Pub Date : 2024-09-18DOI: 10.1016/j.ahj.2024.09.004
Anran Tan MS , Sushama Kattinakere Sreedhara MBBS, MSPH , Massimiliano Russo PhD , Daniel E Singer MD , Julie C. Lauffenburger PharmD, PhD , Elyse DiCesare BA , Kueiyu Joshua Lin MD, ScD
Background
Persistence and adherence to oral anticoagulants (OACs) is crucial for its effectiveness in stroke prevention in atrial fibrillation (AF). We aimed to assess the impact of different ascertainment methods on estimated persistence rates.
Methods
We conducted a retrospective cohort study based on the Medicare claims data (01/01/2013-12/31/2019). We built an incident user cohort of OAC (apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin) prescription filling. We measured OAC medication persistence and adherence using the following approaches: (1) treatment-anniversary based persistence: if there is an active prescription overlapping the 180th and 365th day with vs. without a 15-day buffer period (i.e., overlapping with 165th-195th and 350th-380th day); (2) dispensing-gap-based persistence: if there is OAC discontinuation defined as having gap between prescriptions more than a threshold (e.g., 5-60 days) and secondarily, (3) proportion of days covered (PDC) adherence: proportion of days in which patient had filled medication available over the 365-day interval.
Results
We identified 1,398,692 patients who initiated OACs during the study interval. With the treatment-anniversary based approach, only 51.2% to 65.4% of the patients persisted with the medication for either warfarin or DOACs at 180 days, and the number dropped to 43.4% to 60.7% at 1 year. Adding a 15-day buffer period increased the treatment-anniversary based persistence rates by 6.5% to 10.5%. When the allowable gap increased from 5 to 60 days, the persistence rates increased by 36.3% to 42.4% for all OACs. Apixaban users had the highest PDC (74%-75%) over the 365 days, compared to other OACs (60%-69%).
Conclusions
We found that the estimated persistence rates are sensitive to the choice of ascertainment methods. When reporting and comparing persistence findings using the claims database, definitions of OAC discontinuation must be clearly delineated.
{"title":"Assessing methods to ascertain persistence and adherence of oral anticoagulants in patients with atrial fibrillation","authors":"Anran Tan MS , Sushama Kattinakere Sreedhara MBBS, MSPH , Massimiliano Russo PhD , Daniel E Singer MD , Julie C. Lauffenburger PharmD, PhD , Elyse DiCesare BA , Kueiyu Joshua Lin MD, ScD","doi":"10.1016/j.ahj.2024.09.004","DOIUrl":"10.1016/j.ahj.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>Persistence and adherence to oral anticoagulants (OACs) is crucial for its effectiveness in stroke prevention in atrial fibrillation (AF). We aimed to assess the impact of different ascertainment methods on estimated persistence rates.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study based on the Medicare claims data (01/01/2013-12/31/2019). We built an incident user cohort of OAC (apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin) prescription filling. We measured OAC medication persistence and adherence using the following approaches: (1) treatment-anniversary based persistence: if there is an active prescription overlapping the 180th and 365th day with vs. without a 15-day buffer period (i.e., overlapping with 165th-195th and 350th-380th day); (2) dispensing-gap-based persistence: if there is OAC discontinuation defined as having gap between prescriptions more than a threshold (e.g., 5-60 days) and secondarily, (3) proportion of days covered (PDC) adherence: proportion of days in which patient had filled medication available over the 365-day interval.</div></div><div><h3>Results</h3><div>We identified 1,398,692 patients who initiated OACs during the study interval. With the treatment-anniversary based approach, only 51.2% to 65.4% of the patients persisted with the medication for either warfarin or DOACs at 180 days, and the number dropped to 43.4% to 60.7% at 1 year. Adding a 15-day buffer period increased the treatment-anniversary based persistence rates by 6.5% to 10.5%. When the allowable gap increased from 5 to 60 days, the persistence rates increased by 36.3% to 42.4% for all OACs. Apixaban users had the highest PDC (74%-75%) over the 365 days, compared to other OACs (60%-69%).</div></div><div><h3>Conclusions</h3><div>We found that the estimated persistence rates are sensitive to the choice of ascertainment methods. When reporting and comparing persistence findings using the claims database, definitions of OAC discontinuation must be clearly delineated.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"278 ","pages":"Pages 161-169"},"PeriodicalIF":3.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-18DOI: 10.1016/j.ahj.2024.09.005
Shahzad Hassan MD, MS , Lee-Shing Chang MD , Daniel Gabovitch MBA , Jacqueline Chasse NP , Gretchen Stern PhD , Caitlin Colling MD , David Zelle BA , Christopher P. Cannon MD , Deborah Wexler MD , Benjamin M. Scirica MD, MPH , Alexander J. Blood MD, MSc
We describe the strategies used to identify and enroll participants in a remote health management program aimed at optimizing diabetes care in patients at high cardiovascular and kidney risk. Using a combination of digital and traditional outreach methods, including patient portals, emails, mailed letters, and provider referrals, we successfully enrolled 200 participants. Our experience highlights the effectiveness of a hybrid approach in achieving enrollment targets, addressing the challenges of identification of eligible candidates and engagement while integrating traditional methods for inclusivity.
{"title":"Enrollment strategies in the era of digital revolution: Experience from a remote health management program","authors":"Shahzad Hassan MD, MS , Lee-Shing Chang MD , Daniel Gabovitch MBA , Jacqueline Chasse NP , Gretchen Stern PhD , Caitlin Colling MD , David Zelle BA , Christopher P. Cannon MD , Deborah Wexler MD , Benjamin M. Scirica MD, MPH , Alexander J. Blood MD, MSc","doi":"10.1016/j.ahj.2024.09.005","DOIUrl":"10.1016/j.ahj.2024.09.005","url":null,"abstract":"<div><div>We describe the strategies used to identify and enroll participants in a remote health management program aimed at optimizing diabetes care in patients at high cardiovascular and kidney risk. Using a combination of digital and traditional outreach methods, including patient portals, emails, mailed letters, and provider referrals, we successfully enrolled 200 participants. Our experience highlights the effectiveness of a hybrid approach in achieving enrollment targets, addressing the challenges of identification of eligible candidates and engagement while integrating traditional methods for inclusivity.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"278 ","pages":"Pages 181-185"},"PeriodicalIF":3.7,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1016/j.ahj.2024.09.003
Matthew E. Oster MD MPH , Yanxu Yang DrPH , Caroline Shi MPH , Susan Anderson BA , Jessica Knight PhD , Logan G. Spector PhD , Osamah Aldoss MD , Charles E. Canter MD , Mansi Gaitonde MD , Gurumurthy Hiremath MD , Anitha John MD , Deborah J. Kozik DO , Bradley S. Marino MD , Kimberly E. McHugh MD , David Overman MD , Geetha Raghuveer MD , James Louis St. MD , Jeffrey P. Jacobs MD , Michelle Gurvitz MD, MPH , Grace Smith BS , Lazaros K. Kochilas MD, MSCR
Background
With improved survival of adults with congenital heart disease (CHD) comes a need to understand the lifelong outcomes of this population. The aim of this paper is to describe the rationale and design of Congenital Heart Disease Project to Understand Lifelong Survivor Experience (CHD PULSE), a study to determine long-term medical, neurocognitive, and psychosocial outcomes among adults with a history of intervention for CHD and to identify factors associated with those outcomes.
Methods
CHD PULSE is a cross-sectional survey conducted from September 2021 to April 2023 among adults aged 18 and older with a history of at least 1 intervention for CHD at 1 of 11 participating U.S. centers in the Pediatric Cardiac Care Consortium. Participants with CHD were asked to complete a 99-question survey on a variety of topics including: demographics, surgeries, health insurance, health care, heart doctors, general health, height and weight, education and work history, reproductive health (for women only), and COVID-19. To construct a control group for the study, siblings of survey respondents were invited to complete a similar survey. Descriptive statistics for demographics, disease severity, center, and method of survey completion were computed for participants and controls. Comparisons were made between participants and non-participants to assess for response bias and between CHD participants and sibling controls to assess for baseline differences.
Results
Among the 14,322 eligible participants, there were 3,133 respondents (21.9%) from 48 U.S. states with surveys returned for inclusion in the study. Sibling contact information was provided by 691 respondents, with surveys returned by 326 siblings (47.2%). The median age of participants was 32.8 years at time of survey completion, with an interquartile range of 27.2 years to 39.7 years and an overall range of 20.1 to 82.9 years. Participants were predominantly female (55.1%) and of non-Hispanic White race/ethnicity (87.1%). There were no differences between participants and non-participants regarding severity of CHD. Compared to nonparticipants, participants were more likely to be female, of older age, and be of non-Hispanic White race/ethnicity. Enrolled siblings were more likely to be female and slightly younger than participants.
Conclusions
With surveys from 3,133 participants from across the U.S., CHD PULSE is poised to provide keen insights into the lifelong journey of those living with CHD, extending beyond mere survival. These insights will offer opportunities for informing strategies to enhance and improve future outcomes for this population of patients.
{"title":"Rationale and design of CHD PULSE: Congenital Heart Disease Project to Understand Lifelong Survivor Experience","authors":"Matthew E. Oster MD MPH , Yanxu Yang DrPH , Caroline Shi MPH , Susan Anderson BA , Jessica Knight PhD , Logan G. Spector PhD , Osamah Aldoss MD , Charles E. Canter MD , Mansi Gaitonde MD , Gurumurthy Hiremath MD , Anitha John MD , Deborah J. Kozik DO , Bradley S. Marino MD , Kimberly E. McHugh MD , David Overman MD , Geetha Raghuveer MD , James Louis St. MD , Jeffrey P. Jacobs MD , Michelle Gurvitz MD, MPH , Grace Smith BS , Lazaros K. Kochilas MD, MSCR","doi":"10.1016/j.ahj.2024.09.003","DOIUrl":"10.1016/j.ahj.2024.09.003","url":null,"abstract":"<div><h3>Background</h3><div>With improved survival of adults with congenital heart disease (CHD) comes a need to understand the lifelong outcomes of this population. The aim of this paper is to describe the rationale and design of Congenital Heart Disease Project to Understand Lifelong Survivor Experience (CHD PULSE), a study to determine long-term medical, neurocognitive, and psychosocial outcomes among adults with a history of intervention for CHD and to identify factors associated with those outcomes.</div></div><div><h3>Methods</h3><div>CHD PULSE is a cross-sectional survey conducted from September 2021 to April 2023 among adults aged 18 and older with a history of at least 1 intervention for CHD at 1 of 11 participating U.S. centers in the Pediatric Cardiac Care Consortium. Participants with CHD were asked to complete a 99-question survey on a variety of topics including: demographics, surgeries, health insurance, health care, heart doctors, general health, height and weight, education and work history, reproductive health (for women only), and COVID-19. To construct a control group for the study, siblings of survey respondents were invited to complete a similar survey. Descriptive statistics for demographics, disease severity, center, and method of survey completion were computed for participants and controls. Comparisons were made between participants and non-participants to assess for response bias and between CHD participants and sibling controls to assess for baseline differences.</div></div><div><h3>Results</h3><div>Among the 14,322 eligible participants, there were 3,133 respondents (21.9%) from 48 U.S. states with surveys returned for inclusion in the study. Sibling contact information was provided by 691 respondents, with surveys returned by 326 siblings (47.2%). The median age of participants was 32.8 years at time of survey completion, with an interquartile range of 27.2 years to 39.7 years and an overall range of 20.1 to 82.9 years. Participants were predominantly female (55.1%) and of non-Hispanic White race/ethnicity (87.1%). There were no differences between participants and non-participants regarding severity of CHD. Compared to nonparticipants, participants were more likely to be female, of older age, and be of non-Hispanic White race/ethnicity. Enrolled siblings were more likely to be female and slightly younger than participants.</div></div><div><h3>Conclusions</h3><div>With surveys from 3,133 participants from across the U.S., CHD PULSE is poised to provide keen insights into the lifelong journey of those living with CHD, extending beyond mere survival. These insights will offer opportunities for informing strategies to enhance and improve future outcomes for this population of patients.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"278 ","pages":"Pages 150-160"},"PeriodicalIF":3.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-17DOI: 10.1016/j.ahj.2024.09.002
Shurjeel Uddin Qazi MBBS , Arsalan Hamid MD , Huzaifa Ul Haq Ansari MBBS , Michel G. Khouri MD , Markus S. Anker , Michael E. Hall MD , Stefan D. Anker , Javed Butler MD, MPH, MBA , Muhammad Shahzeb Khan MD, MS
Background
With the advent of novel chemotherapy, survival of patients with cancer has improved. However, people with cancer have an increased risk of heart failure (HF). Conversely, HF-related mortality may undermine survival among people with cancer. We aim to analyze the trends of mortality in people with HF and cancer in the adult US population.
Methods
We conducted an examination of death certificates sourced from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database, from the years 1999 to 2020. Mortality in adults with HF and cancer was assessed. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change were reported.
Results
Between 1999 and 2020, 621,783 deaths occurred from HF in people with cancer. The AAMR declined from 16.4 in 1999 to 11.9 in 2017, after which an increase to 14.5 was observed in 2020. Men had consistently higher overall AAMR as compared to women (men = 18.1 vs women = 9.9). Similar AAMR was observed between non-Hispanic (NH) Blacks/African Americans (13.9) and NH Whites (13.3), with lower in American Indian/Alaska Native (9.6) and Hispanics (7.4). Asian/Pacific Islanders reported the lowest AAMR (5.7). The Midwestern region reported the highest AAMR (14.8). We observed the highest AAMR amongst the older population (61.4).
Conclusion
The mortality rates of people with HF and cancer are increasing in the adult U.S. population. This underscores the need for increased screening, aggressive management, and subsequent surveillance of people at risk or with manifested HF in people with cancer.
{"title":"Trends in cancer and heart failure related mortality in adult US population: A CDC WONDER database analysis from 1999 to 2020","authors":"Shurjeel Uddin Qazi MBBS , Arsalan Hamid MD , Huzaifa Ul Haq Ansari MBBS , Michel G. Khouri MD , Markus S. Anker , Michael E. Hall MD , Stefan D. Anker , Javed Butler MD, MPH, MBA , Muhammad Shahzeb Khan MD, MS","doi":"10.1016/j.ahj.2024.09.002","DOIUrl":"10.1016/j.ahj.2024.09.002","url":null,"abstract":"<div><h3>Background</h3><div>With the advent of novel chemotherapy, survival of patients with cancer has improved. However, people with cancer have an increased risk of heart failure (HF). Conversely, HF-related mortality may undermine survival among people with cancer. We aim to analyze the trends of mortality in people with HF and cancer in the adult US population.</div></div><div><h3>Methods</h3><div>We conducted an examination of death certificates sourced from the CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research) database, from the years 1999 to 2020. Mortality in adults with HF and cancer was assessed. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change were reported.</div></div><div><h3>Results</h3><div>Between 1999 and 2020, 621,783 deaths occurred from HF in people with cancer. The AAMR declined from 16.4 in 1999 to 11.9 in 2017, after which an increase to 14.5 was observed in 2020. Men had consistently higher overall AAMR as compared to women (men = 18.1 vs women = 9.9). Similar AAMR was observed between non-Hispanic (NH) Blacks/African Americans (13.9) and NH Whites (13.3), with lower in American Indian/Alaska Native (9.6) and Hispanics (7.4). Asian/Pacific Islanders reported the lowest AAMR (5.7). The Midwestern region reported the highest AAMR (14.8). We observed the highest AAMR amongst the older population (61.4).</div></div><div><h3>Conclusion</h3><div>The mortality rates of people with HF and cancer are increasing in the adult U.S. population. This underscores the need for increased screening, aggressive management, and subsequent surveillance of people at risk or with manifested HF in people with cancer.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"278 ","pages":"Pages 170-180"},"PeriodicalIF":3.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142279379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-10DOI: 10.1016/j.ahj.2024.08.019
Francesco Santoro MD, PhD , Thomas Stiermaier MD , Iván J. Núñez Gil MD, PhD , Ibrahim El-Battrawy MD , Toni Pätz MD , Luca Cacciotti MD, PhD , Federico Guerra MD , Giuseppina Novo MD, PhD , Beatrice Musumeci MD , Massimo Volpe MD , Enrica Mariano MD, PhD , Pasquale Caldarola MD , Roberta Montisci MD , Ilaria Ragnatela MD , Rosa Cetera MD , Ravi Vazirani MD , Carmen Lluch MD , Aitor Uribarri MD , Miguel Corbi-Pascual MD , David Aritza Conty Cardona MD , Luca Arcari MD
Background
Few data are available on long-term drug therapy and its potential prognostic impact after Takotsubo syndrome (TTS). Aim of the study is to evaluate clinical characteristics and long-term outcome of TTS patients on Renin Angiotensin system inhibitors (RASi).
Methods
TTS patients were enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry. Median follow-up was 31 (Interquartile range 12-56) months. Comparison of RASi treated vs. untreated patients was performed within the overall population and after 1:1 propensity score matching for age, sex, comorbidities, type of trigger and in-hospital complications.
Of the 2453 TTS patients discharged alive, 1683 (68%) received RASi therapy. Patients with RASi were older (age 71 ± 11 vs 69 ± 13 years, P = .01), with higher prevalence of hypertension (74% vs 53%, P < .01) and diabetes (19% v s15%, P = .01), higher admission left ventricular ejection fraction (LVEF) (41 ± 11% vs 39 ± 12%, P < .01) and lower rates of in-hospital complications (18.9% vs 29.6%, P < .01). At multivariable analysis, RASi therapy at discharge was independently associated with lower mortality (HR 0.63, 95% CI 0.45-0.87, P < .01). Survival analysis showed that at long term, patients treated with RASi had lower mortality rates in the overall cohort (log-rank P = .001). However, this benefit was not found among patients treated with RASi in the matched cohort (log-rank P = .168). Potential survival benefit of RASi were present, both in the overall and matched cohort, in 2 subgroups: patients with admission LVEF ≤ 40% (HR 0.54 95% CI 0.38-0.78, P = .001; HR 0.59, 95% CI 0.37-0.95, P = .030) and diabetes (HR 0.41, 95% CI 0.23-0.73, P = .002; HR 0.41, 95% CI 0.21-0.82, P = .011).
Conclusions
Long-term therapy with RASi after a TTS episode was not associated with lower mortality rates at propensity score analysis. However, potential survival benefit can be found among patients with admission LVEF ≤ 40% or diabetes.
背景关于塔克次氏综合征（TTS）后长期药物治疗及其潜在预后影响的数据很少。本研究旨在评估服用肾素血管紧张素系统抑制剂（RASi）的 TTS 患者的临床特征和长期预后。中位随访时间为 31 个月（四分位距为 12-56 个月）。RASi治疗与未治疗患者的比较在总体人群中进行，并根据年龄、性别、合并症、触发类型和院内并发症进行1:1倾向评分匹配。REGISTRATIONclinicaltrials.gov, NCT04361994, https://clinicaltrials.gov/study/NCT04361994 结果：在2453名活着出院的TTS患者中，1683人（68%）接受了RASi治疗。接受RASi治疗的患者年龄较大（71±11岁 vs 69±13岁，P=0.01），高血压（74% vs 53%，P<0.01）和糖尿病（19% vs 15%，P=0.01）患病率较高，入院左室射血分数（LVEF）较高（41±11% vs 39±12%，P<0.01），院内并发症发生率较低（18.9% vs 29.6%，P<0.01）。在多变量分析中，出院时接受 RASi 治疗与较低的死亡率独立相关（HR 0.63，95%CI 0.45-0.87，p<0.01）。生存分析表明，从长期来看，接受RASi治疗的患者在整个队列中的死亡率较低（对数秩P=0.001）。然而，在配对队列中，接受 RASi 治疗的患者并没有发现这种益处（对数秩 P=0.168）。在总体队列和匹配队列中，RASi的潜在生存获益存在于两个亚组：入院时LVEF≤40%的患者（HR 0.54，95%CI 0.38-0.78，p=0.001；HR 0.59，95%CI 0.37-0.95，p=0.030）和糖尿病（HR 0.41，95%CI 0.23-0.73，p= 0.002；HR 0.41，95%CI 0.21-0.82，p=0.011）。结论TTS发作后长期使用RASi治疗与倾向评分分析中较低的死亡率无关。然而，入院时 LVEF ≤40% 或患有糖尿病的患者可能会获得生存益处。
{"title":"Renin angiotensin system inhibitors and outcome in patients with takotsubo syndrome: A propensity score analysis of the GEIST registry","authors":"Francesco Santoro MD, PhD , Thomas Stiermaier MD , Iván J. Núñez Gil MD, PhD , Ibrahim El-Battrawy MD , Toni Pätz MD , Luca Cacciotti MD, PhD , Federico Guerra MD , Giuseppina Novo MD, PhD , Beatrice Musumeci MD , Massimo Volpe MD , Enrica Mariano MD, PhD , Pasquale Caldarola MD , Roberta Montisci MD , Ilaria Ragnatela MD , Rosa Cetera MD , Ravi Vazirani MD , Carmen Lluch MD , Aitor Uribarri MD , Miguel Corbi-Pascual MD , David Aritza Conty Cardona MD , Luca Arcari MD","doi":"10.1016/j.ahj.2024.08.019","DOIUrl":"10.1016/j.ahj.2024.08.019","url":null,"abstract":"<div><h3>Background</h3><div>Few data are available on long-term drug therapy and its potential prognostic impact after Takotsubo syndrome (TTS). Aim of the study is to evaluate clinical characteristics and long-term outcome of TTS patients on Renin Angiotensin system inhibitors (RASi).</div></div><div><h3>Methods</h3><div>TTS patients were enrolled in the international multicenter GEIST (GErman Italian Spanish Takotsubo) registry. Median follow-up was 31 (Interquartile range 12-56) months. Comparison of RASi treated vs. untreated patients was performed within the overall population and after 1:1 propensity score matching for age, sex, comorbidities, type of trigger and in-hospital complications.</div></div><div><h3>Registration</h3><div>clinicaltrials.gov, NCT04361994, https://clinicaltrials.gov/study/NCT04361994</div></div><div><h3>Results</h3><div>Of the 2453 TTS patients discharged alive, 1683 (68%) received RASi therapy. Patients with RASi were older (age 71 ± 11 vs 69 ± 13 years, <em>P</em> = .01), with higher prevalence of hypertension (74% vs 53%, <em>P</em> < .01) and diabetes (19% v s15%, <em>P</em> = .01), higher admission left ventricular ejection fraction (LVEF) (41 ± 11% vs 39 ± 12%, <em>P</em> < .01) and lower rates of in-hospital complications (18.9% vs 29.6%, <em>P</em> < .01). At multivariable analysis, RASi therapy at discharge was independently associated with lower mortality (HR 0.63, 95% CI 0.45-0.87, <em>P</em> < .01). Survival analysis showed that at long term, patients treated with RASi had lower mortality rates in the overall cohort (log-rank <em>P</em> = .001). However, this benefit was not found among patients treated with RASi in the matched cohort (log-rank <em>P</em> = .168). Potential survival benefit of RASi were present, both in the overall and matched cohort, in 2 subgroups: patients with admission LVEF ≤ 40% (HR 0.54 95% CI 0.38-0.78, <em>P</em> = .001; HR 0.59, 95% CI 0.37-0.95, <em>P</em> = .030) and diabetes (HR 0.41, 95% CI 0.23-0.73, <em>P</em> = .002; HR 0.41, 95% CI 0.21-0.82, <em>P</em> = .011).</div></div><div><h3>Conclusions</h3><div>Long-term therapy with RASi after a TTS episode was not associated with lower mortality rates at propensity score analysis. However, potential survival benefit can be found among patients with admission LVEF ≤ 40% or diabetes.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"278 ","pages":"Pages 127-138"},"PeriodicalIF":3.7,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142269068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-07DOI: 10.1016/j.ahj.2024.09.001
Matthew T. Mefford PhD , Andrew P. Ambrosy MD , Rong Wei MS , Chengyi Zheng PhD , Rishi V. Parikh MPH , Teresa N. Harrison SM , Ming-Sum Lee MD , Alan S. Go MD , Kristi Reynolds PhD
Background
Prior studies characterizing worsening heart failure events (WHFE) have been limited in using structured healthcare data from hospitalizations, and with little exploration of sociodemographic variation. The current study examined the impact of incorporating unstructured data to identify WHFE, describing age-, sex-, race and ethnicity-, and left ventricular ejection fraction (LVEF)-specific rates.
Methods
Adult members of Kaiser Permanente Southern California (KPSC) with a HF diagnosis between 2014 and 2018 were followed through 2019 to identify hospitalized WHFE. The main outcome was hospitalizations with a principal or secondary HF discharge diagnosis meeting rule-based Natural Language Processing (NLP) criteria for WHFE. In comparison, we examined hospitalizations with a principal discharge diagnosis of HF. Age-, sex-, and race and ethnicity-adjusted rates per 100 person-years (PY) were calculated among age, sex, race and ethnicity (non-Hispanic (NH) Asian/Pacific Islander [API], Hispanic, NH Black, NH White) and LVEF subgroups.
Results
Among 44,863 adults with HF, 10,560 (23.5%) had an NLP-defined, hospitalized WHFE. Adjusted rates (per 100 PY) of WHFE using NLP were higher compared to rates based only on HF principal discharge diagnosis codes (12.7 and 9.3, respectively), and this followed similar patterns among subgroups, with the highest rates among adults ≥75 years (16.3 and 11.2), men (13.2 and 9.7), and NH Black (16.9 and 14.3) and Hispanic adults (15.3 and 11.4), and adults with reduced LVEF (16.2 and 14.0). Using NLP disproportionately increased the perceived burden of WHFE among API and adults with mid-range and preserved LVEF.
Conclusion
Rule-based NLP improved the capture of hospitalized WHFE above principal discharge diagnosis codes alone. Applying standardized consensus definitions to EHR data may improve understanding of the burden of WHFE and promote optimal care overall and in specific sociodemographic groups.
{"title":"Rule-based natural language processing to examine variation in worsening heart failure hospitalizations by age, sex, race and ethnicity, and left ventricular ejection fraction","authors":"Matthew T. Mefford PhD , Andrew P. Ambrosy MD , Rong Wei MS , Chengyi Zheng PhD , Rishi V. Parikh MPH , Teresa N. Harrison SM , Ming-Sum Lee MD , Alan S. Go MD , Kristi Reynolds PhD","doi":"10.1016/j.ahj.2024.09.001","DOIUrl":"10.1016/j.ahj.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Prior studies characterizing worsening heart failure events (WHFE) have been limited in using structured healthcare data from hospitalizations, and with little exploration of sociodemographic variation. The current study examined the impact of incorporating unstructured data to identify WHFE, describing age-, sex-, race and ethnicity-, and left ventricular ejection fraction (LVEF)-specific rates.</div></div><div><h3>Methods</h3><div>Adult members of Kaiser Permanente Southern California (KPSC) with a HF diagnosis between 2014 and 2018 were followed through 2019 to identify hospitalized WHFE. The main outcome was hospitalizations with a principal or secondary HF discharge diagnosis meeting rule-based Natural Language Processing (NLP) criteria for WHFE. In comparison, we examined hospitalizations with a principal discharge diagnosis of HF. Age-, sex-, and race and ethnicity-adjusted rates per 100 person-years (PY) were calculated among age, sex, race and ethnicity (non-Hispanic (NH) Asian/Pacific Islander [API], Hispanic, NH Black, NH White) and LVEF subgroups.</div></div><div><h3>Results</h3><div>Among 44,863 adults with HF, 10,560 (23.5%) had an NLP-defined, hospitalized WHFE. Adjusted rates (per 100 PY) of WHFE using NLP were higher compared to rates based only on HF principal discharge diagnosis codes (12.7 and 9.3, respectively), and this followed similar patterns among subgroups, with the highest rates among adults ≥75 years (16.3 and 11.2), men (13.2 and 9.7), and NH Black (16.9 and 14.3) and Hispanic adults (15.3 and 11.4), and adults with reduced LVEF (16.2 and 14.0). Using NLP disproportionately increased the perceived burden of WHFE among API and adults with mid-range and preserved LVEF.</div></div><div><h3>Conclusion</h3><div>Rule-based NLP improved the capture of hospitalized WHFE above principal discharge diagnosis codes alone. Applying standardized consensus definitions to EHR data may improve understanding of the burden of WHFE and promote optimal care overall and in specific sociodemographic groups.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"278 ","pages":"Pages 117-126"},"PeriodicalIF":3.7,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142253435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-07DOI: 10.1016/j.ahj.2024.08.008
Chao Jiang MD , Zhiyan Wang MD , Xin Du MD, PhD , Yufeng Wang MD , Mingyang Gao MD , Zhaoxu Jia MD , Zhongyi Chai MD , Zhiyun Yang MD , Chi Wang PhD , Liu He PhD , Rong Hu MD , Qiang Lv MD , Jiahui Wu MD , Xu Li MD , Changqi Jia MD , Rong Han ME , Hisatomi Arima MD, PhD , Xia Wang PhD , Bruce Neal MD, PhD , Anthony Rodgers MD, PhD , Changsheng Ma MD
Background
Co-morbid hypertension is strong predictor of adverse cardiovascular (CV) outcomes in patients with atrial fibrillation (AF) but the optimal target for blood pressure (BP) control in this patient population has not been clearly defined.
Methods
The Cardiovascular Risk reduction in patients with Atrial Fibrillation Trial (CRAFT) is an investigator-initiated and conducted, international, multicenter, open-label, parallel-group, blinded outcome assessed, randomized controlled trial of intensive BP control in patients with AF. The aim is to determine whether intensive BP control (target home systolic blood pressure [SBP] <120 mmHg) is superior to standard BP control (home SBP <135 mmHg) on the hierarchical composite outcome of time to CV death, number of stroke events, time to the first stroke, number of myocardial infarction (MI) events, time to the first MI, number of heart failure hospitalization (HFH) events, and time to the first HFH. A sample size of 1,675 patients is estimated to provide 80% power to detect a win-ratio of 1.50 for intensive versus standard BP control on the primary composite outcome. Study visits are conducted at 1, 2, 3, and 6 months postrandomization, and every 6 months thereafter during the study.
Conclusions
This clinical trial aims to provide reliable evidence of the effects of intensive BP control in patients with AF.
Trial registration
The trial is registered at ClinicalTrials.gov (NCT04347330)
{"title":"Protocol for a randomized controlled trial of intensive blood pressure control on cardiovascular risk reduction in patients with atrial fibrillation: Rationale and design of the CRAFT trial","authors":"Chao Jiang MD , Zhiyan Wang MD , Xin Du MD, PhD , Yufeng Wang MD , Mingyang Gao MD , Zhaoxu Jia MD , Zhongyi Chai MD , Zhiyun Yang MD , Chi Wang PhD , Liu He PhD , Rong Hu MD , Qiang Lv MD , Jiahui Wu MD , Xu Li MD , Changqi Jia MD , Rong Han ME , Hisatomi Arima MD, PhD , Xia Wang PhD , Bruce Neal MD, PhD , Anthony Rodgers MD, PhD , Changsheng Ma MD","doi":"10.1016/j.ahj.2024.08.008","DOIUrl":"10.1016/j.ahj.2024.08.008","url":null,"abstract":"<div><h3>Background</h3><p>Co-morbid hypertension is strong predictor of adverse cardiovascular (CV) outcomes in patients with atrial fibrillation (AF) but the optimal target for blood pressure (BP) control in this patient population has not been clearly defined.</p></div><div><h3>Methods</h3><p>The Cardiovascular Risk reduction in patients with Atrial Fibrillation Trial (CRAFT) is an investigator-initiated and conducted, international, multicenter, open-label, parallel-group, blinded outcome assessed, randomized controlled trial of intensive BP control in patients with AF. The aim is to determine whether intensive BP control (target home systolic blood pressure [SBP] <120 mmHg) is superior to standard BP control (home SBP <135 mmHg) on the hierarchical composite outcome of time to CV death, number of stroke events, time to the first stroke, number of myocardial infarction (MI) events, time to the first MI, number of heart failure hospitalization (HFH) events, and time to the first HFH. A sample size of 1,675 patients is estimated to provide 80% power to detect a win-ratio of 1.50 for intensive versus standard BP control on the primary composite outcome. Study visits are conducted at 1, 2, 3, and 6 months postrandomization, and every 6 months thereafter during the study.</p></div><div><h3>Conclusions</h3><p>This clinical trial aims to provide reliable evidence of the effects of intensive BP control in patients with AF.</p></div><div><h3>Trial registration</h3><p>The trial is registered at ClinicalTrials.gov (NCT04347330)</p></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"278 ","pages":"Pages 33-40"},"PeriodicalIF":3.7,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142054634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1016/j.ahj.2024.07.004
Ana Navas-Acien MD, PhD , Daniel B. Mark MD, MPH , Kevin Anstrom PhD, MS , Gervasio A. Lamas MD
{"title":"Response to Tomoyuki Kawada: Blood and urine metal levels in patients with diabetes and cardiovascular disease","authors":"Ana Navas-Acien MD, PhD , Daniel B. Mark MD, MPH , Kevin Anstrom PhD, MS , Gervasio A. Lamas MD","doi":"10.1016/j.ahj.2024.07.004","DOIUrl":"10.1016/j.ahj.2024.07.004","url":null,"abstract":"","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"277 ","pages":"Pages 143-144"},"PeriodicalIF":3.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-04DOI: 10.1016/j.ahj.2024.08.023
Masaki Kodaira MD , Mohammad Sazzad Hasan PhD , Yoni Grossman MD , Carlos Guerrero MD , Liming Guo MSc , Aihua Liu PhD , Judith Therrien MD, FRCPC , Ariane Marelli MD, MPH, FRCPC, FACC, FAHA
Background
Cardiovascular complications due to viral infection pose a significant risk in vulnerable patients such as those with congenital heart disease (CHD). Limited data exists regarding the incidence of influenza and its impact on cardiovascular outcomes among this specific patient population.
Methods
A retrospective cohort study was designed using the Canadian Congenital Heart Disease (CanCHD) database—a pan-Canadian database of CHD patients with up to 35 years of follow-up. CHD patients aged 40 to 65 years with influenza virus-associated hospitalizations between 2010 and 2017 were identified and 1:1 matched with CHD patients with limb fracture hospitalizations on age and calendar time. Our primary endpoint was cardiovascular complications: heart failure, acute myocardial infarction, atrial arrhythmia, ventricular arrhythmia, heart block, myocarditis, and pericarditis.
Results
Of the 303 patients identified with incident influenza virus-associated hospitalizations, 255 were matched to 255 patients with limb fracture hospitalizations. Patients with influenza virus-related hospitalizations showed significantly higher cumulative probability of cardiovascular complications at 1 year (0.16 vs. 0.03) and 5 years (0.33 vs. 0.15) compared to patients hospitalized with bone fracture. Time-dependent hazard function modeling demonstrated a significantly higher risk of cardiovascular complications within 9 months postdischarge for influenza-related hospitalizations. This association was confirmed by Cox regression model (average hazard ratio throughout follow-up: 2.48; 95% CI: 1.59-3.84).
Conclusions
This pan-Canadian cohort study of adults with CHD demonstrated an association between influenza virus-related hospitalization and risk of cardiovascular complications during the 9 months post discharge. This data is essential in planning surveillance strategies to mitigate adverse outcomes and provides insights into interpreting complication rates of other emerging pathogens, such as COVID-19.
{"title":"Risk of cardiovascular events after influenza infection-related hospitalizations in adults with congenital heart disease: A nationwide population based study","authors":"Masaki Kodaira MD , Mohammad Sazzad Hasan PhD , Yoni Grossman MD , Carlos Guerrero MD , Liming Guo MSc , Aihua Liu PhD , Judith Therrien MD, FRCPC , Ariane Marelli MD, MPH, FRCPC, FACC, FAHA","doi":"10.1016/j.ahj.2024.08.023","DOIUrl":"10.1016/j.ahj.2024.08.023","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular complications due to viral infection pose a significant risk in vulnerable patients such as those with congenital heart disease (CHD). Limited data exists regarding the incidence of influenza and its impact on cardiovascular outcomes among this specific patient population.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was designed using the Canadian Congenital Heart Disease (CanCHD) database—a pan-Canadian database of CHD patients with up to 35 years of follow-up. CHD patients aged 40 to 65 years with influenza virus-associated hospitalizations between 2010 and 2017 were identified and 1:1 matched with CHD patients with limb fracture hospitalizations on age and calendar time. Our primary endpoint was cardiovascular complications: heart failure, acute myocardial infarction, atrial arrhythmia, ventricular arrhythmia, heart block, myocarditis, and pericarditis.</div></div><div><h3>Results</h3><div>Of the 303 patients identified with incident influenza virus-associated hospitalizations, 255 were matched to 255 patients with limb fracture hospitalizations. Patients with influenza virus-related hospitalizations showed significantly higher cumulative probability of cardiovascular complications at 1 year (0.16 vs. 0.03) and 5 years (0.33 vs. 0.15) compared to patients hospitalized with bone fracture. Time-dependent hazard function modeling demonstrated a significantly higher risk of cardiovascular complications within 9 months postdischarge for influenza-related hospitalizations. This association was confirmed by Cox regression model (average hazard ratio throughout follow-up: 2.48; 95% CI: 1.59-3.84).</div></div><div><h3>Conclusions</h3><div>This pan-Canadian cohort study of adults with CHD demonstrated an association between influenza virus-related hospitalization and risk of cardiovascular complications during the 9 months post discharge. This data is essential in planning surveillance strategies to mitigate adverse outcomes and provides insights into interpreting complication rates of other emerging pathogens, such as COVID-19.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"278 ","pages":"Pages 93-105"},"PeriodicalIF":3.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142144983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号