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Levene J, Voigt A, Thoma F, Mulukutla S, Bhonsale A, Kancharla K, Shalaby A, Estes NM, Jain S, Saba S. Patient Outcomes by Ventricular Systolic and Diastolic Function. J Am Heart Assoc 2024; 13:e033211. [PMID: 38353214 PMCID: PMC11010111 DOI: 10.1161/jaha.123.033211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/27/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Left ventricular dysfunction is characterized by systolic and diastolic parameters, leading to heart failure (HF) with reduced or preserved ejection fraction (EF), respectively. The goal of this study is to examine the impact of left ventricular systolic and diastolic dysfunction (DD) on patient outcomes. METHODS AND RESULTS Two cohorts were used in this analysis: Cohort A included 136 455 patients with EF ≥50%, stratified by the presence and grade of DD. Cohort B included 16 850 patients with EF <50%, stratified by EF quartiles. Patients were followed to the end points of all-cause death and cardiovascular, HF, or cardiac arrest hospitalizations. Over a median follow-up of 3.42 years, 23 946 (16%) patients died and 31 113 (20%), 13 305 (9%), and 1269 (1%) were hospitalized for cardiovascular, HF, or cardiac arrest causes, respectively. With adjustment for comorbidities, the risk of all-cause mortality and of cardiovascular and HF hospitalizations increased steadily with increasing grade of DD in patients with normal EF, and even more so in patients with worsening EF. The risk of hospitalization for cardiac arrest in patients with grade III DD, however, was comparable to that of patients with EF <25% (hazard ratio, 1.00 [95% CI, 0.98-1.01]) and worse than that of patients in better EF quartiles. CONCLUSIONS Although systolic dysfunction is associated with a greater risk of overall death and HF hospitalizations than DD, the risk of cardiac arrest in patients with grade II and III DD is comparable to that of patients with moderate and severe systolic dysfunction, respectively. Future studies are needed to examine treatment strategies than can improve these outcomes.
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Affiliation(s)
- Jacqueline Levene
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Andrew Voigt
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Floyd Thoma
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Suresh Mulukutla
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Aditya Bhonsale
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Krishna Kancharla
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Alaa Shalaby
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - N.A. Mark Estes
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Sandeep Jain
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Samir Saba
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
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Wann DG, Baird AS, Wang NC, Mulukutla SR, Thoma FW, Sezer A, Canterbury AM, Barakat AF, Gardner MW, Skowronski JN, Aronis KN, Voigt AH, Jain SK, Saba SF, Bhonsale A, Estes NM, Keebler ME, Hickey GW, Bazaz RR, Kancharla K. Association of pre-left ventricular assist device defibrillator shocks for ventricular arrhythmia with clinical outcomes after left ventricular assist device implantation. Heart Rhythm O2 2023; 4:708-714. [PMID: 38034894 PMCID: PMC10685166 DOI: 10.1016/j.hroo.2023.10.002] [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] [Indexed: 12/02/2023] Open
Abstract
Background Implantable cardioverter-defibrillation (ICD) shocks after left ventricular assist device therapy (LVAD) are associated with adverse clinical outcomes. Little is known about the association of pre-LVAD ICD shocks on post-LVAD clinical outcomes and whether LVAD therapy affects the prevalence of ICD shocks. Objectives The purpose of this study was to determine whether pre-LVAD ICD shocks are associated with adverse clinical outcomes post-LVAD and to compare the prevalence of ICD shocks before and after LVAD therapy. Methods Patients 18 years or older with continuous-flow LVADs and ICDs were retrospectively identified within the University of Pittsburgh Medical Center system from 2006-2020. We analyzed the association between appropriate ICD shocks within 1 year pre-LVAD with a primary composite outcome of death, stroke, and pump thrombosis and secondary outcomes of post-LVAD ICD shocks and ICD shock hospitalizations. Results Among 309 individuals, average age was 57 ± 12 years, 87% were male, 80% had ischemic cardiomyopathy, and 42% were bridge to transplantation. Seventy-one patients (23%) experienced pre-LVAD shocks, and 69 (22%) experienced post-LVAD shocks. The overall prevalence of shocks pre-LVAD and post-LVAD were not different. Pre-LVAD ICD shocks were not associated with the composite outcome. Pre-LVAD ICD shocks were found to predict post-LVAD shocks (hazard ratio [HR] 5.7; 95% confidence interval [CI] 3.42-9.48; P <.0001) and hospitalizations related to ICD shocks from ventricular arrhythmia (HR 10.34; 95% CI 4.1-25.7; P <.0001). Conclusion Pre-LVAD ICD shocks predicted post-LVAD ICD shocks and hospitalizations but were not associated with the composite outcome of death, pump thrombosis, or stroke at 1 year. The prevalence of appropriate ICD shocks was similar before and after LVAD implantation in the entire cohort.
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Affiliation(s)
- Daniel G. Wann
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew S. Baird
- Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Norman C. Wang
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Suresh R. Mulukutla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd W. Thoma
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ahmet Sezer
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ann M. Canterbury
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Amr F. Barakat
- Cardiology Department, Ascension St. Vincent’s Medical Center, Jacksonville, Florida
| | | | - Jenna N. Skowronski
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Konstantinos N. Aronis
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Andrew H. Voigt
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sandeep K. Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Samir F. Saba
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Aditya Bhonsale
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - N.A. Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mary E. Keebler
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gavin W. Hickey
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Raveen R. Bazaz
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Krishna Kancharla
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Leunig AA, Allam SD, Shalaby AA, Estes NM. Cut it and forget it: Can patient agency go too far? HeartRhythm Case Rep 2023; 9:808-810. [PMID: 38023679 PMCID: PMC10667119 DOI: 10.1016/j.hrcr.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Affiliation(s)
- Alexander A.W. Leunig
- University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shalini D. Allam
- University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alaa A. Shalaby
- University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - N.A. Mark Estes
- University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Dhande M, Rangavajla G, Canterbury A, Hamandi M, Boricha H, Newhouse D, Osterhaus EC, Thoma F, Mulukutla S, Aronis KN, Bhonsale A, Kancharla K, Shalaby A, Estes NM, Jain SK, Saba S. Guideline-Directed Medical Therapy and the Risk of Death in Primary Prevention Defibrillator Recipients. JACC Clin Electrophysiol 2022; 8:1024-1030. [DOI: 10.1016/j.jacep.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 12/15/2022]
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Wann DG, Baird A, Mulukutla S, Thoma F, Sezer A, Canterbury A, Barakat AF, Gardner MW, Skowronski J, Jain S, Saba S, Bhonsale A, Estes NM, Hickey G, Voigt A, Kaczorowski D, Keebler M, Bazaz R, Kancharla K. Association Of Pre-LVAD ICD Shocks With Post-LVAD Outcomes. J Card Fail 2022. [DOI: 10.1016/j.cardfail.2022.03.253] [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: 11/30/2022]
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Alyesh D, Gambhir A, Waase M, Remo B, Singh A, Green J, Kittleson M, Estes NM, Heist EK. A Blueprint for Productive Maintenance of Certification, But Is the American Board of Internal Medicine up to the Challenge? Circ Cardiovasc Qual Outcomes 2020; 13:e006696. [DOI: 10.1161/circoutcomes.120.006696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The future of the American Board of Internal Medicine Maintenance of Certification (MOC) program is at a crossroads. The current MOC program lacks a clear visible mission, adds to modern health care’s onerous bureaucracy, and thus pulls physicians from the most important humanistic aspects of their profession. The aim of the MOC program should be to promote the best patient care by ensuring certified physicians maintain core skills through continuous education and evaluation. The program should focus on education and be designed with the rigorous obligations of practicing physicians in mind. Moving forward, the American Board of Internal Medicine should cocreate MOC with the physician community and apply innovative adult education techniques. Over time, data-driven methods and member feedback should be used to provide continuous program improvement. This review describes the origins of the current state of MOC, explores its evidence base, provides examples of model programs for the maintenance of complex professional skills, and outlines guiding principles for the future of MOC.
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Affiliation(s)
- Daniel Alyesh
- South Denver Cardiology Associates, Littleton, CO (D.A.)
| | - Alok Gambhir
- The Heart Center of Northeast Georgia Medical Center, Gainesville (A.G.)
| | - Marc Waase
- Columbia University Medical Center, New York, NY (M.W.)
| | - Benjamin Remo
- University of Maryland Medical Center, Baltimore (B.R.)
| | | | | | - Michelle Kittleson
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.K.)
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Rowin EJ, Burrows A, Madias C, Estes NM, Link MS, Maron MS, Maron BJ. Long-Term Outcome in High-Risk Patients With Hypertrophic Cardiomyopathy After Primary Prevention Defibrillator Implants. Circ Arrhythm Electrophysiol 2020; 13:e008123. [DOI: 10.1161/circep.119.008123] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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:
The implantable cardioverter-defibrillator (ICD) is effective for preventing sudden death in patients with hypertrophic cardiomyopathy. However, data on performance and complications of implanted ICDs over particularly long time periods to inform clinical practice is presently incomplete.
Methods:
The study cohort comprises 217 consecutive hypertrophic cardiomyopathy patients with primary prevention ICDs implanted before 2008 and followed for ≥10 years (mean 12±4; range to 31).
Results:
Patients were 38±17 years at implant and 45 (21%) experienced appropriate interventions terminating ventricular tachycardia/ventricular fibrillation. The majority of ICD discharges occurred ≥5 years after implant (29 patients; 64%), including ≥10 years in 16 patients (36%). Initial device therapy increased in frequency from 2.3% of patients at <1 year to 8.5% of patients at ≥10-years after implant (
P
=0.005). Inappropriate ICD shocks in 39 patients occurred most commonly <5 years after implant (54%) and decreased in frequency with increasing time from implant (from 9.7% of patients at <5 years to 3.8% at ≥10 years,
P
=0.02). Other major device complications including infection and lead fractures and dislodgement occurred in 27 patients (12%) but did not increase in frequency over follow-up after implant (
P
=0.47). There were no arrhythmic sudden death events among the 217 patients with ICD.
Conclusions:
In hypertrophic cardiomyopathy, after a primary prevention implant, ICD therapy often followed prolonged periods of device dormancy and increased progressively in frequency over time, including one-third of patients with initial therapy after 5 to 9 years, and an additional one-third of patients at ≥10 years. Frequency of inappropriate shocks decreased over follow-up, likely reflecting standard changes in device programming, while occurrence of device complications, such as lead fractures/infection, did not increase during follow-up.
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Affiliation(s)
- Ethan J. Rowin
- Hypertrophic Cardiomyopathy Institute (E.J.R., M.S.M., B.J.M.), Tufts Medical Center, Boston, MA
| | - Austin Burrows
- Cardiac Arrhythmia Center (A.B., C.M.), Tufts Medical Center, Boston, MA
| | - Christopher Madias
- Cardiac Arrhythmia Center (A.B., C.M.), Tufts Medical Center, Boston, MA
| | - N.A. Mark Estes
- Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (N.A.M.E.)
| | - Mark S. Link
- Division of Cardiology, Department of Medicine, UT Southwestern Medical Center, Dallas TX (M.S.L.)
| | - Martin S. Maron
- Hypertrophic Cardiomyopathy Institute (E.J.R., M.S.M., B.J.M.), Tufts Medical Center, Boston, MA
| | - Barry J. Maron
- Hypertrophic Cardiomyopathy Institute (E.J.R., M.S.M., B.J.M.), Tufts Medical Center, Boston, MA
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Affiliation(s)
- N.A. Mark Estes
- Address reprint requests and correspondence: Dr. N.A. Mark Estes III, UPMC Heart and Vascular Institute, Presbyterian Hospital, 200 Lothrop St, 3rd Floor South Tower (WE352.1), Pittsburgh, PA 15213.
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Medhekar A, Mulukutla S, Thoma F, Wang NC, Bhonsale A, Kancharla K, Estes NM, Jain SK, Saba S. Reply. JACC Clin Electrophysiol 2020; 6:1026-1027. [DOI: 10.1016/j.jacep.2020.07.001] [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] [Received: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022]
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Barakat AF, Inashvili A, Alkukhun L, Shalaby AA, Wang NC, Bhonsale A, Wann D, Gardner M, Khan M, Bidani S, Skowronski J, Jain S, Voigt A, Bazaz R, Estes NM, Saba S, Kancharla K. Use Trends and Adverse Reports of SelectSecure 3830 Lead Implantations in the United States. Circ Arrhythm Electrophysiol 2020; 13:e008577. [DOI: 10.1161/circep.120.008577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amr F. Barakat
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Ana Inashvili
- Department of Medicine, University of Pittsburgh Medical Center, PA (A.I., M.K.)
| | - Laith Alkukhun
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Alaa A. Shalaby
- Cardiology Division, Pittsburgh VA Healthcare System, PA (A.A.S.)
| | - Norman C. Wang
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Aditya Bhonsale
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Dan Wann
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Michael Gardner
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Muzammil Khan
- Department of Medicine, University of Pittsburgh Medical Center, PA (A.I., M.K.)
| | - Shruti Bidani
- University of Pittsburgh School of Medicine, Pittsburgh, PA (S.B.)
| | - Jenna Skowronski
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Sandeep Jain
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Andrew Voigt
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Raveen Bazaz
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - N.A. Mark Estes
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Samir Saba
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
| | - Krishna Kancharla
- UPMC Heart and Vascular Institute, University of Pittsburgh, PA (A.F.B., L.A., N.C.W., A.B., D.W., M.G., J.S., S.J., A.V., R.B., N.A.M.E., S.S., K.K.)
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McLaughlin TJ, Gordon NT, Bhonsale A, Kancharla K, Voigt A, Wang N, Estes NM, Saba SF, Mulukutla S, Jain S. DESCRIPTION OF POST-HIP FRACTURE ANTICOAGULATION MANAGEMENT FOR ATRIAL FIBRILLATION PATIENTS AND ASSOCIATED OUTCOMES. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)31090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Maron B, Daimee U, Olshansky B, Cannom DS, Heidbuchel H, Salberg L, Ackerman M, Carre F, Estes NM, Law I, Link MS, Saarel E, Wilhelm M, Gan G, Lampert RJ. OUTCOMES OF SPORTS PARTICIPATION FOR PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY AND IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS: DATA FROM THE ICD SPORTS REGISTRY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30932-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Guhl E, Barakat A, Medhekar A, Pham R, Bazaz R, Wang N, Voigt A, Kancharla K, Bhonsale A, Estes NM, Saba SF, Jain S. LONG TERM EFFICACY FOR CRYOBALLOON PULMONARY VEIN ISOLATION IN ATRIAL FIBRILLATION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30903-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Makani A, Saba S, Jain SK, Bhonsale A, Sharbaugh MS, Thoma F, Wang Y, Marroquin OC, Lee JS, Estes NM, Mulukutla SR. Safety and Efficacy of Direct Oral Anticoagulants Versus Warfarin in Patients With Chronic Kidney Disease and Atrial Fibrillation. Am J Cardiol 2020; 125:210-214. [PMID: 31780073 DOI: 10.1016/j.amjcard.2019.10.033] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 10/25/2022]
Abstract
Patients with atrial fibrillation (AF) commonly have impaired renal function. The safety and efficacy of direct oral anticoagulants (DOACs) in patients with chronic kidney disease (CKD) and end-stage renal disease has not been fully elucidated. This study evaluated and compared the safety outcomes of DOACs versus warfarin in patients with nonvalvular AF and concomitant CKD. Patients in our health system with AF prescribed oral anticoagulants during 2010 to 2017 were identified. All-cause mortality, bleeding and hemorrhagic, and ischemic stroke were evaluated based on degree of renal impairment and method of anticoagulation. There were 21,733 patients with a CHA2DS2-VASc score of ≥2 included in this analysis. Compared with warfarin, DOAC use in patients with impaired renal function was associated with lower risk of mortality with a hazard ratio (HR): 0.76 (95% confidence interval [CI] 0.70 to 0.84, p value <0.001) in patients with eGFR >60, HR 0.74 (95% CI 0.68 to 0.81, p value <0.001) in patients with eGFR >30 to 60, and HR 0.76 (95% CI 0.63 to 0.92, p value <0.001) in patients with eGFR ≤30 or on dialysis. Bleeding requiring hospitalization was also less in the DOAC group with a HR 0.93 (95% CI 0.82 to 1.04, p value 0.209) in patients with eGFR >60, HR 0.83 (95% CI 0.74 to 0.94, p value 0.003) in patients with eGFR >30 to 60, and HR 0.69 (95% CI 0.50 to 0.93, p value 0.017) in patients with eGFR ≤30 or on dialysis. In conclusion, in comparison to warfarin, DOACs appear to be safe and effective with a lower risk of all-cause mortality and lower bleeding across all levels of CKD.
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Wann D, Bhonsale A, Jain S, Saba S, Estes NM, Kancharla K. Novel method of superior vena cava electrical isolation with close proximity to the phrenic nerve. HeartRhythm Case Rep 2019; 5:461-464. [PMID: 31934541 PMCID: PMC6951328 DOI: 10.1016/j.hrcr.2019.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Barakat AF, Thalappillil A, Qin D, Ladejobi A, Bhonsale A, Kancharla K, Wang NC, Adelstein E, Jain S, Estes NM, Saba S. Implications of Neurological Status on Defibrillator Therapy and Long-Term Mortality of Sudden Cardiac Arrest Survivors. JACC Clin Electrophysiol 2019; 5:843-850. [DOI: 10.1016/j.jacep.2019.04.003] [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] [Received: 12/13/2018] [Revised: 03/26/2019] [Accepted: 04/18/2019] [Indexed: 11/25/2022]
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Rogers PA, Bernard ML, Madias C, Thihalolipavan S, Mark Estes N, Morin DP. Current Evidence-Based Understanding of the Epidemiology, Prevention, and Treatment of Atrial Fibrillation. Curr Probl Cardiol 2018; 43:241-283. [DOI: 10.1016/j.cpcardiol.2017.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Maron BJ, Estes NM, Maron MS. Is It Fair to Screen Only Competitive Athletes for Sudden Death Risk, or Is It Time to Level the Playing Field? Am J Cardiol 2018; 121:1008-1010. [PMID: 29472006 DOI: 10.1016/j.amjcard.2017.12.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/19/2017] [Accepted: 12/29/2017] [Indexed: 10/18/2022]
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