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201. ACC/AHA 2013 Methodology for Developing Clinical Data Standards: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards

Author

Hendel, Robert C., primary, Bozkurt, Biykem, additional, Fonarow, Gregg C., additional, Jacobs, Jeffrey P., additional, Lichtman, Judith H., additional, Smith, Eric E., additional, Tcheng, James E., additional, Wang, Tracy Y., additional, and Weintraub, William S., additional

Published
2014
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206. Accuracy of Prediction Instruments for Diagnosing Large Vessel Occlusion in Individuals With Suspected Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Author

Smith, Eric E., Kent, David M., Bulsara, Ketan R., Leung, Lester Y., Lichtman, Judith H., Reeves, Mathew J., Towfighi, Amytis, Whiteley, William N., and Zahuranec, Darin B.

Abstract

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Published
2018
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208. Editor’s Choice-Sex differences in young patients with acute myocardial infarction: A VIRGO study analysis

Author

Bucholz, Emily M, Strait, Kelly M, Dreyer, Rachel P, Lindau, Stacy T, D’Onofrio, Gail, Geda, Mary, Spatz, Erica S, Beltrame, John F, Lichtman, Judith H, Lorenze, Nancy P, Bueno, Hector, and Krumholz, Harlan M

Abstract

Aims: Young women with acute myocardial infarction (AMI) have a higher risk of adverse outcomes than men. However, it is unclear how young women with AMI are different from young men across a spectrum of characteristics. We sought to compare young women and men at the time of AMI on six domains of demographic and clinical factors in order to determine whether they have distinct profiles.Methods and results: Using data from Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO), a prospective cohort study of women and men aged ⩽55 years hospitalized for AMI (n= 3501) in the United States and Spain, we evaluated sex differences in demographics, healthcare access, cardiovascular risk and psychosocial factors, symptoms and pre-hospital delay, clinical presentation, and hospital management for AMI. The study sample included 2349 (67%) women and 1152 (33%) men with a mean age of 47 years. Young women with AMI had higher rates of cardiovascular risk factors and comorbidities than men, including diabetes, congestive heart failure, chronic obstructive pulmonary disease, renal failure, and morbid obesity. They also exhibited higher levels of depression and stress, poorer physical and mental health status, and lower quality of life at baseline. Women had more delays in presentation and presented with higher clinical risk scores on average than men; however, men presented with higher levels of cardiac biomarkers and more classic electrocardiogram findings. Women were less likely to undergo revascularization procedures during hospitalization, and women with ST segment elevation myocardial infarction were less likely to receive timely primary reperfusion.Conclusions: Young women with AMI represent a distinct, higher-risk population that is different from young men.

Published
2017
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213. Abstract 223: National and Regional Trends in Hospitalizations for Hemorrhagic Stroke after Acute Myocardial Infarction in the United States: 1999-2010

Author

Shi, Ruizhi, primary, Wang, Yun, additional, Lichtman, Judith H, additional, Dharmarajan, Kumar, additional, Masoudi, Frederick A, additional, Dodson, John A, additional, Chen, Jersey, additional, Chaudhry, Sarwat I, additional, Spertus, John A, additional, Nallamothu, Brahmajee K, additional, and Krumholz, Harlan M, additional

Published
2013
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215. Abstract 221: National and Regional Trends in Hospitalizations for Ischemic Stroke after Acute Myocardial Infarction in the United States: 1999-2010

Author

Shi, Ruizhi, primary, Wang, Yun, additional, Lichtman, Judith H, additional, Krumholz, Harlan M, additional, Dharmarajan, Kumar, additional, Masoudi, Frederick A, additional, Dodson, John A, additional, Chen, Jersey, additional, Chaudhry, Sarwat I, additional, Spertus, John A, additional, and Nallamothu, Brahmajee K, additional

Published
2013
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219. Executive Summary: Heart Disease and Stroke Statistics—2013 Update

Author

Go, Alan S., primary, Mozaffarian, Dariush, additional, Roger, Véronique L., additional, Benjamin, Emelia J., additional, Berry, Jarett D., additional, Borden, William B., additional, Bravata, Dawn M., additional, Dai, Shifan, additional, Ford, Earl S., additional, Fox, Caroline S., additional, Franco, Sheila, additional, Fullerton, Heather J., additional, Gillespie, Cathleen, additional, Hailpern, Susan M., additional, Heit, John A., additional, Howard, Virginia J., additional, Huffman, Mark D., additional, Kissela, Brett M., additional, Kittner, Steven J., additional, Lackland, Daniel T., additional, Lichtman, Judith H., additional, Lisabeth, Lynda D., additional, Magid, David, additional, Marcus, Gregory M., additional, Marelli, Ariane, additional, Matchar, David B., additional, McGuire, Darren K., additional, Mohler, Emile R., additional, Moy, Claudia S., additional, Mussolino, Michael E., additional, Nichol, Graham, additional, Paynter, Nina P., additional, Schreiner, Pamela J., additional, Sorlie, Paul D., additional, Stein, Joel, additional, Turan, Tanya N., additional, Virani, Salim S., additional, Wong, Nathan D., additional, Woo, Daniel, additional, and Turner, Melanie B., additional

Published
2013
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220. Heart Disease and Stroke Statistics—2013 Update

Author

Go, Alan S., primary, Mozaffarian, Dariush, additional, Roger, Véronique L., additional, Benjamin, Emelia J., additional, Berry, Jarett D., additional, Borden, William B., additional, Bravata, Dawn M., additional, Dai, Shifan, additional, Ford, Earl S., additional, Fox, Caroline S., additional, Franco, Sheila, additional, Fullerton, Heather J., additional, Gillespie, Cathleen, additional, Hailpern, Susan M., additional, Heit, John A., additional, Howard, Virginia J., additional, Huffman, Mark D., additional, Kissela, Brett M., additional, Kittner, Steven J., additional, Lackland, Daniel T., additional, Lichtman, Judith H., additional, Lisabeth, Lynda D., additional, Magid, David, additional, Marcus, Gregory M., additional, Marelli, Ariane, additional, Matchar, David B., additional, McGuire, Darren K., additional, Mohler, Emile R., additional, Moy, Claudia S., additional, Mussolino, Michael E., additional, Nichol, Graham, additional, Paynter, Nina P., additional, Schreiner, Pamela J., additional, Sorlie, Paul D., additional, Stein, Joel, additional, Turan, Tanya N., additional, Virani, Salim S., additional, Wong, Nathan D., additional, Woo, Daniel, additional, and Turner, Melanie B., additional

Published
2013
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221. Analysis of predicted loss-of-function variants in UK Biobank identifies variants protective for disease

Author

Emdin, Connor A., Khera, Amit V., Chaffin, Mark, Klarin, Derek, Natarajan, Pradeep, Aragam, Krishna, Haas, Mary, Bick, Alexander, Zekavat, Seyedeh M., Nomura, Akihiro, Ardissino, Diego, Wilson, James G., Schunkert, Heribert, McPherson, Ruth, Watkins, Hugh, Elosua, Roberto, Bown, Matthew J., Samani, Nilesh J., Baber, Usman, Erdmann, Jeanette, Gupta, Namrata, Danesh, John, Chasman, Daniel, Ridker, Paul, Denny, Joshua, Bastarache, Lisa, Lichtman, Judith H., D’Onofrio, Gail, Mattera, Jennifer, Spertus, John A., Sheu, Wayne H.-H., Taylor, Kent D., Psaty, Bruce M., Rich, Stephen S., Post, Wendy, Rotter, Jerome I., Chen, Yii-Der Ida, Krumholz, Harlan, Saleheen, Danish, Gabriel, Stacey, and Kathiresan, Sekar

Abstract

Less than 3% of protein-coding genetic variants are predicted to result in loss of protein function through the introduction of a stop codon, frameshift, or the disruption of an essential splice site; however, such predicted loss-of-function (pLOF) variants provide insight into effector transcript and direction of biological effect. In >400,000 UK Biobank participants, we conduct association analyses of 3759 pLOF variants with six metabolic traits, six cardiometabolic diseases, and twelve additional diseases. We identified 18 new low-frequency or rare (allele frequency < 5%) pLOF variant-phenotype associations. pLOF variants in the gene GPR151 protect against obesity and type 2 diabetes, in the gene IL33 against asthma and allergic disease, and in the gene IFIH1 against hypothyroidism. In the gene PDE3B, pLOF variants associate with elevated height, improved body fat distribution and protection from coronary artery disease. Our findings prioritize genes for which pharmacologic mimics of pLOF variants may lower risk for disease.

Published
2018
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222. Average Temperature, Diurnal Temperature Variation, and Stroke Hospitalizations.

Author

Lichtman, Judith H., Leifheit-Limson, Erica C., Jones, Sara B., Wang, Yun, and Goldstein, Larry B.

Abstract

Background: Studies assessing the relationship between meteorological factors and stroke incidence are inconsistent. We assessed the associations of average temperature and diurnal temperature fluctuations with ischemic stroke hospitalizations in a nationally representative sample of patients in the United States.Methods: Hospitalizations were identified for adults aged 18 years or older in the 2009-2011 Nationwide Inpatient Sample and linked with county-level monthly average temperatures from the United States National Climatic Data Center. Logistic regression models assessed the relationships of 5°F increases in average temperature and diurnal temperature variation (difference between high- and low-daily temperatures) with the odds of ischemic stroke hospitalization (International Classification of Diseases, Ninth Revision, Clinical Modification codes 433, 434, and 436), adjusting for patient characteristics and dew point. Models were stratified by age (18-64, ≥65 years), season, and region, with analysis at the hospitalization level.Results: Increased average temperature was associated with decreased odds of stroke hospitalization among both age groups and across seasons in the Northeast, and among the elderly in the West. Increased diurnal temperature variation was associated with increased odds of stroke hospitalization for nearly all regions in the spring to fall seasons; associations were most pronounced in the Northeast and strongest in the spring.Conclusions: Lower average temperature and larger diurnal temperature variations were associated with stroke hospitalizations. Associations were strongest in the Northeast and largely similar across seasons and age. Further research is needed to explore the mechanisms underlying these associations. Understanding these patterns may lead to targeted prevention strategies for vulnerable populations during periods of extreme weather conditions. [ABSTRACT FROM AUTHOR]

Published
2016
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223. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association.

Author

Mozaffarian, Dariush, Benjamin, Emelia J, Go, Alan S, Arnett, Donna K, Blaha, Michael J, Cushman, Mary, Das, Sandeep R, de Ferranti, Sarah, Després, Jean-Pierre, Fullerton, Heather J, Howard, Virginia J, Huffman, Mark D, Isasi, Carmen R, Jiménez, Monik C, Judd, Suzanne E, Kissela, Brett M, Lichtman, Judith H, Lisabeth, Lynda D, Liu, Simin, and Mackey, Rachel H

Published
2016
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224. 2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Cardiovascular Endpoints Data Standards).

Author

Hicks, Karen A, Tcheng, James E, Bozkurt, Biykem, Chaitman, Bernard R, Cutlip, Donald E, Farb, Andrew, Fonarow, Gregg C, Jacobs, Jeffrey P, Jaff, Michael R, Lichtman, Judith H, Limacher, Marian C, Mahaffey, Kenneth W, Mehran, Roxana, Nissen, Steven E, Smith, Eric E, Targum, Shari L, and ACC/AHA TASK FORCE ON CLINICAL DATA STANDARDS MEMBERS

Published
2015
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231. Association of Somatic and Cognitive Depressive Symptoms and Biomarkers in Acute Myocardial Infarction: Insights from the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status Registry

Author

Smolderen, Kim G., primary, Spertus, John A., additional, Reid, Kimberly J., additional, Buchanan, Donna M., additional, Vaccarino, Viola, additional, Lichtman, Judith H., additional, Bekelman, David B., additional, and Chan, Paul S., additional

Published
2012
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233. Abstract P405: Low Social Support Mediates the Effect of Marital Stress on 12-month Cardiac-Specific Quality of Life in Young Adults With Acute Myocardial Infarction

Author

Zhu, Cenjing, Dreyer, Rachel P, Li, Fan, Spatz, Erica S, Caraballo, Cesar, Mahajan, Shiwani, Raparelli, Valeria, Leifheit, Erica C, Lu, Yuan, Krumholz, Harlan M, Spertus, John, DONOFRIO, Gail, Pilote, Louise, and Lichtman, Judith H

Abstract

Background:Marital stress is associated with worse cardiac outcomes in young adults (≤55 years) with acute myocardial infarction (AMI), but whether psychosocial factors mediate this association remains largely unknown. We conducted a mediation analysis to investigate whether marital stress worsened quality of life (QoL) after AMI by increasing the likelihood of depression or low social support.Methods:There were 1,037 married/partnered AMI survivors aged 18-55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study (2008-2012) (67% women, mean age 47 years). Marital stress was measured by the Stockholm Marital Stress Scale at 1 month post-AMI; categorized as absent/moderate or severe. Depression (Patient Health Questionnaire-9 score ≥10), low social support (ENRICHD Social Support Instrument score ≤3 on ≥2 items and total score ≤18), and cardiac-specific QoL (Seattle Angina Questionnaire) were assessed at 1 year post-AMI. Natural direct and indirect effects of marital stress, depression, and low social support on QoL were estimated by causal mediation analysis with bias-corrected bootstrapped confidence intervals. Baseline QoL, sex, age, race, and socioeconomic factors (education, income, employment, and insurance status) were entered as covariates in all models.Results:There was a statistically significant direct effect from severe marital stress to lower 1-year cardiac-specific QoL after adjusting for covariates (Figure). Low social support and depression mediated 14.7% and 11.1% of the total relationship between marital stress and QoL, respectively; however, only the mediating effect through low social support was statistically significant.Conclusion:Marital stress was significantly associated with worse 1-year cardiac-specific QoL, and this effect was partially mediated by low social support. Interventions to decrease marital stress that also screen and provide resources for social support may help to improve AMI outcomes.

Published
2023
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234. Abstract WMP104: Mortality And Recurrence Within 1 Year After Ischemic Stroke For Urban Vs Rural US Medicare Beneficiaries

Author

Leifheit, Erica C, Wang, Yun, Goldstein, Larry B, and Lichtman, Judith H

Abstract

Background:Approximately 14% of the US population resides in rural areas, which have higher rates of chronic disease and are often medically underserved. We compared 1-year outcomes after ischemic stroke for Medicare beneficiaries living in urban vs rural areas.Methods:We identified all Medicare fee-for-service beneficiaries aged ≥65 years discharged alive from US acute-care hospitals with ischemic stroke in 2015 to 2017. Patients were followed up to 1 year through 2018 for death or ischemic stroke recurrence and categorized according to geographic remoteness of their residence using the Rural-Urban Community Area codes. We balanced patient characteristics between the rural/urban categories using stabilized inverse probability weights (IPW) based on patient demographic and clinical characteristics. We created adjusted Kaplan-Meier curves based on the IPW and fit Cox models to assess differences in 1-year all-cause mortality and recurrent stroke weighted by the IPW and accounting for competing risks.Results:There were 536,930 stroke patients (32,635 isolated rural, 40,240 small rural, 66,320 large rural, 397,735 urban; mean age 79.0 years, 54.7% women, 82.5% White). For isolated rural, small rural, large rural, and urban residents, 1-year adjusted mortality rates were 24.1%, 24.6%, 24.7%, and 22.9%, and 1-year stroke recurrence rates were 8.0%, 7.8%, 7.9%, and 8.1%, respectively. Compared with urban residents, isolated rural (HR 1.07, 95% CI 1.04-1.09), small rural (1.09, 1.07-1.12), and large rural (1.10, 1.08-1.12) residents had greater risk of death within 1 year after stroke, but there was little difference in recurrence (Fig. A). Urban residents had the lowest mortality across regions, but there was variation among the rural subcategories and for recurrence in region-stratified analyses (Fig. B).Conclusions:Ischemic stroke patients living in urban areas had a lower risk of mortality within 1 year compared with those living in more rural areas.

Published
2023
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235. Abstract 157: Association Of Hospital Performance With 1-Year Mortality And Recurrence After Ischemic Stroke Among US Medicare Beneficiaries

Author

Leifheit, Erica C, Wang, Yun, Goldstein, Larry B, and Lichtman, Judith H

Abstract

Background:Whether stroke patients treated at hospitals with better short-term quality performance metrics have better long-term outcomes is unknown. We determined if ischemic stroke patients treated at US hospitals with better past performance on the Centers for Medicare & Medicaid Services (CMS) 30-day mortality and readmission outcome measures for stroke had better 1-year outcomes compared to those treated at other hospitals.Methods:We included all Medicare fee-for-service beneficiaries aged ≥65 years discharged alive from US hospitals with a principal diagnosis of ischemic stroke from 07/01/2015 to 12/31/2018. We categorized patients by the treating hospital’s performance on the CMS hospital-specific 30-day risk-standardized all-cause mortality and readmission rate measures for stroke from 07/01/2012 to 06/30/2015: Low-Low (both CMS mortality and readmission rates for the hospital were <25thpercentile of national rates), High-High (both >75thpercentile), and Intermediate (all others). We balanced characteristics between hospital performance categories using stabilized inverse probability weights (IPW) based on patient demographic and clinical factors. We fit Cox models to assess patient risks of 1-year mortality and recurrent stroke across hospital performance categories, weighted by the IPW and accounting for competing risks.Results:There were 595,929 stroke patients (mean age 78.9y, 54.4% women, 82.2% White) discharged from 134 Low-Low, 2288 Intermediate, and 141 High-High hospitals. For patients treated at Low-Low, Intermediate, and High-High hospitals, respectively, 1-year mortality rates were 23.8% (95% CI 23.3-24.3%), 25.2% (25.1-25.3%), and 26.5% (26.1-26.9%), and recurrence rates were 8.0% (7.6-8.3%), 7.9% (7.8-8.0%), and 8.0% (7.7-8.3%). Compared with patients at High-High hospitals, those at Low-Low and Intermediate hospitals, respectively, had 15% (hazard ratio 0.85; 95% CI 0.82-0.87) and 9% (0.91; 0.89-0.93) lower risks of 1-year mortality but no difference in 1-year recurrence.Conclusions:Ischemic stroke patients treated at better-performing hospitals had lower risks of post-discharge 1-year mortality but similar risks of recurrent stroke compared with patients treated at other hospitals.

Published
2023
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236. Abstract WMP98: Associations Between Long-term Co, No2, O3, Pm2.5, And So2Exposure And 30-day All-cause Hospital Readmission Among Stroke Patients In The Us: 2014-2015

Author

Tran, Phoebe, Leifheit, Erica C, Warren, Joshua, Goldstein, Larry B, and Lichtman, Judith H

Abstract

Objective:There are known associations between long-term air pollution exposure and greater stroke incidence, morbidity, and mortality; however, there is little research on the association of pollutant exposure with poststroke hospital readmission.Methods:We assessed associations of average annual CO, NO2, O3, PM2.5, and SO2exposure with 30-day all-cause hospital readmission in US fee-for-service Medicare beneficiaries age ≥65 years hospitalized for ischemic stroke in 2014-2015. We fit Cox models to assess 30-day readmission as a function of these pollutants, adjusted for patient and hospital factors and temperature. We repeated the models stratified by performance of the treating hospital on the Centers for Medicare & Medicaid Services (CMS) risk-standardized 30-day all-cause readmission for stroke measure to determine if the results were independent of performance: Low (CMS rate for hospital <25th percentile of national rate), High (>75thpercentile), and Middle (all others).Results:There were 448148 patients discharged with stroke in 2014-2015 of whom 12.5% were readmitted. Average 2-year CO, O3, PM2.5, and SO2values during the study were below national standards. In adjusted analyses, each 1 standard deviation increase in average annual NO2and SO2exposure was associated with a 3.6% (95% CI 2.9%-4.4%) and a 2.0% (95% CI 1.1%-3.0%) increased readmission risk within 30-days, respectively (Table). Associations between long-term air pollution exposure and increased readmissions persisted across performance categories.Conclusion:Long-term air pollution exposure was associated with increased 30-day readmissions after stroke at pollutant levels below national standards across hospital performance categories. Additional research is needed to determine whether improvements in air quality lead to reductions in poststroke hospital readmissions.

Published
2023
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239. Abstract P73: Social Support and Adherence to Cardiac Risk Factor Management Instructions during the First Year after Acute Myocardial Infarction

Author

Leifheit-Limson, Erica C, primary, Reid, Kimberly J, additional, Kasl, Stanislav V, additional, Lin, Haiqun, additional, Jones, Philip G, additional, Buchanan, Donna M, additional, Peterson, Pamela N, additional, Parashar, Susmita, additional, Spertus, John A, additional, and Lichtman, Judith H, additional

Published
2011
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245. Heart Disease and Stroke Statistics—2011 Update

Author

Roger, Véronique L., primary, Go, Alan S., additional, Lloyd-Jones, Donald M., additional, Adams, Robert J., additional, Berry, Jarett D., additional, Brown, Todd M., additional, Carnethon, Mercedes R., additional, Dai, Shifan, additional, de Simone, Giovanni, additional, Ford, Earl S., additional, Fox, Caroline S., additional, Fullerton, Heather J., additional, Gillespie, Cathleen, additional, Greenlund, Kurt J., additional, Hailpern, Susan M., additional, Heit, John A., additional, Ho, P. Michael, additional, Howard, Virginia J., additional, Kissela, Brett M., additional, Kittner, Steven J., additional, Lackland, Daniel T., additional, Lichtman, Judith H., additional, Lisabeth, Lynda D., additional, Makuc, Diane M., additional, Marcus, Gregory M., additional, Marelli, Ariane, additional, Matchar, David B., additional, McDermott, Mary M., additional, Meigs, James B., additional, Moy, Claudia S., additional, Mozaffarian, Dariush, additional, Mussolino, Michael E., additional, Nichol, Graham, additional, Paynter, Nina P., additional, Rosamond, Wayne D., additional, Sorlie, Paul D., additional, Stafford, Randall S., additional, Turan, Tanya N., additional, Turner, Melanie B., additional, Wong, Nathan D., additional, and Wylie-Rosett, Judith, additional

Published
2011
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247. Variation in Recovery

Author

Lichtman, Judith H., primary, Lorenze, Nancy P., additional, D'Onofrio, Gail, additional, Spertus, John A., additional, Lindau, Stacy T., additional, Morgan, Thomas M., additional, Herrin, Jeph, additional, Bueno, Héctor, additional, Mattera, Jennifer A., additional, Ridker, Paul M., additional, and Krumholz, Harlan M., additional

Published
2010
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248. Hospital Volume and 30-Day Mortality for Three Common Medical Conditions

Author

Ross, Joseph S., primary, Normand, Sharon-Lise T., additional, Wang, Yun, additional, Ko, Dennis T., additional, Chen, Jersey, additional, Drye, Elizabeth E., additional, Keenan, Patricia S., additional, Lichtman, Judith H., additional, Bueno, Héctor, additional, Schreiner, Geoffrey C., additional, and Krumholz, Harlan M., additional

Published
2010
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