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51. Cardiac Arrest Survival at Emergency Medical Service Agencies in Catchment Areas With Primarily Black and Hispanic Populations

Author

Uzendu, Anezi I., primary, Spertus, John A., additional, Nallamothu, Brahmajee K., additional, Girotra, Saket, additional, Jones, Philip G., additional, McNally, Bryan F., additional, Del Rios, Marina, additional, Sasson, Comilla, additional, Breathett, Khadijah, additional, Sperling, Jessica, additional, Dukes, Kimberly C., additional, and Chan, Paul S., additional

Published
2023
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55. Differences in Anticoagulant Therapy Prescription in Patients with Paroxysmal Versus Persistent Atrial Fibrillation

Author

Hsu, Jonathan C, Chan, Paul S, Tang, Fengming, Maddox, Thomas M, and Marcus, Gregory M

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Hematology, Clinical Trials and Supportive Activities, Heart Disease, Cardiovascular, Clinical Research, Aged, Aged, 80 and over, Anticoagulants, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Multivariate Analysis, Platelet Aggregation Inhibitors, Practice Patterns, Physicians', Risk Assessment, Risk Factors, Stroke, Thromboembolism, Atrial fibrillation, Paroxysmal, Persistent, Medical and Health Sciences, General & Internal Medicine, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundPatients with paroxysmal and persistent atrial fibrillation experience a similar risk of thromboembolism. Therefore, consensus guidelines recommend anticoagulant therapy in those at risk for thromboembolism irrespective of atrial fibrillation classification. We sought to examine whether there are differences in rates of appropriate oral anticoagulant treatment among patients with paroxysmal vs persistent atrial fibrillation in real-world cardiology practices.MethodsWe studied 71,316 outpatients with atrial fibrillation and intermediate to high thromboembolic risk (CHADS2 score ≥2) enrolled in the American College of Cardiology PINNACLE Registry between 2008 and 2012. Using hierarchical modified Poisson regression models adjusted for patient characteristics, we examined whether anticoagulant treatment rates differed between patients with paroxysmal vs persistent atrial fibrillation.ResultsThe majority of outpatients (78.4%, n = 55,905) had paroxysmal atrial fibrillation. In both unadjusted and multivariable adjusted analyses, patients with paroxysmal atrial fibrillation were less frequently prescribed oral anticoagulant therapy than those with persistent atrial fibrillation (50.3% vs 64.2%; adjusted risk ratio [RR] 0.74; 95% confidence interval [CI], 0.72-0.76). Instead, patients with paroxysmal atrial fibrillation were prescribed more frequently only antiplatelet therapy (35.1% vs 25.0%; adjusted RR 1.77; 95% CI, 1.69-1.86) or neither antiplatelet nor anticoagulant therapy (14.6% vs 10.8%; adjusted RR 1.35; 95% CI, 1.26-1.44; P < .0001 for differences across all 3 comparisons).ConclusionsIn a large, real-world cardiac outpatient population, patients with paroxysmal atrial fibrillation with a moderate to high risk of stroke were less likely to be prescribed appropriate oral anticoagulant therapy and more likely to be prescribed less effective or no therapy for thromboembolism prevention.

Published
2015

56. Oral Anticoagulant Prescription in Patients With Atrial Fibrillation and a Low Risk of Thromboembolism: Insights From the NCDR PINNACLE Registry

Author

Hsu, Jonathan C, Chan, Paul S, Tang, Fengming, Maddox, Thomas M, and Marcus, Gregory M

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Administration, Oral, Adult, Anticoagulants, Atrial Fibrillation, Female, Guideline Adherence, Humans, Male, Middle Aged, Registries, Thromboembolism, Clinical Sciences, Opthalmology and Optometry, Public Health and Health Services, Clinical sciences, Health services and systems
Abstract

OBJECTIVES: We sought to investigate the prevalence and predictors of oral anticoagulation prescription among patients with atrial fibrillation (AF) at the lowest risk for thromboembolism, despite contemporary consensus guidelines that do not recommend anticoagulation therapy in this population. BACKGROUND: In young and healthy AF patients without significant thromboembolic risk factors, anticoagulant treatment carries bleeding risks that outweigh stroke prevention benefit. METHODS: Within a large contemporary registry of cardiology outpatients, we identified low-risk patients with AF meeting criteria for a contemporary consensus guideline class III indication against use of anticoagulation (age < 60 years, CHADS2 Score=0, and no structural heart disease) between 2008–2012, and a second cohort with the same criteria and a CHA2DS2-VASc Score of 0. Using hierarchical modified Poisson regression models adjusted for patient characteristics, we examined predictors of oral anticoagulation treatment in these low thromboembolic risk AF patients. RESULTS: Oral anticoagulation was prescribed in a total of 2,561 of 10,995 (23.2%) AF patients with a CHADS2 score of 0 and 1,787 of 6,730 (26.6%) AF patients with a CHA2DS2-VASc score of 0. In multivariable analysis, older age (RR 1.48 per 10 years; 95% CI, 1.41–1.56; p

Published
2015

60. 2021 Interim Guidance to Health Care Providers for Basic and Advanced Cardiac Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19

Author

Hsu, Antony, Sasson, Comilla, Kudenchuk, Peter J., Atkins, Dianne L., Aziz, Khalid, Becker, Lance B., Berg, Robert A., Bhanji, Farhan, Bradley, Steven M., Brooks, Steven C., Chan, Melissa, Chan, Paul S., Cheng, Adam, Clemency, Brian M., de Caen, Allan, Duff, Jonathan P., Edelson, Dana P., Flores, Gustavo E., Fuchs, Susan, Girotra, Saket, Hinkson, Carl, Joyner, Benny L., Jr, Kamath-Rayne, Beena D., Kleinman, Monica, Lasa, Javier J., Lavonas, Eric J., Lee, Henry C., Lehotzky, Rebecca E., Levy, Arielle, Mancini, Mary E., McBride, Mary E., Meckler, Garth, Merchant, Raina M., Moitra, Vivek K., Morgan, Ryan W., Nadkarni, Vinay, Panchal, Ashish R., Peberdy, Mary Ann, Raymond, Tia, Roberts, Kathryn, Sayre, Michael R., Schexnayder, Stephen M., Sutton, Robert M., Terry, Mark, Walsh, Brian, Wang, David S., Zelop, Carolyn M., and Topjian, Alexis

Published
2021
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61. Contemporary use of dual antiplatelet therapy for preventing cardiovascular events.

Author

Goldsweig, Andrew M, Reid, Kimberly J, Gosch, Kensey, Tang, Fengming, Fang, Margaret C, Maddox, Thomas M, Chan, Paul S, Cohen, David J, and Chen, Jersey

Subjects
Health Services and Systems, Health Sciences, Clinical Trials and Supportive Activities, Clinical Research, Cardiovascular, Prevention, Heart Disease, 6.1 Pharmaceuticals, Evaluation of treatments and therapeutic interventions, Good Health and Well Being, Aged, Aspirin, Cardiovascular Diseases, Clopidogrel, Drug Therapy, Combination, Female, Humans, Male, Platelet Aggregation Inhibitors, Practice Patterns, Physicians', Retrospective Studies, Risk Factors, Secondary Prevention, Ticlopidine, Public Health and Health Services, Health Policy & Services, Health services and systems
Abstract

ObjectivesCHARISMA was a landmark randomized clinical trial that failed to demonstrate a benefit of dual antiplatelet therapy (DAPT) over aspirin alone for preventing cardiovascular events. However, subgroup analyses of the trial found fewer major adverse cardiovascular events (MACEs) for patients with established cardiovascular disease but more MACEs for patients with multiple risk factors without established cardiovascular disease. Our objective was to examine DAPT use in contemporary clinical practice after publication of CHARISMA results.Study designRetrospective analysis of a large clinical registry of outpatient cardiovascular visits to over 1000 physicians that collected data on patient clinical history, symptoms, vital signs, and medications.MethodsClinical characteristics and prescription rates of aspirin and clopidogrel were compared for patients with established cardiovascular disease and for patients with only multiple cardiovascular risk factors. Prescription of DAPT by calendar quarter was evaluated from 2008 to 2011 using multivariable Poisson regression models.ResultsOf 167,839 patients with established cardiovascular disease, 20.5% were prescribed both aspirin and clopidogrel. Of 20,478 patients with multiple risk factors but no known cardiovascular disease, 3.5% were prescribed both aspirin and clopidogrel. Across 14 calendar quarters, prescription rates of DAPT did not change significantly for patients with established CVD but decreased for patients with multiple risk factors with an incidence rate ratio of 0.77.ConclusionsUse of DAPT is modest in patients with established cardiovascular disease, for whom the CHARISMA trial suggested decreased MACEs, and prescription rates have remained stable over time. Use of DAPT in patients with multiple risk factors only, for whom CHARISMA suggested that DAPT may lead to increased MACE, was low and decreased over time.

Published
2014

67. Trends in Survival After In-Hospital Cardiac Arrest During Nights and Weekends

Author

Abella, Benjamin, Anderson, Monique L., Bradley, Steven M., Chan, Paul S., Edelson, Dana P., Churpek, Matthew M., Geocadin, Romergryko, Goldberger, Zachary D., Howard, Patricia K., Kurz, Michael C., Mosesso, Vincent N., Jr., Nassar, Boulos, Ornato, Joseph P., Peberdy, Mary Ann, Perman, Sarah M., Ofoma, Uchenna R., Basnet, Suresh, Berger, Andrea, Kirchner, H. Lester, and Girotra, Saket

Published
2018
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70. Mobile App to Improve House Officers’ Adherence to Advanced Cardiac Life Support Guidelines: Quality Improvement Study

Author

Hejjaji, Vittal, Malik, Ali O, Peri-Okonny, Poghni A, Thomas, Merrill, Tang, Yuanyuan, Wooldridge, David, Spertus, John A, and Chan, Paul S

Subjects
Information technology, T58.5-58.64, Public aspects of medicine, RA1-1270
Abstract

BackgroundEffective and timely delivery of cardiac arrest interventions during in-hospital cardiac arrest resuscitation is associated with greater survival. Whether a mobile app that provides timely reminders of critical interventions improves adherence to Advanced Cardiovascular Life Support (ACLS) guidelines among house officers, who may lack experience in leading resuscitations, remains unknown. ObjectiveThe aim of this study was to assess the impact of a commercially available, dynamic mobile app on house officers’ adherence to ACLS guidelines. MethodsAs part of a quality improvement initiative, internal medicine house officers were invited to participate and randomized to lead 2 consecutive cardiac arrest simulations, one with a novel mobile app and one without a novel mobile app. All simulations included 4 cycles of cardiopulmonary resuscitation with different cardiac arrest rhythms and were video recorded. The coprimary end points were chest compression fraction and number of correct interventions in each simulation. The secondary end point was incorrect interventions, defined as interventions not indicated by the 2015 ACLS guidelines. Paired t tests compared performance with and without the mobile app. ResultsAmong 53 house officers, 26 house officers were randomized to lead the first simulation with the mobile app, and 27 house officers were randomized to do so without the app. Use of the mobile app was associated with a higher number of correct ACLS interventions (out of 7; mean 6.2 vs 5.1; absolute difference 1.1 [95% CI 0.6 to 1.6]; P

Published
2020
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71. Health Status and Clinical Outcomes in Older Adults With Chronic Coronary Disease

Author

Nguyen, Dan D., primary, Spertus, John A., additional, Alexander, Karen P., additional, Newman, Jonathan D., additional, Dodson, John A., additional, Jones, Philip G., additional, Stevens, Susanna R., additional, O’Brien, Sean M., additional, Gamma, Reto, additional, Perna, Gian P., additional, Garg, Pallav, additional, Vitola, João V., additional, Chow, Benjamin J.W., additional, Vertes, Andras, additional, White, Harvey D., additional, Smanio, Paola E.P., additional, Senior, Roxy, additional, Held, Claes, additional, Li, Jianghao, additional, Boden, William E., additional, Mark, Daniel B., additional, Reynolds, Harmony R., additional, Bangalore, Sripal, additional, Chan, Paul S., additional, Stone, Gregg W., additional, Arnold, Suzanne V., additional, Maron, David J., additional, and Hochman, Judith S., additional

Published
2023
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78. Interim Guidance for Basic and Advanced Life Support in Adults, Children, and Neonates With Suspected or Confirmed COVID-19: From the Emergency Cardiovascular Care Committee and Get With The Guidelines-Resuscitation Adult and Pediatric Task Forces of the American Heart Association

Author

Edelson, Dana P., Sasson, Comilla, Chan, Paul S., Atkins, Dianne L., Aziz, Khalid, Becker, Lance B., Berg, Robert A., Bradley, Steven M., Brooks, Steven C., Cheng, Adam, Escobedo, Marilyn, Flores, Gustavo E., Girotra, Saket, Hsu, Antony, Kamath-Rayne, Beena D., Lee, Henry C., Lehotsky, Rebecca E., Mancini, Mary E., Merchant, Raina M., Nadkarni, Vinay M., Panchal, Ashish R., Peberdy, Mary Ann R., Raymond, Tia T., Walsh, Brian, Wang, David S., Zelop, Carolyn M., and Topjian, Alexis A.

Published
2020
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79. Outcomes of Cardiac Catheterization in Patients With Atrial Fibrillation on Anticoagulation in Contemporary in Practice: An Analysis of the ORBIT II Registry

Author

Sherwood, Matthew W., Piccini, Jonathan P., Holmes, DaJuanicia N., Pieper, Karen S., Steinberg, Benjamin A., Fonarow, Gregg C., Allen, Larry A., Naccarelli, Gerald V., Kowey, Peter R., Gersh, Bernard J., Mahaffey, Kenneth W., Singer, Daniel E., Ansell, Jack E., Freeman, James V., Chan, Paul S., Reiffel, James A., Blanco, Rosalia, Peterson, Eric D., and Rao, Sunil V.

Published
2020
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81. 2019 American Heart Association Focused Update on Systems of Care: Dispatcher-Assisted Cardiopulmonary Resuscitation and Cardiac Arrest Centers: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Author

Panchal, Ashish R., Berg, Katherine M., Cabañas, José G., Kurz, Michael C., Link, Mark S., Del Rios, Marina, Hirsch, Karen G., Chan, Paul S., Hazinski, Mary Fran, Morley, Peter T., Donnino, Michael W., and Kudenchuk, Peter J.

Published
2019
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82. 2019 American Heart Association Focused Update on Advanced Cardiovascular Life Support: Use of Advanced Airways, Vasopressors, and Extracorporeal Cardiopulmonary Resuscitation During Cardiac Arrest: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Author

Panchal, Ashish R., Berg, Katherine M., Hirsch, Karen G., Kudenchuk, Peter J., Del Rios, Marina, Cabañas, José G., Link, Mark S., Kurz, Michael C., Chan, Paul S., Morley, Peter T., Hazinski, Mary Fran, and Donnino, Michael W.

Published
2019
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84. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Template for In-Hospital Cardiac Arrest: A Consensus Report From a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia)

Author

Nolan, Jerry P., Berg, Robert A., Andersen, Lars W., Bhanji, Farhan, Chan, Paul S., Donnino, Michael W., Lim, Swee Han, Ma, Matthew Huei-Ming, Nadkarni, Vinay M., Starks, Monique A., Perkins, Gavin D., Morley, Peter T., and Soar, Jasmeet

Published
2019
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89. Health Status Outcomes in Older Adults Undergoing Chronic Total Occlusion Percutaneous Coronary Intervention

Author

Nguyen, Dan D., primary, Gosch, Kensey L., additional, El‐Zein, Rayan, additional, Chan, Paul S., additional, Lombardi, William L., additional, Karmpaliotis, Dimitri, additional, Spertus, John A., additional, Wyman, R. Michael, additional, Nicholson, William J., additional, Moses, Jeffrey W., additional, Grantham, J. Aaron, additional, Salisbury, Adam C., additional, Cook, Stephen L., additional, Doshi, Parag, additional, Federici, Robert, additional, Karmpaliotis, Dmitri, additional, Pershad, Ashish, additional, and Spaedy, Anthony J., additional

Published
2023
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93. Health Status and Clinical Outcomes in Older Adults With Chronic Coronary Disease: The ISCHEMIA Trial

Author

Nguyen, Dan D, Spertus, John A, Alexander, Karen P, Newman, Jonathan D, Dodson, John A, Jones, Philip G, Stevens, Susanna R, O'Brien, Sean M, Gamma, Reto, Perna, Gian P, Garg, Pallav, Vitola, João V, Chow, Benjamin J W, Vertes, Andras, White, Harvey D, Smanio, Paola E P, Senior, Roxy, Held, Claes, Li, Jianghao, Boden, William E, Mark, Daniel B, Reynolds, Harmony R, Bangalore, Sripal, Chan, Paul S, Stone, Gregg W, Arnold, Suzanne V, Maron, David J, and Hochman, Judith S

Subjects
610 Medizin und Gesundheit
Abstract

BACKGROUND Whether initial invasive management in older vs younger adults with chronic coronary disease and moderate or severe ischemia improves health status or clinical outcomes is unknown. OBJECTIVES The goal of this study was to examine the impact of age on health status and clinical outcomes with invasive vs conservative management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial. METHODS One-year angina-specific health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ) (score range 0-100; higher scores indicate better health status). Cox proportional hazards models estimated the treatment effect of invasive vs conservative management as a function of age on the composite clinical outcome of cardiovascular death, myocardial infarction, or hospitalization for resuscitated cardiac arrest, unstable angina, or heart failure. RESULTS Among 4,617 participants, 2,239 (48.5%) were aged

Published
2023
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97. Defining Clinically Important Difference in the Atrial Fibrillation Effect on Quality-of-Life Score: Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation

Author

Holmes, DaJuanicia N., Piccini, Jonathan P., Allen, Larry A., Fonarow, Gregg C., Gersh, Bernard J., Kowey, Peter R., O’Brien, Emily C., Reiffel, James A., Naccarelli, Gerald V., Ezekowitz, Michael D., Chan, Paul S., Singer, Daniel E., Spertus, John A., Peterson, Eric D., and Thomas, Laine

Published
2019
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100. Delays in Cardiopulmonary Resuscitation, Defibrillation, and Epinephrine Administration All Decrease Survival in In-hospital Cardiac Arrest

Author

Bircher, Nicholas G., Chan, Paul S., Xu, Yan, Faillace, Robert T., Mancini, Mary E., Berg, Robert A., Allen, Emilie, Hunt, Elizabeth A., Nadkarni, Vinay M., Ann Peberdy, Mary, Ornato, Joseph P., Braithwaite, Scott, Nichol, Graham, Warren, Samuel, Duncan, Kathy, LaBresh, Kenneth, Sasson, Comilla, Knight, Lynda, Donnino, Michael W., Smyth, Mindy, Eigel, Brian, Gent, Lana, Mader, Timothy J., Kern, Karl B., and Geocadin, Romergryko G.

Published
2019
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