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Fischer MA, Mahajan A, Cabaj M, Kimball TH, Morselli M, Soehalim E, Chapski DJ, Montoya D, Farrell CP, Scovotti J, Bueno CT, Mimila NA, Shemin RJ, Elashoff D, Pellegrini M, Monte E, Vondriska TM. DNA Methylation-Based Prediction of Post-operative Atrial Fibrillation. Front Cardiovasc Med 2022; 9:837725. [PMID: 35620521 PMCID: PMC9127230 DOI: 10.3389/fcvm.2022.837725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/17/2022] [Indexed: 12/14/2022] Open
Abstract
BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia and post-operative atrial fibrillation (POAF) is a major healthcare burden, contributing to an increased risk of stroke, kidney failure, heart attack and death. Genetic studies have identified associations with AF, but no molecular diagnostic exists to predict POAF based on pre-operative measurements. Such a tool would be of great value for perioperative planning to improve patient care and reduce healthcare costs. In this pilot study of epigenetic precision medicine in the perioperative period, we carried out bisulfite sequencing to measure DNA methylation status in blood collected from patients prior to cardiac surgery to identify biosignatures of POAF.MethodsWe enrolled 221 patients undergoing cardiac surgery in this prospective observational study. DNA methylation measurements were obtained from blood samples drawn from awake patients prior to surgery. After controlling for clinical and methylation covariates, we analyzed DNA methylation loci in the discovery cohort of 110 patients for association with POAF. We also constructed predictive models for POAF using clinical and DNA methylation data. We subsequently performed targeted analyses of a separate cohort of 101 cardiac surgical patients to measure the methylation status solely of significant methylation loci in the discovery cohort.ResultsA total of 47 patients in the discovery cohort (42.7%) and 43 patients in the validation cohort (42.6%) developed POAF. We identified 12 CpGs that were statistically significant in the discovery cohort after correcting for multiple hypothesis testing. Of these sites, 6 were amenable to targeted bisulfite sequencing and chr16:24640902 was statistically significant in the validation cohort. In addition, the methylation POAF prediction model had an AUC of 0.79 in the validation cohort.ConclusionsWe have identified DNA methylation biomarkers that can predict future occurrence of POAF associated with cardiac surgery. This research demonstrates the use of precision medicine to develop models combining epigenomic and clinical data to predict disease.
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Affiliation(s)
- Matthew A. Fischer
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- *Correspondence: Matthew A. Fischer
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Maximilian Cabaj
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Todd H. Kimball
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Marco Morselli
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Elizabeth Soehalim
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Douglas J. Chapski
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Dennis Montoya
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Colin P. Farrell
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jennifer Scovotti
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Claudia T. Bueno
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Naomi A. Mimila
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Richard J. Shemin
- Division of Cardiac Surgery, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States
| | - David Elashoff
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Biostatistics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Matteo Pellegrini
- Department of Molecular, Cellular and Developmental Biology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Emma Monte
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
| | - Thomas M. Vondriska
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States
- Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Physiology, University of California, Los Angeles, Los Angeles, CA, United States
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Mimila NA, Chung PJ, Elliott MN, Bethell CD, Chacon S, Biely C, Contreras S, Chavis T, Bruno Y, Moss T, Coker TR. Well-Child Care Redesign: A Mixed Methods Analysis of Parent Experiences in the PARENT Trial. Acad Pediatr 2017; 17:747-754. [PMID: 28232142 PMCID: PMC5555836 DOI: 10.1016/j.acap.2017.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/23/2017] [Accepted: 02/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), is a well-child care (WCC) model that has demonstrated effectiveness in improving the receipt of comprehensive WCC services and reducing emergency department utilization for children aged 0 to 3 in low-income communities. PARENT relies on a health educator ("parent coach") to provide WCC services; it utilizes a Web-based previsit prioritization/screening tool (Well-Visit Planner) and an automated text message reminder/education service. We sought to assess intervention feasibility and acceptability among PARENT trial intervention participants. METHODS Intervention parents completed a survey after a 12-month study period; a 26% random sample of them were invited to participate in a qualitative interview. Interviews were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis; survey responses were analyzed using bivariate methods. RESULTS A total of 115 intervention participants completed the 12-month survey; 30 completed a qualitative interview. Nearly all intervention participants reported meeting with the coach, found her helpful, and would recommend continuing coach-led well visits (97-99%). Parents built trusting relationships with the coach and viewed her as a distinct and important part of their WCC team. They reported that PARENT well visits more efficiently used in-clinic time and were comprehensive and family centered. Most used the Well-Visit Planner (87%), and found it easy to use (94%); a minority completed it at home before the visit (18%). Sixty-two percent reported using the text message service; most reported it as a helpful source of new information and a reinforcement of information discussed during visits. CONCLUSIONS A parent coach-led intervention for WCC for young children is a model of WCC delivery that is both acceptable and feasible to parents in a low-income urban population.
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Affiliation(s)
- Naomi A. Mimila
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Paul J. Chung
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA,RAND, Santa Monica, CA,UCLA Fielding School of Public Health, Los Angeles, CA
| | | | | | - Sandra Chacon
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Christopher Biely
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sandra Contreras
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | | | - Tanesha Moss
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Tumaini R. Coker
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA,RAND, Santa Monica, CA
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Coker TR, Chacon S, Elliott MN, Bruno Y, Chavis T, Biely C, Bethell CD, Contreras S, Mimila NA, Mercado J, Chung PJ. A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial. Pediatrics 2016; 137:e20153013. [PMID: 26908675 PMCID: PMC4771128 DOI: 10.1542/peds.2015-3013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [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] [Accepted: 11/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal of this study was to examine the effects of a new model for well-child care (WCC), the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), on WCC quality and health care utilization among low-income families. METHODS PARENT includes 4 elements designed by using a stakeholder-engaged process: (1) a parent coach (ie, health educator) to provide anticipatory guidance, psychosocial screening and referral, and developmental/behavioral guidance and screening at each well-visit; (2) a Web-based tool for previsit screening; (3) an automated text message service to provide periodic, age-specific health messages to families; and (4) a brief, problem-focused encounter with the pediatric clinician. The Promoting Healthy Development Survey-PLUS was used to assess receipt of recommended WCC services at 12 months' postenrollment. Intervention effects were examined by using bivariate analyses. RESULTS A total of 251 parents with a child aged ≤12 months were randomized to receive either the control (usual WCC) or the intervention (PARENT); 90% completed the 12-month assessment. Mean child age at enrollment was 4.5 months; 64% had an annual household income less than $20,000. Baseline characteristics for the intervention and control groups were similar. Intervention parents scored higher on all preventive care measures (anticipatory guidance, health information, psychosocial assessment, developmental screening, and parental developmental/behavioral concerns addressed) and experiences of care measures (family-centeredness, helpfulness, and overall rating of care). Fifty-two percent fewer intervention children had ≥2 emergency department visits over the 12-month period. There were no significant differences in WCC or sick visits/urgent care utilization. CONCLUSIONS A parent coach-led model for WCC may improve the receipt of comprehensive WCC for low-income families, and it may potentially lead to cost savings by reducing emergency department utilization.
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Affiliation(s)
- Tumaini R. Coker
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California;,RAND, Santa Monica, California
| | - Sandra Chacon
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | | | - Christopher Biely
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Sandra Contreras
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Naomi A. Mimila
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jeffrey Mercado
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Paul J. Chung
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California;,RAND, Santa Monica, California;,UCLA Fielding School of Public Health, Los Angeles, California
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