and 12-month SF-12 physical component scores) to study the association between HAA and health status, after adjusting for site, GRACE risk score and the presence/severity of in-hospital bleeding (TIMI minimal, minor, major).
Results:
Compared to pts without anemia, moderate/severe HAA and chronic anemia were independently associated with higher mortality and worse health status (Figure). The outcomes of patients with mild HAA were similar to those without anemia.
Conclusions:
Moderate/severe HAA is associated with increased mortality and worse health status 12 months post-MI, independent of comorbidities and bleeding. This highlights an important potential opportunity to improve care by developing HAA prevention strategies in patients hospitalized with AMI.
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Affiliation(s)
- Adam C Salisbury
- Saint Luke's Mid-America Heart Institute and the Univ of Missouri-Kansas City, Kansas City, MO
| | | | | | - John A Spertus
- Saint Luke's Mid-America Heart Institute and the Univ of Missouri-Kansas City, Kansas City, MO
| | | | | | | | | | - Steven P Marso
- Saint Luke's Mid-America Heart Institute and the Univ of Missouri-Kansas City, Kansas City, MO
| | | | - Mikhail Kosiborod
- Saint Luke's Mid-America Heart Institute and the Univ of Missouri-Kansas City, Kansas City, MO
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Salisbury AC, Kosiborod M, Amin AP, Reid KJ, Alexander KP, Spertus JA, Masoudi FA. Recovery from hospital-acquired anemia after acute myocardial infarction and effect on outcomes. Am J Cardiol 2011; 108:949-54. [PMID: 21784387 DOI: 10.1016/j.amjcard.2011.05.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 05/23/2011] [Accepted: 05/23/2011] [Indexed: 11/17/2022]
Abstract
New-onset, hospital-acquired anemia (HAA) during acute myocardial infarction (AMI) is independently associated with poor outcomes. The patterns of recovery from HAA after AMI and their association with mortality and health status are unknown. In the prospective 24-center Translational Research Investigating Underlying disparities in acute myocardial infarction Patients' Health Status (TRIUMPH) registry, we identified 530 patients with AMI and HAA (defined as normal hemoglobin at admission with the development of anemia by discharge) who had a repeat, protocol-driven hemoglobin measurement at 1 month after discharge. The 1-month measures were used to define persistent (persistent anemia) and transient (anemia resolved) HAA. The patients' health status was assessed at 1, 6, and 12 months after AMI using the Short-Form 12 Physical Component Summary, and the health status of patients with persistent and transient HAA was compared using multivariate repeated measures regression analysis. Mortality was compared using the log-rank test and proportional hazards regression analysis. Overall, 165 patients (31%) developed persistent HAA. The adjusted mean Short-Form 12 Physical Component Summary scores at the follow-up visit were significantly lower in those with persistent HAA than in those with transient HAA (-2.0 points, 95% confidence interval -3.6 to -0.3; p = 0.02). During a median follow-up of 36 months, the crude mortality (13% vs 5%, p = 0.002) and multivariate-adjusted mortality (hazard ratio 2.08, 95% confidence interval 1.02 to 4.21, p = 0.04) was greater in patients with persistent HAA. In conclusion, HAA persists 1 month after discharge in nearly 1 of 3 patients and is associated with worse health status and greater mortality. Additional investigation is needed to understand whether HAA prevention, recognition, and treatment, particularly among those with persistent HAA, will improve outcomes.
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Affiliation(s)
- Adam C Salisbury
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA.
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Allen LA, Gheorghiade M, Reid KJ, Dunlay SM, Chan PS, Hauptman PJ, Zannad F, Konstam MA, Spertus JA. Identifying patients hospitalized with heart failure at risk for unfavorable future quality of life. Circ Cardiovasc Qual Outcomes 2011; 4:389-98. [PMID: 21693723 DOI: 10.1161/circoutcomes.110.958009] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [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: 01/11/2023]
Abstract
BACKGROUND Communicating prognosis to enable shared decision-making is strongly endorsed by heart failure (HF) guidelines. Patients are concerned with both their quantity and quality of life (QoL). To facilitate the recognition of patients at high risk for unfavorable future QoL or death, we created a simple prognostic tool to estimate this combined outcome. METHODS AND RESULTS We identified factors associated with 6-month mortality or persistently unfavorable QoL, defined by Kansas City Cardiomyopathy Questionnaire (KCCQ) scores <45 at 1 and 24 weeks after hospital discharge, among 1458 patients from the Efficacy of Vasopressin Antagonism in HF Outcome Study with Tolvaptan (EVEREST). Within 24 weeks of discharge, 478 (32.8%) patients had died and 192 (13.2%) patients had serial KCCQ scores <45. After adjusting for 23 predischarge covariates, independent predictors of the combined end point included low admission KCCQ score, high B-type natriuretic peptide, hyponatremia, tachycardia, hypotension, absence of β-blocker therapy, and history of diabetes mellitus and arrhythmia. A simplified predischarge HF score for subsequent death or unfavorable QoL had moderate discrimination (c-statistic 0.72). Predischarge clinical covariates were substantially different in predicting the QoL end point as compared with traditional death or rehospitalization end points. CONCLUSIONS At the time of hospital discharge, readily available clinical characteristics are associated with HF patients at high risk for persistently unfavorable QoL or death over the next 6 months. Such information can target patients for whom aggressive treatment options (eg, devices or transplantation) and/or end-of-life discussions should be strongly considered before hospital discharge.
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Affiliation(s)
- Larry A Allen
- Colorado Cardiovascular Outcomes Research Group, University of Colorado-Denver, Aurora, CO 80045, USA.
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Magalski A, McCoy M, Zabel M, Magee LM, Goeke J, Main ML, Bunten L, Reid KJ, Ramza BM. Cardiovascular screening with electrocardiography and echocardiography in collegiate athletes. Am J Med 2011; 124:511-8. [PMID: 21605728 DOI: 10.1016/j.amjmed.2011.01.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 12/21/2010] [Accepted: 01/11/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND Current guidelines for preparticipation screening of competitive athletes in the US include a comprehensive history and physical examination. The objective of this study was to determine the incremental value of electrocardiography and echocardiography added to a screening program consisting of history and physical examination in college athletes. METHODS Competitive collegiate athletes at a single university underwent prospective collection of medical history, physical examination, 12-lead electrocardiography, and 2-dimensional echocardiography. Electrocardiograms (ECGs) were classified as normal, mildly abnormal, or distinctly abnormal according to previously published criteria. Eligibility for competition was determined using criteria from the 36(th) Bethesda Conference on Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities. RESULTS In 964 consecutive athletes, ECGs were classified as abnormal in 334 (35%), of which 95 (10%) were distinctly abnormal. Distinct ECG abnormalities were more common in men than women (15% vs 6%, P<.001) as well as black compared with white athletes (18% vs 8%, P<.001). Echocardiographic and electrocardiographic findings initially resulted in exclusion of 9 athletes from competition, including 1 for long QT syndrome and 1 for aortic root dilatation; 7 athletes with Wolff-Parkinson-White patterns were ultimately cleared for participation. (Four received further evaluation and treatment, and 3 were determined to not need treatment.) After multivariable adjustment, black race was a statistically significant predictor of distinctly abnormal ECGs (relative risk 1.82, 95% confidence interval, 1.22-2.73; P=.01). CONCLUSIONS Distinctly abnormal ECGs were found in 10% of athletes and were most common in black men. Noninvasive screening using both electrocardiography and echocardiography resulted in identification of 9 athletes with important cardiovascular conditions, 2 of whom were excluded from competition. These findings offer a framework for performing preparticipation screening for competitive collegiate athletes.
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Affiliation(s)
- Anthony Magalski
- Saint Luke's Mid America Heart and Vascular Institute, Kansas City, MO 64111, USA.
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Salisbury AC, Amin AP, Reid KJ, Wang TY, Masoudi FA, Chan PS, Alexander KP, Bach RG, Spertus JA, Kosiborod M. RELATIONSHIP OF ACUTE, HOSPITAL-ACQUIRED ANEMIA WITH IN-HOSPITAL MORTALITY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Maddox TM, Reid KJ, Ho PM, Tsai TT, Spertus JA, Rumsfeld JS. MI PATIENTS WITH NON-OBSTRUCTIVE CAD APPEAR TO HAVE SIMILAR OUTCOMES AS MI PATIENTS WITH OBSTRUCTIVE CAD: INSIGHTS FROM THE TRIUMPH STUDY. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Longmore RB, Spertus JA, Alexander KP, Gosch K, Reid KJ, Masoudi FA, Krumholz HM, Rich MW. Angina frequency after myocardial infarction and quality of life in older versus younger adults: the Prospective Registry Evaluating Myocardial Infarction: Event and Recovery study. Am Heart J 2011; 161:631-8. [PMID: 21392621 DOI: 10.1016/j.ahj.2010.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Residual angina is known to be strongly associated with health-related quality of life (HRQL) in patients with chronic coronary artery disease. As the age of myocardial infarction (MI) survivors increases, better insights into the relationship between angina frequency and HRQL in older as compared to younger patients are needed to efficiently target medical resources. METHODS We evaluated angina frequency and HRQL at 1 and 6 months after MI in 1,795 post-MI survivors using the Seattle Angina Questionnaire (SAQ). We compared changes in HRQL between older (age ≥70 years, n = 464) and younger (age <70 years, n = 1,331) patients as a function of change in SAQ angina frequency scores using hierarchical linear modeling within site. RESULTS After adjusting for baseline HRQL and 26 other covariates, older patients with similar or improved angina control at 6 months had significantly greater improvements in HRQL than younger patients (difference in SAQ quality-of-life scale 8.77 points [CI 4.00-13.54, P = .0003] and 2.56 points [CI 0.66-4.47, P = .0084], respectively). However, older patients with increased angina experienced similar declines in HRQL as compared to younger patients. CONCLUSION In stable patients with coronary artery disease after a recent MI, changes in angina control were correlated with HRQL in both older and younger patients. However, improved angina control was associated with greater HRQL improvements in older than in younger adults, underscoring the importance of aggressive angina control in older patients.
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Wetmore JB, Sankaran S, Jones PG, Reid KJ, Spertus JA. Association of decreased glomerular filtration rate with racial differences in survival after acute myocardial infarction. Clin J Am Soc Nephrol 2011; 6:733-40. [PMID: 21310822 DOI: 10.2215/cjn.02030310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES African-American race and decreased kidney function have been associated with higher mortality after acute myocardial infarction (AMI). However, whether there are racial differences in the prevalence or prognostic importance of renal insufficiency in AMI is unknown. DESIGN, SETTING, PARTICIPANTS & MEASUREMENTS Among 1847 AMI patients enrolled in the multicenter Prospective Registry Evaluating Myocardial Infarction Event and Recovery (PREMIER) study, estimated glomerular filtration rate (eGFR) was used to stratify prognosis and to examine potential interactions among eGFR, race, and mortality. Multivariable proportional hazards regression was used to examine the effect of race and eGFR on 3.5-year all-cause mortality. RESULTS Race and eGFR were significantly associated with mortality. After adjustment for eGFR alone, differences in mortality by race were substantially attenuated (unadjusted hazard ratio [HR] for African Americans=1.56 [95% confidence interval {CI}=1.2 to 2.1]; eGFR-adjusted HR=1.32 [95% CI=0.99 to 1.75]). A similar magnitude of attenuation in racial differences in survival was observed after adjustment for all covariates except eGFR (HR=1.29 [95% CI=0.96 to 1.72]). A final model adjusting for all covariates only slightly attenuated the association further. No interaction between race and eGFR was detected. CONCLUSIONS Renal insufficiency, which may represent chronic kidney disease, is a prognostically important comorbidity in African Americans after AMI. However, the effect of decreased eGFR on mortality is comparable between races, suggesting that preventing renal insufficiency in African Americans could be an important target to reduce racial disparities in post-AMI survival.
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Affiliation(s)
- James B Wetmore
- Division of Nephrology, Department of Medicine, University of Kansas School of Medicine, Kansas City, Kansas, USA
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Chan PS, Khumri T, Chung ES, Ghio S, Reid KJ, Gerritse B, Nallamothu BK, Spertus JA. Echocardiographic dyssynchrony and health status outcomes from cardiac resynchronization therapy: insights from the PROSPECT trial. JACC Cardiovasc Imaging 2010; 3:451-60. [PMID: 20466340 DOI: 10.1016/j.jcmg.2009.08.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [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: 09/04/2008] [Revised: 08/03/2009] [Accepted: 08/10/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study sought to assess the prognostic utility of echocardiographic dyssynchrony for health status improvement after cardiac resynchronization therapy (CRT). BACKGROUND Echocardiographic measures of dyssynchrony have been proposed for patient selection for CRT, but prospective validation studies are lacking. METHODS A prospective cohort of 324 patients from 53 centers with moderate to severe heart failure, left ventricular dysfunction, QRS > or =130 ms, and available echocardiographic and health status information were identified from the PROSPECT (Predictors of Response to Cardiac Re-Synchronization Therapy) trial, which evaluated the prognostic utility of dyssynchrony measures in CRT recipients. The association of 12 echocardiographic dyssynchrony parameters with 6-month improvement in health status, as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ), was assessed both as a continuous variable and by responder status (DeltaKCCQ > or =+10 points reflecting moderate to large improvement). RESULTS Of 12 pre-defined dyssynchrony parameters, only 3 were consistently reported: interventricular mechanical delay (IVMD), left ventricular filling time relative to the cardiac cycle (LVFT), and left ventricular pre-ejection interval. After multivariable adjustment, IVMD (+5.18, 95% confidence interval [CI]: +0.76 to +9.60; p = 0.02) and LVFT (+5.19, 95% CI: +0.45 to +0.94; p = 0.03) were independently associated with 6-month improvements in KCCQ. Patients with 6-month improvements in KCCQ had lower subsequent mortality (adjusted hazard ratio [HR] for each 5-point improvement: 0.83; 95% CI: 0.72 to 0.93; p = 0.03). Additionally, IVMD was associated with CRT responder status (for DeltaKCCQ > or =+10 points: odds ratio [OR]: 1.85; 95% CI: 1.12 to 3.05; p = 0.03), whereas LVFT was not (OR: 1.63; 95% CI: 0.85 to 3.11; p = 0.14). Patients classified as health status responders had a 76% lower subsequent risk of all-cause mortality (adjusted HR: 0.24; 95% CI: 0.07 to 0.84; p = 0.03). CONCLUSIONS The presence of pre-implantation IVMD and LVFT was associated with 6-month health status improvement, and IVMD was associated with a significant CRT response. These echocardiographic factors may help clinicians counsel patients regarding their likelihood of symptomatic improvement with CRT. ( PROSPECT Predictors of Response to Cardiac Re-Synchronization Therapy; NCT00253357).
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Affiliation(s)
- Paul S Chan
- Mid America Heart Institute, Kansas City, Missouri 64111, USA.
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