30 results on '"Samuel W. Reinhardt"'
Search Results
2. Trends in transcatheter and surgical aortic valve replacement in the United States, 2008-2018
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Fouad Chouairi, Katherine A.A. Clark, Tariq Ahmad, Clancy W. Mullan, Michael Fuery, Samuel W. Reinhardt, Avirup Guha, P. Elliott Miller, Bradley Kay, and Nihar R. Desai
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Heart Valve Prosthesis Implantation ,medicine.medical_specialty ,Demographics ,business.industry ,Retrospective cohort study ,Aortic Valve Stenosis ,Discharge home ,medicine.disease ,United States ,Transcatheter Aortic Valve Replacement ,Stenosis ,Patient population ,Treatment Outcome ,Aortic valve replacement ,Risk Factors ,Aortic Valve ,Emergency medicine ,Humans ,Medicine ,Hospital Mortality ,Cardiology and Cardiovascular Medicine ,business ,Resource utilization ,Retrospective Studies - Abstract
We conducted a retrospective study using the NIS database from 2008 to 2018 to examine the most contemporary national hospitalization trends of transcatheter (TAVR) and surgical (SAVR) aortic valve replacement regarding volume, patient and hospital demographics and economics, resource utilization, total cost of stay, and in-hospital mortality. We demonstrate that TAVR procedures have been performed on a slow by steadily diversifying patient population while volume has grown significantly, while in-hospital mortality, length of stay, discharge home, and costs have improved, whereas these metrics have generally remained stable for SAVR. These trends will likely drive continued TAVR adoption, greatly expanding the overall aortic stenosis patient population eligible for AVR.
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- 2022
3. Forgone Medical Care Associated With Increased Health Care Costs Among the U.S. Heart Failure Population
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Nihar R. Desai, Haider J. Warraich, Alexander Thomas, Hyeon‐Ju J. Ali, Javier Valero-Elizondo, Khurram Nasir, Samuel W. Reinhardt, and Rohan Khera
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medicine.medical_specialty ,education.field_of_study ,Health economics ,Medical treatment ,business.industry ,Population ,medicine.disease ,Medical care ,Patient care ,Heart failure ,Health care ,Emergency medicine ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Medical Expenditure Panel Survey ,education - Abstract
Objectives The objective of this study was to describe the prevalence of patients with forgone/delayed care for heart failure (HF) and examine the associated demographic characteristics, health care utilization, and costs. Background HF is a leading cause of morbidity and mortality, with health care expenditures projected to increase 3-fold from 2012 to 2030. The proportion of HF patients with forgone/delayed medical care and the association with health care expenditures and utilization remain unknown. Methods Data on patients with HF were obtained from the Medical Expenditure Panel Survey to assess expenditures and health care utilization in the United States from 2004 to 2015. Patients with HF who reported forgone/delayed care, any missed or delayed medical treatment, were compared with those without care lapses. Results Overall, 16% of patients with HF reported forgone/delayed care, including 10% among the elderly (aged ≥65 years) and 27% among the nonelderly (aged Conclusions Nearly 1 in 6 patients with HF in the United States reported forgone/delayed medical care, with one-half attributing it to financial reasons, and this was associated with higher overall health care spending.
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- 2021
4. Cannabis use disorder among atrial fibrillation admissions, 2008–2018
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Tariq Ahmad, Fouad Chouairi, Samuel W. Reinhardt, Daniel J. Friedman, Avirup Guha, John-Ross D. Clarke, P. Elliott Miller, Nihar R. Desai, and James V. Freeman
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Adult ,Male ,Marijuana Abuse ,medicine.medical_specialty ,Adolescent ,Demographics ,Population ,Internal medicine ,Atrial Fibrillation ,medicine ,Humans ,education ,Aged ,Retrospective Studies ,Cannabis use disorder ,education.field_of_study ,biology ,business.industry ,Atrial fibrillation ,General Medicine ,Middle Aged ,Cannabis use ,medicine.disease ,biology.organism_classification ,United States ,Hospitalization ,Cross-Sectional Studies ,Quartile ,Female ,Diagnosis code ,Cannabis ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND Despite changes inthe legality of cannabis use and the increasing prevalence of cannabis use disorder (CUD), there is little data investigating the association between CUD and inpatient atrial fibrillation (AF) hospitalizations. METHODS Using the National Inpatient Sample, we identified Atrial Fibrillation (AF) hospitalizations with and without a codiagnosis of CUD using International Classification of Diseases diagnosis codes and compared demographics, socioeconomics, comorbidities, outcomes, and trends between cohorts. RESULTS Between 2008 and 2018, we identified 5,155,789 admissions for AF of which 31,768 (0.6%) had a codiagnosis of CUD. The proportion of admissions with a history of CUD increased from 0.3% in 2008 to 1.0% in 2018 (p
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- 2021
5. Intercountry Differences in Guideline-Directed Medical Therapy and Outcomes Among Patients With Heart Failure
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Cesar Caraballo, Samuel W. Reinhardt, Neal G. Ravindra, Nihar R. Desai, Andrew S. Oseran, Megan McCullough, Tariq Ahmad, Peter A. Kahn, Justin Pacor, Avirup Guha, Mona Fiuzat, G. Michael Felker, Gordon W. Moe, Avinainder Singh, Katherine A.A. Clark, James L. Januzzi, Michael Fuery, Christopher M. O'Connor, P. Elliott Miller, Lina Vadlamani, Fouad Chouairi, Justin A. Ezekowitz, Aidan Milner, and Neeti S. Kulkarni
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Canada ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Mineralocorticoid Receptor Antagonists ,Heart Failure ,Ejection fraction ,business.industry ,Hazard ratio ,Sleep apnea ,Stroke Volume ,Guideline ,medicine.disease ,United States ,Confidence interval ,Hospitalization ,Clinical trial ,Heart failure ,Practice Guidelines as Topic ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Objectives The aim of this study was to examine patterns of care and clinical outcomes among patients with heart failure with reduced ejection fraction (HFrEF) in the United States and Canada. Background In the GUIDE-IT (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment) trial, the use of N-terminal pro–B-type natriuretic peptide–guided titration of guideline-directed medical therapy (GDMT) was compared with usual care alone for patients with HFrEF in the United States and Canada. It remains unknown whether the country of enrollment had an impact on outcomes or GDMT use. Methods A total of 894 patients at 45 sites across the United States and Canada with HFrEF (ejection fraction ≤40%) were enrolled in the trial. Kaplan-Meier survival estimates stratified by country of enrollment were developed for the trial outcomes, and log-rank testing was compared between the groups. GDMT use and titration were also compared. Results U.S. patients were more likely to be younger, to be Black, to have higher body mass index, and to have histories of defibrillator placement or sleep apnea. Use of β-blockers was significantly higher in Canada at baseline (99.3% vs. 94.0%; p = 0.01) and 6 months (99.0% vs. 94.1%; p = 0.04), and use of mineralocorticoid receptor antagonists was higher in Canada at 6 months (68.3% vs. 55.1%; p = 0.01). Canadian patients were less likely to experience the primary study endpoint (hazard ratio [HR]: 0.65; 95% confidence interval [CI]: 0.45 to 0.93; p = 0.01) due to decreased rates of HF hospitalization (HR: 0.57; 95% CI: 0.38 to 0.86; p = 0.003). The differences in outcomes were driven by increased heart failure hospitalization among U.S. Black patients. Conclusions In GUIDE-IT, patients with HFrEF in Canada were significantly less likely to be hospitalized for heart failure. Differences in GDMT use, along with differences in sociodemographics and care delivery structures, may contribute to these differences, highlighting the importance of increasing diversity in clinical trials. (Guiding Evidence Based Therapy Using Biomarker Intensified Treatment [GUIDE-IT]; NCT01685840 )
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- 2021
6. Changes in Use of Left Ventricular Assist Devices as Bridge to Transplantation With New Heart Allocation Policy
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Fouad Chouairi, Christopher Maulion, Joseph G. Rogers, P. Elliott Miller, Nihar R. Desai, Samuel W. Reinhardt, David C. Mulligan, Michael Fuery, Makoto Mori, Muhammad Anwer, Katherine A.A. Clark, Daniel Jacoby, Sounok Sen, Tariq Ahmad, Richard N. Formica, Clancy W. Mullan, and Arnar Geirsson
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Heart transplantation ,United Network for Organ Sharing ,medicine.medical_specialty ,System change ,business.industry ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Donor heart ,Heart failure ,Emergency medicine ,Medicine ,Treatment strategy ,Bridge to transplantation ,030212 general & internal medicine ,Risks and benefits ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives The goal of this study was to describe outcomes of patients with bridge to heart transplantation (BTT) after changes were made to the donor heart allocation system. Background Left ventricular assist devices (LVADs) have been used as a BTT. On October 18, 2018, the donor heart allocation system in the United States was updated. Methods This study identified adults in the United Network for Organ Sharing database with durable, continuous-flow LVAD at listing or implanted while listed between April 2017 and April 2020. Baseline recipient and donor characteristics, waitlist survival, and post-transplantation outcomes were compared pre- and post-allocation system change. Results A total of 1,794 patients met inclusion criteria: 983 in the pre-change period and 814 afterward. The number of patients listed with LVAD decreased nationally over time from 102 in April 2017 to 12 in April 2020 (p Conclusions The number of patients with BTT on the transplant list decreased steadily and dramatically after the allocation system change. Although time to transplant decreased, there was an increase in post-transplant mortality. These data suggest that the risks and benefits of LVAD implantation as a BTT have changed under the new allocation system and that the appropriate indication for this treatment strategy warrants a re-evaluation.
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- 2021
7. Young Man With Shortness of Breath
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Christopher L. Moore, Daniel Hodson, and Samuel W. Reinhardt
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Adult ,Male ,2019-20 coronavirus outbreak ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,SARS-CoV-2 ,business.industry ,Point-of-Care Systems ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,COVID-19 ,Images in Emergency Medicine ,Myocarditis ,Dyspnea ,Echocardiography ,Internal medicine ,Emergency Medicine ,Humans ,Pericarditis ,Medicine ,business - Published
- 2021
8. Thirty-Day and 90-Day Episode of Care Spending Following Heart Failure Hospitalization Among Medicare Beneficiaries
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Samuel W. Reinhardt, Katherine A.A. Clark, Xin Xin, Craig S. Parzynski, Ralph J. Riello III, Phil Sarocco, Tariq Ahmad, and Nihar R. Desai
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Heart Failure ,Hospitalization ,Episode of Care ,Humans ,Renal Insufficiency, Chronic ,Cardiology and Cardiovascular Medicine ,Medicare ,United States ,Aged ,Retrospective Studies - Abstract
BACKGROUND: Despite growing interest in value-based models, utilization patterns and costs for heart failure (HF) admissions are not well understood. We sought to characterize Medicare spending for patients with HF for 30- and 90-day episodes of care (which include an index hospitalization and 30 or 90 days following discharge) and to describe the patterns of post-acute care spending. METHODS: Using Medicare fee-for-service administrative claims data from 2016 to 2018, we performed a retrospective analysis of patients discharged after hospitalization with primary discharge diagnoses of systolic HF, diastolic HF, hypertensive heart disease (HHD) with HF, and HHD with HF and chronic kidney disease. We analyzed coding patterns across these groups over time, median 30- and 90-day payments, and costs allocated to index hospitalization and postacute care. RESULTS: The study included 935 962 patients discharged following hospitalization for HF (systolic HF: 178 603; diastolic HF: 165 156; HHD with HF: 226 929; HHD with HF and chronic kidney disease: 365 274). The proportion of HHD codes increased from 26% of HF hospitalizations in 2016 to 91% in 2018. There was substantial spending on 30-day (median $13 330, interquartile range $9912–$22 489) and 90-day episodes (median $21 658, interquartile range $12 423–$37 630) for HF with significant variation, such that the third quartile of patients incurred costs 3 times the amount of the first quartile. Across all codes, the index hospitalization accounted for ≈70% of 30-day and 45% of 90-day spending. Sixty-one percent of postacute care spending occurred 31 to 90 days following discharge, with readmissions and observation stays (36%) and skilled nursing facilities (27%) comprising the largest categories. CONCLUSIONS: This patient episode-level analysis of contemporary Medicare beneficiaries is the first to examine 90-day spending, which will become an increasingly important pasyment benchmark with the expansion of the Medicare Bundled Payments for Care Improvement Program. Further investigation into the drivers of costs will be essential to provide high-value HF care.
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- 2022
9. Sex Differences in Patients Receiving Left Ventricular Assist Devices for End-Stage Heart Failure
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Tariq Ahmad, Eric J. Velazquez, Samuel W. Reinhardt, Neal G. Ravindra, Jadry Gruen, Makoto Mori, Clancy W. Mullan, Catherine Mezzacappa, Megan McCullough, Arnar Geirsson, Cesar Caraballo, P. Elliott Miller, and Nihar R. Desai
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Risk of mortality ,Humans ,Registries ,030212 general & internal medicine ,Adverse effect ,Aged ,Retrospective Studies ,Heart Failure ,Heart transplantation ,Sex Characteristics ,business.industry ,Incidence (epidemiology) ,Hazard ratio ,medicine.disease ,Confidence interval ,Treatment Outcome ,Heart failure ,Circulatory system ,Cardiology ,Heart Transplantation ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
This study sought to use INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) results to evaluate sex differences in the use and clinical outcomes of left ventricular assist devices (LVAD).Despite a similar incidence of heart failure in men and women, prior studies have highlighted potential underuse of LVADs in women, and studies of clinical outcomes have yielded conflicting results.Patients were enrolled from the INTERMACS study who underwent implantation of their first continuous-flow LVAD between 2008 and 2017, and survival analyses stratified by sex were conducted.Among the 18,868 patients, 3,984 (21.1%) were women. At 1 year, women were less likely to undergo heart transplantation than men (17.9% vs. 20.0%, respectively; p = 0.003). After multivariable adjustments, women had a higher risk of death (hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 1.07 to 1.23; p 0.001) and were more likely to incur post-implantation adverse events, including rehospitalization, bleeding, stroke, and pump thrombosis or device malfunction. Although women younger than 50 years of age had an increased risk of death compared to men of the same age (HR: 1.34; 95% CI: 1.12 to 1.6), men and women 65 years of age and older had a similar risk of death (HR: 1.09; 95% CI: 0.95 to 1.24).This study found that women had a higher risk of mortality and adverse events after LVAD. Only 1 in 5 LVADs were implanted in women, and women were less likely to receive a heart transplant than men. Further investigation is needed to understand the causes of adverse events and potential underuse of advanced treatment options in women.
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- 2020
10. Comfort Measures Only in Myocardial Infarction: Prevalence of This Status, Change Over Time, and Predictors From a Nationwide Study
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Leila Haghighat, Samuel W. Reinhardt, Danielle L. Saly, Di Lu, Roland A. Matsouaka, Tracy Y. Wang, and Nihar R. Desai
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Male ,Time Factors ,Myocardial Infarction ,Prevalence ,Shock, Cardiogenic ,Humans ,Hospital Mortality ,Registries ,Cardiology and Cardiovascular Medicine ,Retrospective Studies - Abstract
Background: Patients hospitalized with acute myocardial infarction (AMI) have a high mortality rate. Despite increasing recognition of the role for comfort focused care, little is known about the prevalence of comfort measures only (CMO) care among patients with AMI. The objective of this study was to investigate patient- and hospital-level patterns and predictors of CMO care among patients admitted with AMI. Methods: This retrospective cohort study used the National Cardiovascular Data Registry Chest Pain-MI Registry, which contains data on patients admitted with AMI. Data were analyzed in 6-month increments from January 2015 to June 2018. Results: Among 483 696 patients with AMI across 827 hospitals, 13 955 (2.9%) had CMO status at discharge (2.6% non–ST-segment–elevation myocardial infarction and 3.4% ST-segment–elevation myocardial infarction). There was a modest decline in CMO rates over time (3.0% to 2.8%). Independent patient characteristics associated with CMO status included male gender, White race, nonprivate insurance, frailty, and higher estimated bleeding and mortality risks. There was substantial variation in CMO rates across hospitals, with the proportion of CMO patients ranging from 0% to 17.1% and a median odds ratio of 1.59 (95% CI, 1.56–1.62). Among the 13 955 patients who were CMO by discharge, 8134 (58.3%) underwent diagnostic catheterization. This is despite significantly elevated risks predicted using precatheterization models, specifically the ACTION Registry GWTG in-hospital major bleeding and mortality risk scores. Patients who were initially managed invasively but later made CMO experienced high rates of procedural complications, including cardiogenic shock (38.3%), dialysis (10.1%), and bleeding (33.3%). Conclusions: Most patients with AMI who were CMO by discharge had aggressive initial management and became CMO following in-hospital complications of their care. Early identification of high-risk patients and appropriate transition of such patients to CMO, if aligned with their values, remain important areas for future quality programs in AMI.
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- 2022
11. Clinical Outcomes After Left Ventricular Assist Device Implantation in Older Adults
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Mathew S. Maurer, Nihar R. Desai, Samuel W. Reinhardt, Neal G. Ravindra, Ayyaz Ali, Clancy W. Mullan, Megan McCullough, Tariq Ahmad, Cesar Caraballo, Ersilia M. DeFilippis, P. Elliott Miller, Jadry Gruen, Shunichi Nakagawa, Veli K. Topkara, Catherine Mezzacappa, and Andrew E. Levin
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Geriatrics ,medicine.medical_specialty ,education.field_of_study ,Adult patients ,business.industry ,medicine.medical_treatment ,Population ,030204 cardiovascular system & hematology ,equipment and supplies ,medicine.disease ,03 medical and health sciences ,Regimen ,0302 clinical medicine ,Age groups ,Heart failure ,Ventricular assist device ,Emergency medicine ,medicine ,030212 general & internal medicine ,Cardiology and Cardiovascular Medicine ,education ,business - Abstract
Objectives The purpose of this study was to examine outcomes after left ventricular assist device (LVAD) implantation in older adults (>75 years of age). Background An aging heart failure population together with improvements in mechanical circulatory support (MCS) technology have led to increasing LVAD implantations in older adults. However, data presenting age-specific outcomes are limited. Methods Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who required durable MCS between 2008 and 2017 were included. Patients were stratified by 4 age groups: 75 years of age. Kaplan-Meier survival estimates were used to assess post-LVAD outcomes, with log-rank testing used to compare groups. Univariate and multivariate cox proportional hazard regression models were used to determine predictors of survival and complications. Results A total of 20,939 individuals received an LVAD during the study period: 7,743 (37.0%) were Conclusions Despite careful selection of older adults for LVAD implantation, age remains a significant predictor of mortality. Higher bleeding and lower clotting risk in elderly patients with LVADs support the use of a less intense antithrombotic regimen in this unique population.
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- 2019
12. Trends and Outcomes of Cardiac Transplantation in the Lowest Urgency Candidates
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Joseph G. Rogers, Maya Rose Chiravuri, Peter Natov, Clancy W. Mullan, Tariq Ahmad, Samuel W. Reinhardt, Michael Fuery, Lynn D. Wilson, Sounok Sen, Muhammad Anwer, Arnar Geirsson, Chetan B. Patel, Katherine A.A. Clark, Jasjit Bhinder, Robert P Davis, Fouad Chouairi, Nihar R. Desai, and P. Elliott Miller
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Male ,medicine.medical_specialty ,System change ,Databases, Factual ,Waiting Lists ,medicine.medical_treatment ,outcomes research ,Internal medicine ,Diabetes mellitus ,medicine ,Retrospective analysis ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Retrospective Studies ,Heart transplantation ,business.industry ,Hepatitis C ,medicine.disease ,Survival Analysis ,advanced heart failure ,Tissue Donors ,Transplantation ,Treatment Outcome ,RC666-701 ,Heart Transplantation ,Female ,Outcomes research ,Cardiology and Cardiovascular Medicine ,business ,UNOS - Abstract
Background Because of discrepancies between donor supply and recipient demand, the cardiac transplantation process aims to prioritize the most medically urgent patients. It remains unknown how recipients with the lowest medical urgency compare to others in the allocation process. We aimed to examine differences in clinical characteristics, organ allocation patterns, and outcomes between cardiac transplantation candidates with the lowest and highest medical urgency. Methods and Results We performed a retrospective analysis of the United Network for Organ Sharing database. Patients listed for cardiac transplantation between January 2011 and May 2020 were stratified according to status at time of transplantation. Baseline recipient and donor characteristics, waitlist survival, and posttransplantation outcomes were compared in the years before and after the 2018 allocation system change. Lower urgency patients in the old system were older (58.5 versus 56 years) and more likely female (54.4% versus 23.8%) compared with the highest urgency patients, and these trends persisted in the new system ( P P P P Conclusions Patients transplanted as lower urgency receive hearts from donors with additional comorbidities compared with higher urgency patients, but outcomes are similar at 1 year.
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- 2021
13. Limitations of Natriuretic Peptide Levels in Establishing SGLT-2 Inhibitors for Heart Failure Care
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Samuel W. Reinhardt and Eric J. Velazquez
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Heart Failure ,business.industry ,medicine.drug_class ,MEDLINE ,Bioinformatics ,medicine.disease ,Peptide Fragments ,Cardiovascular Diseases ,Heart Disease Risk Factors ,Risk Factors ,Heart failure ,Natriuretic Peptide, Brain ,Natriuretic peptide ,Humans ,Medicine ,Canagliflozin ,Natriuretic Peptides ,Cardiology and Cardiovascular Medicine ,business ,Sodium-Glucose Transporter 2 Inhibitors - Published
- 2020
14. Trends In US Heart Failure Hospitalizations: Increased Volume And Patient Diversity With Decreased Total Costs, 2008-2018
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Samuel W. Reinhardt, Katherine Clark, Fouad Chouairi, Elliott Miller, Bradley Kay, Michael Fuery, Avirup Guha, Tariq Ahmad, and Nihar Desai
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Cardiology and Cardiovascular Medicine - Published
- 2022
15. Late Presentation and Missed Opportunities for HIV Diagnosis in Guatemala
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Andrea Alonzo Cordon, Jane A. O’Halloran, Carlos Mejia Villatoro, William G. Powderly, Samuel W. Reinhardt, Johanna Meléndez, and Andrej Spec
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Delayed Diagnosis ,Time Factors ,Social Psychology ,HIV diagnosis ,Human immunodeficiency virus (HIV) ,HIV Infections ,medicine.disease_cause ,Delayed diagnosis ,Article ,Late presentation ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,Ambulatory care ,Ambulatory Care ,medicine ,Humans ,030212 general & internal medicine ,Heterosexuality ,Retrospective Studies ,030505 public health ,Primary Health Care ,business.industry ,Public health ,Age Factors ,Public Health, Environmental and Occupational Health ,Retrospective cohort study ,Homosexuality ,Middle Aged ,Guatemala ,medicine.disease ,CD4 Lymphocyte Count ,Early Diagnosis ,Infectious Diseases ,Female ,0305 other medical science ,business - Abstract
Early HIV diagnosis remains a challenge in many regions with delayed diagnosis resulting in increased morbidity and mortality. We conducted a retrospective cohort study of people living with HIV receiving outpatient care at a large tertiary referral center in Guatemala to describe the proportion of late presenters (LP) and missed opportunities for HIV diagnosis. Of 3686 patients, 2990 (81.1%) were LP who were more likely to be male (60.2% vs. 48.0%, p
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- 2018
16. Trends in Heart Failure Hospitalizations in the US from 2008 to 2018
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Fouad Chouairi, Katherine A.A. Clark, Tariq Ahmad, Samuel W. Reinhardt, Bradley Kay, P. Elliott Miller, Nihar R. Desai, Avirup Guha, and Michael Fuery
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Heart Failure ,medicine.medical_specialty ,Inpatient mortality ,Ejection fraction ,Demographics ,business.industry ,Stroke Volume ,Comorbidity ,medicine.disease ,Prognosis ,United States ,Ventricular Function, Left ,Hospitalization ,Heart failure ,Emergency medicine ,medicine ,Humans ,Cardiology and Cardiovascular Medicine ,business ,Heart failure with preserved ejection fraction - Abstract
Heart failure (HF) is a major driver of health care costs in the United States and is increasing in prevalence. There is a paucity of contemporary data examining trends among hospitalizations for HF that specifically compare HF with reduced or preserved ejection fraction (HFrEF or HFpEF, respectively).Using the National Inpatient Sample, we identified 11,692,995 hospitalizations due to HF. Hospitalizations increased from 1,060,540 in 2008 to 1,270,360 in 2018. Over time, the median age of patients hospitalized because of HF decreased from 76.0 to 73.0 years (P0.001). There were increases in the proportions of Black patients (18.4% in 2008 to 21.2% in 2018) and of Hispanic patients (7.1% in 2008 to 9.0% in 2018; P0.001, all). Over the study period, we saw an increase in comorbid diabetes, sleep apnea and obesity (P0.001, all) in the entire cohort with HF as well as in the HFrEF and HFpEF subgroups. Persons admitted because of HFpEF were more likely to be white and older compared to admissions because of HFrEF and also had lower costs. Inpatient mortality decreased from 2008 to 2018 for overall HF (3.3% to 2.6%) and HFpEF (2.4% to 2.1%; P0.001, all) but was stable for HFrEF (2.8%, both years). Hospital costs, adjusted for inflation, decreased in all 3 groups across the study period, whereas length of stay was relatively stable over time for all groups.The volume of patients hospitalized due to HF has increased over time and across subgroups of ejection fraction. The demographics of HF, HFrEF and HFpEF have become more diverse over time, and hospital inpatient costs have decreased, regardless of HF type. Inpatient mortality rates improved for overall HF and HFpEF admissions but remained stable for HFrEF admissions.
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- 2021
17. Comparison of Transcatheter and Open Mitral Valve Repair Among Patients With Mitral Regurgitation
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Tariq Ahmad, Fouad Chouairi, Nihar R. Desai, Michael Fuery, Avirup Guha, Bradley Kay, Ryan Kaple, Samuel W. Reinhardt, and Katherine A.A. Clark
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Food and drug administration ,Medicine ,Humans ,Aged ,Retrospective Studies ,Heart Valve Prosthesis Implantation ,Mitral regurgitation ,Mitral valve repair ,business.industry ,Discharge disposition ,Age Factors ,Mitral Valve Insufficiency ,Retrospective cohort study ,General Medicine ,Health Care Costs ,Length of Stay ,Middle Aged ,medicine.disease ,Surgical risk ,Surgery ,Stenosis ,Mitral Valve ,Transcatheter mitral valve repair ,Female ,business - Abstract
In 2013, the Food and Drug Administration approved the first transcatheter mitral valve repair (TMVr) device for degenerative mitral regurgitation for patients at prohibitive surgical risk. To better understand contemporary utilization trends and outcomes, we reviewed hospitalizations, identified using International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes, in which the patient underwent TMVr or mitral valve repair (MVr) with a diagnosis of mitral regurgitation, without stenosis, from the National (Nationwide) Inpatient Sample from 2014 to 2017. We included 10,020 hospitalizations in which the patient underwent TMVr and 5845 in which the patient underwent MVr and assessed trends in demographic characteristics, patient comorbidities, total hospital charges, and outcomes. Transcatheter mitral valve repair experienced exponential growth, increasing from 150 to 5115 over the study period (P
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- 2020
18. Clinical Implications of Respiratory Failure in Patients Receiving Durable Left Ventricular Assist Devices for End-Stage Heart Failure
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Andrew E. Levin, Jadry Gruen, Cesar Caraballo, Nihar R. Desai, P. Elliott Miller, Samuel W. Reinhardt, Neal G. Ravindra, Ayyaz Ali, Catherine Mezzacappa, Megan McCullough, and Tariq Ahmad
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Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Health Status ,030204 cardiovascular system & hematology ,Prosthesis Design ,Risk Assessment ,Ventricular Function, Left ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Intubation, Intratracheal ,Medicine ,Humans ,In patient ,030212 general & internal medicine ,Registries ,Heart-Assist Devices ,Lung ,Aged ,Retrospective Studies ,Mechanical ventilation ,Heart Failure ,Frailty ,business.industry ,Recovery of Function ,Middle Aged ,medicine.disease ,Treatment Outcome ,Respiratory failure ,Ventricular assist device ,Heart failure ,Cardiology ,Disease Progression ,Quality of Life ,Female ,End stage heart failure ,Cardiology and Cardiovascular Medicine ,business ,Respiratory Insufficiency - Abstract
Background: The impact of respiratory failure on patients undergoing left ventricular assist device (LVAD) implantation is not well understood, especially since these patients were excluded from landmark clinical trials. We sought to evaluate the associations between immediate preimplant and postimplant respiratory failure on outcomes in advanced heart failure patients undergoing LVAD implantation. Methods and Results: We included all patients in the Interagency Registry for Mechanically Assisted Circulatory Support who were implanted with continuous-flow LVADs from 2008 to 2016. Of the 16 362 patients who underwent continuous-flow LVAD placement, 906 (5.5%) required preimplant intubation within 48 hours before implantation, and 1001 (6.1%) patients developed respiratory failure within 1 week after implantation. A higher proportion of patients requiring preimplant intubation were Interagency Registry for Mechanically Assisted Circulatory Support profile 1, required mechanical circulatory support, and presented with cardiac arrest or myocardial infarction ( P P P =0.001). After multivariable analysis, both preimplant intubation (hazard ratio, 1.20 [95% CI, 1.03–1.41]; P =0.021) and respiratory failure within 1 week (hazard ratio, 2.54 [95% CI, 2.26–2.85]; P Conclusions: Respiratory failure both before and after LVAD implantation identifies an advanced heart failure population with significantly worse 1-year mortality. This data might be helpful in counseling patients and their families about expectations about life with an LVAD.
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- 2019
19. INTRAOPERATIVE MORTALITY AND DISPOSITION OF ELECTIVE PCI: INSIGHTS FROM THE NATIONAL AMBULATORY SURGERY SAMPLE
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Avirup Guha, Cesar Caraballo, Justin Pacor, Aidan Milner, Samuel W. Reinhardt, Katherine A.A. Clark, Bradley Kay, Ioannis Milioglou, Paul Miller, Fouad Chouairi, Daniel J. Friedman, Nihar R. Desai, Tariq Ahmad, and Neal G. Ravindra
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medicine.medical_specialty ,business.industry ,Ambulatory ,Emergency medicine ,Conventional PCI ,Medicine ,Sample (statistics) ,Disposition ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
20. LONGITUDINAL AND CONTEMPORARY OUTCOMES OF TEMPORARY MECHANICAL CIRCULATORY SUPPORT IN CARDIAC TRANSPLANTATION
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Michael Fuery, Tariq Ahmad, Fouad Chouiari, Paul Miller, Katherine A.A. Clark, Clancy W. Mullan, Avirup Guha, Sounok Sen, Nihar R. Desai, and Samuel W. Reinhardt
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Transplantation ,medicine.medical_specialty ,business.industry ,Circulatory system ,medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2021
21. AN EVALUATION OF RACIAL DISPARITIES IN HEART TRANSPLANTATION OUTCOMES
- Author
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Fouad Chouiari, Katherine A.A. Clark, P. Elliott Miller, Samuel W. Reinhardt, Tariq Ahmad, Sounok Sen, Avirup Guha, Clancy W. Mullan, Michael Fuery, and Nihar R. Desai
- Subjects
Heart transplantation ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business - Published
- 2021
22. NINETY-DAY EPISODE OF CARE SPENDING FOLLOWING HEART FAILURE HOSPITALIZATION AMONG MEDICARE BENEFICIARIES
- Author
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Tariq Ahmad, Katherine A.A. Clark, Craig S. Parzynski, Ralph Riello, Phil Sarocco, Nihar R. Desai, Xin Xin, and Samuel W. Reinhardt
- Subjects
medicine.medical_specialty ,Episode of care ,business.industry ,Heart failure ,Emergency medicine ,Medicare beneficiary ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease - Published
- 2021
23. Large Traumatic Ventricular Septal Defect
- Author
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Wanda M. Popescu, Ian Crandall, Hossam Tantawy, Robert L. McNamara, and Samuel W. Reinhardt
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Predictive value of tests ,Treatment outcome ,medicine ,MEDLINE ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Shunt (medical) ,Computed tomography angiography - Published
- 2019
24. Effect of Race on Outcomes Following Early Coronary Computed Tomographic Angiography or Standard Emergency Department Evaluation for Acute Chest Pain
- Author
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Eric Novak, Samuel W. Reinhardt, Adefolakemi Babatunde, and David L. Brown
- Subjects
Male ,Acute coronary syndrome ,medicine.medical_specialty ,Chest Pain ,Randomization ,Epidemiology ,Computed Tomography Angiography ,Infarction ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Chest pain ,Coronary Angiography ,Original Report: Cardiovascular Disease and Risk Factors ,White People ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Diabetes mellitus ,Hyperlipidemia ,medicine ,Humans ,030212 general & internal medicine ,Acute Coronary Syndrome ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,General Medicine ,Emergency department ,Middle Aged ,medicine.disease ,United States ,Black or African American ,Hospitalization ,Early Diagnosis ,Angiography ,Female ,medicine.symptom ,business ,Emergency Service, Hospital - Abstract
Objective: To examine racial differences in outcomes with coronary computed tomographic angiography (CCTA) vs standard emergency department (ED) evaluation for chest pain.Design: Retrospective analysis of the prospective, randomized, multicenter Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT-II) trial.Setting: ED at nine hospitals in the United States.Participants: 940 patients who were Caucasian or African American (AA) presenting to the ED with chest pain.Interventions: CCTA or standard ED evaluationMain Outcome Measures: Length of stay, hospital admission, direct ED discharge, downstream testing and repeat ED visit or hospitalization for recurrent chest pain at 28 days. Safety end points: missed acute coronary syndrome (ACS) and cumulative radiation exposure during the index visit and follow-up period.Results: 659 (66%) patients self-identified as Caucasian and 281 (28%) self-identified as AA. AA were younger and more often female compared with Caucasians, had a higher prevalence of hypertension (64% vs 49%, P
- Published
- 2018
25. Neurohormonal Blockade and Clinical Outcomes in Patients With Heart Failure Supported by Left Ventricular Assist Devices
- Author
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Megan McCullough, Cesar Caraballo, Catherine Mezzacappa, Tariq Ahmad, Andrew E. Levin, Nihar R. Desai, David van Dijk, Ayyaz Ali, Jadry Gruen, P. Elliott Miller, Benjamin A. Rodwin, Samuel W. Reinhardt, and Neal G. Ravindra
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Survival rate ,Aged ,Retrospective Studies ,Heart Failure ,Neurotransmitter Agents ,business.industry ,Hazard ratio ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,Survival Rate ,Regimen ,Treatment Outcome ,Heart failure ,Ventricular assist device ,Female ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Importance Left ventricular assist devices (LVADs) improve outcomes in patients with advanced heart failure, but little is known about the role of neurohormonal blockade (NHB) in treating these patients. Objective To analyze the association between NHB blockade and outcomes in patients with LVADs. Design, Setting, and Participants This retrospective cohort analysis of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) included patients from more than 170 centers across the United States and Canada with continuous flow LVADs from 2008 to 2016 who were alive with the device in place at 6 months after implant. The data were analyzed between February and November 2019. Exposures Patients were stratified based on exposure to NHB and represented all permutations of the following drug classes: angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, and mineralocorticoid antagonists. Main Outcomes and Measures The outcomes of interest were survival at 4 years and quality of life at 2 years based on Kansas City Cardiomyopathy Questionnaire scores and a 6-minute walk test. Results A total of 12 144 patients in INTERMACS met inclusion criteria, of whom 2526 (20.8% ) were women, 8088 (66.6%) were white, 3024 (24.9%) were African American, and 753 (6.2%) were Hispanic; the mean (SD) age was 56.8 (12.9) years. Of these, 10 419 (85.8%) were receiving NHB. Those receiving any NHB medication at 6 months had a better survival rate at 4 years compared with patients not receiving NHB (56.0%; 95% CI, 54.5%-57.5% vs 43.9%; 95% CI, 40.5%-47.7%). After sensitivity analyses with an adjusted model, this trend persisted with patients receiving triple therapy with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, β-blocker, and mineralocorticoid antagonist having the lowest hazard of death compared with patients in the other groups (hazard ratio, 0.34; 95% CI, 0.28-0.41). Compared with patients not receiving NHB, use of NHB was associated with a higher Kansas City Cardiomyopathy Questionnaire score (66.6; bootstrapped 95% CI, 65.8-67.3 vs 63.0; bootstrapped 95% CI, 60.1-65.8;P = .02) and a 6-minute walk test (1103 ft; bootstrapped 95% CI, 1084-1123 ft vs 987 ft; bootstrapped 95% CI, 913-1060 ft;P Conclusions and Relevance Among patients with LVADs who tolerated NHB therapy, continued treatment was associated with improved survival and quality of life. The optimal heart failure regimen for patients after LVAD implant may be the initiation and continuation of guideline-directed medical therapy.
- Published
- 2020
26. Bouveret's Syndrome Complicated by Classic Gallstone Ileus: Progression of Disease or Iatrogenic?
- Author
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Susan C. Pitt, William C. Chapman, Samuel W. Reinhardt, Majella B. Doyle, T. Mark Earl, and Linda X. Jin
- Subjects
Male ,medicine.medical_specialty ,Abdominal pain ,Vomiting ,Nausea ,medicine.medical_treatment ,Gallstones ,Enterotomy ,Ileus ,Gallstone ileus ,medicine ,Humans ,Duodenal Diseases ,Aged ,medicine.diagnostic_test ,business.industry ,General surgery ,Gastroenterology ,Gastric outlet obstruction ,Syndrome ,Middle Aged ,medicine.disease ,Extracorporeal shock wave lithotripsy ,digestive system diseases ,Abdominal Pain ,Endoscopy ,Surgery ,Bowel obstruction ,Female ,medicine.symptom ,business ,Intestinal Obstruction - Abstract
Bouveret's syndrome is a rare variant of gallstone ileus resulting in gastroduodenal obstruction from an impacted gallstone. We report two cases of Bouveret's syndrome that were complicated by classic (distal) gallstone ileus, which has previously been reported only twice. The first patient presented with vomiting, epigastric pain, and what was initially believed to be a duodenal diverticulum on computed tomography scan and endoscopy. He initially improved, but later developed symptoms of a small bowel obstruction. Repeat imaging revealed a classic distal gallstone ileus. The second patient presented with nausea, abdominal pain, and imaging consistent with Bouveret's syndrome. Multiple non-operative endoscopic techniques and extracorporeal shock wave lithotripsy were employed to fragment and retrieve the obstructing stone, and she subsequently developed a distal gallstone ileus from a stone fragment. Both patients were managed operatively with enterotomy and stone removal. These cases highlight a rare complication of Bouveret's syndrome, classic (distal) gallstone ileus, and juxtapose the natural history of a stone passing versus an iatrogenic etiology. We review the presentation and management of Bouveret's syndrome though no clear consensus exists as to the optimal treatment of these patients. We recommend that therapy should be decided on a case-by-case basis.
- Published
- 2013
27. AIDS-Defining Illnesses at Initial Diagnosis of HIV in a Large Guatemalan Cohort
- Author
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Andrej Spec, Ian Ross, William G. Powderly, Carlos Mejia Villatoro, Samuel W. Reinhardt, Andrea Alonzo Cordon, and Johanna Meléndez
- Subjects
0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,global health ,HIV Wasting Syndrome ,Esophageal candidiasis ,Histoplasmosis ,03 medical and health sciences ,0302 clinical medicine ,Acquired immunodeficiency syndrome (AIDS) ,parasitic diseases ,Epidemiology ,Major Article ,Global health ,medicine ,030212 general & internal medicine ,0303 health sciences ,business.industry ,030306 microbiology ,HIV ,Retrospective cohort study ,Guatemala ,medicine.disease ,030112 virology ,3. Good health ,AIDS ,Infectious Diseases ,Oncology ,AIDS-defining illnesses ,Cohort ,business - Abstract
BackgroundAnecdotal evidence suggests that a high proportion of patients diagnosed with HIV in Guatemala present with AIDS. There remain limited data on the epidemiology of AIDS-defining illnesses (ADIs) in Central America.MethodsWe conducted a retrospective cohort study of all patients living with HIV at the largest HIV clinic in Guatemala. Charts were analyzed for clinical and demographic data. Presence of an ADI was assessed by US Centers for Disease Control definitions; patients who presented with an ADI were compared with those without ADI using descriptive statistics.ResultsOf 3686 patients living with HIV, 931 (25.3%) had an ADI at HIV diagnosis, 748 (80.3%) of whom had CD4 counts lower than 200 cells/mm3. Those with ADIs were more likely to be male (67.5% vs 54.6%; P < .0001) and heterosexual (89.4% vs 85.0%; P = .005). The most common ADIs were Mycobacterium tuberculosis (55.0%), Pneumocystis jirovecii pneumonia (13.7%), esophageal candidiasis (13.4%), and histoplasmosis (11.4%). Histoplasmosis and HIV wasting syndrome were both more common among rural patients.ConclusionsIn this large Guatemalan cohort of patients currently living with HIV, a significant portion presented with an ADI. These data inform the most common ADIs diagnosed among survivors, show that histoplasmosis is more commonly diagnosed in rural patients, and suggest that HIV wasting syndrome may reflect missed histoplasmosis diagnoses.
- Published
- 2016
28. Incorrect Conclusions of a Secondary Analysis—Reply
- Author
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Samuel W. Reinhardt, David L. Brown, and Chien-Jung Lin
- Subjects
medicine.medical_specialty ,business.industry ,010102 general mathematics ,MEDLINE ,01 natural sciences ,03 medical and health sciences ,0302 clinical medicine ,Secondary analysis ,Internal Medicine ,Medicine ,030212 general & internal medicine ,0101 mathematics ,business ,Intensive care medicine - Published
- 2018
29. Noninvasive Cardiac Testing vs Clinical Evaluation Alone in Acute Chest Pain
- Author
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Samuel W. Reinhardt, Chien Jung Lin, David L. Brown, and Eric Novak
- Subjects
Acute coronary syndrome ,medicine.medical_specialty ,Surrogate endpoint ,business.industry ,medicine.medical_treatment ,Stress testing ,Percutaneous coronary intervention ,Emergency department ,030204 cardiovascular system & hematology ,medicine.disease ,Chest pain ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Internal medicine ,Internal Medicine ,medicine ,Cardiology ,030212 general & internal medicine ,medicine.symptom ,business ,Mace ,Original Investigation - Abstract
Importance The incremental benefit of noninvasive testing in addition to clinical evaluation (history, physical examination, an electrocardiogram [ECG], and biomarker assessment) vs clinical evaluation alone for patients who present to the emergency department (ED) with acute chest pain is unknown. Objective To examine differences in outcomes with clinical evaluation and noninvasive testing (coronary computed tomographic angiography [CCTA] or stress testing) vs clinical evaluation alone. Design, Setting, and Participants This study was a retrospective analysis of data from the randomized multicenter Rule Out Myocardial Ischemia/Infarction by Computer Assisted Tomography (ROMICAT-II) trial. Data for 1000 patients who presented with chest pain to the EDs at 9 hospitals in the United States were evaluated. Interventions Clinical evaluation plus noninvasive testing (CCTA or stress test) vs clinical evaluation alone. Main Outcomes and Measures Primary outcome was length of stay (LOS). Secondary outcomes included hospital admission, direct ED discharge, downstream testing, rates of invasive coronary angiography, revascularization, major adverse cardiac events (MACE), repeated ED visit or hospitalization for recurrent chest pain at 28 days, and cost. Safety end points were missed acute coronary syndrome (ACS) and cumulative radiation exposure during the index visit and follow-up period. Results Of the 1000 patients randomized, 118 patients (12%) (mean [SD] age, 53.2 [7.8]; 49 [42%] were female) did not undergo noninvasive testing, whereas 882 (88%) (mean [SD] age, 54.4 [8.14] years; 419 [48%] were female) received CCTA or stress testing. There was no difference in baseline characteristics or clinical presentation between groups. Patients who underwent clinical evaluation alone experienced a shorter LOS (20.3 vs 27.9 hours;P Conclusions and Relevance In patients presenting to the ED with acute chest pain, negative biomarkers, and a nonischemic ECG result, noninvasive testing with CCTA or stress testing leads to longer LOS, more downstream testing, more radiation exposure, and greater cost without an improvement in clinical outcomes. Trial Registration clinicaltrials.gov Identifier:NCT01084239
- Published
- 2018
30. Chronic Renal Disease Is an Independent Risk Factor for Mortality in Older Adults With Pneumococcal Disease
- Author
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Steven J. Lawrence and Samuel W. Reinhardt
- Subjects
Pediatrics ,medicine.medical_specialty ,Infectious Diseases ,Pneumococcal disease ,Oncology ,business.industry ,medicine ,Chronic renal disease ,Risk factor ,business - Published
- 2015
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