149 results on '"Kaltenbach, Lisa A."'
Search Results
102. ASSOCIATION BETWEEN USE OF ANTI-ANGINAL MEDICATIONS FOR STABLE CORONARY DISEASE AND RATES OF PERCUTANEOUS CORONARY INTERVENTION: A REPORT FROM THE NCDR®
- Author
-
Borden, William, primary, Spertus, John, additional, Mushlin, Alvin I., additional, Roe, Matthew, additional, Kaltenbach, Lisa, additional, and Redberg, Rita, additional
- Published
- 2012
- Full Text
- View/download PDF
103. HOSPITAL CHARACTERISTICS ASSOCIATED WITH PROVIDING OPTIMAL MEDICAL THERAPY FOR PERCUTANEOUS CORONARY INTERVENTION PATIENTS: A REPORT FROM THE NCDR®
- Author
-
Borden, William, primary, Spertus, John, additional, Mushlin, Alvin I., additional, Roe, Matthew, additional, Kaltenbach, Lisa, additional, and Redberg, Rita, additional
- Published
- 2012
- Full Text
- View/download PDF
104. NON-SYSTEM REASONS FOR DELAY IN DOOR-TO-BALLOON TIME AND IN-HOSPITAL MORTALITY: A REPORT FROM THE NATIONAL CARDIOVASCULAR DATA REGISTRY®
- Author
-
Swaminathan, Rajesh V., primary, Wang, Tracy, additional, Kaltenbach, Lisa, additional, Kim, Luke, additional, Minutello, Robert, additional, and Feldman, Dmitriy, additional
- Published
- 2012
- Full Text
- View/download PDF
105. Abstract 21: Patient and Hospital Characteristics Associated with Assessment for Rehabilitation During Hospitalization for Acute Ischemic Stroke
- Author
-
Prvu Bettger, Janet, primary, Kaltenbach, Lisa, additional, Reeves, Mathew, additional, Smith, Eric E, additional, Fonarow, Gregg C, additional, Schwamm, Lee H, additional, and Peterson, Eric D, additional
- Published
- 2012
- Full Text
- View/download PDF
106. Care and Outcomes of Asian-American Acute Myocardial Infarction Patients: Findings From the American Heart Association Get With The Guidelines-Coronary Artery Disease Program
- Author
-
Qian, Feng, primary, Ling, Frederick S., additional, Deedwania, Prakash, additional, Hernandez, Adrian F., additional, Fonarow, Gregg C., additional, Cannon, Christopher P., additional, Peterson, Eric D., additional, Peacock, W. Frank, additional, Kaltenbach, Lisa A., additional, Laskey, Warren K., additional, Schwamm, Lee H., additional, and Bhatt, Deepak L., additional
- Published
- 2012
- Full Text
- View/download PDF
107. Abstract 5: Regional Variation in Recommended Treatments for Ischemic Stroke and TIA: Get With The Guidelines-Stroke, 2003-2010
- Author
-
Allen, Norrina B, primary, Kaltenbach, Lisa, additional, Goldstein, Larry B, additional, Olson, DaiWai, additional, Smith, Eric E, additional, Schwamm, Lee, additional, and Lichtman, Judith H, additional
- Published
- 2011
- Full Text
- View/download PDF
108. Comparative Effectiveness of Antibiotic Treatment Strategies for Pediatric Skin and Soft-Tissue Infections
- Author
-
Williams, Derek J., primary, Cooper, William O., additional, Kaltenbach, Lisa A., additional, Dudley, Judith A., additional, Kirschke, David L., additional, Jones, Timothy F., additional, Arbogast, Patrick G., additional, Griffin, Marie R., additional, and Creech, C. Buddy, additional
- Published
- 2011
- Full Text
- View/download PDF
109. LONG-TERM MORTALITY ASSOCIATED WITH MULTIVESSEL VERSUS CULPRIT VESSEL ONLY PERCUTANEOUS CORONARY INTERVENTION FOR PATIENTS WITH ACUTE MYOCARDIAL INFARCTION: INSIGHTS FROM THE NATIONAL CARDIOVASCULAR CATHPCI DATA REGISTRY
- Author
-
Wang, Tracy, primary, Kaltenbach, Lisa A., additional, Bhatt, Deepak L., additional, Rao, Sunil V., additional, Roe, Matthew T., additional, Resnic, Frederic S., additional, Cavender, Matthew A., additional, Messenger, John C., additional, and Peterson, Eric D., additional
- Published
- 2011
- Full Text
- View/download PDF
110. CARE AND OUTCOMES OF ASIAN ACUTE MYOCARDIAL INFARCTION PATIENTS: RESULTS FROM THE AMERICAN HEART ASSOCIATION GET WITH THE GUIDELINES-CORONARY ARTERY DISEASE PROGRAM
- Author
-
Qian, Feng, primary, Ling, Frederick S., additional, Deedwania, Prakash, additional, Hernandez, Adrian F., additional, Fonarow, Gregg C., additional, Cannon, Christopher P., additional, Peterson, Eric D., additional, Peacock, W. Frank, additional, Kaltenbach, Lisa A., additional, Laskey, Warren K., additional, Schwamm, Lee H., additional, and Bhatt, Deepak L., additional
- Published
- 2011
- Full Text
- View/download PDF
111. PRESENTATION TREATMENT AND OUTCOMES OF EARLY LATE AND VERY LATE STENT THROMBOSIS: A REPORT FROM THE AMERICAN COLLEGE OF CARDIOLOGY NATIONAL CARDIOVASCULAR DATA REGISTRY®
- Author
-
Feldman, Dmitriy N., primary, Armstrong, Ehrin J., additional, Wang, Tracy Y., additional, Kaltenbach, Lisa A., additional, Yeo, Khung Keong, additional, Spertus, John, additional, Wong, S. Chiu, additional, Minutello, Robert M., additional, Moussa, Issam, additional, Shaw, Richard, additional, Rogers, Jason H., additional, and Shunk, Kendrick A., additional
- Published
- 2011
- Full Text
- View/download PDF
112. Patient centered primary care is associated with patient hypertension medication adherence
- Author
-
Roumie, Christianne L., primary, Greevy, Robert, additional, Wallston, Kenneth A., additional, Elasy, Tom A., additional, Kaltenbach, Lisa, additional, Kotter, Kristen, additional, Dittus, Robert S., additional, and Speroff, Theodore, additional
- Published
- 2010
- Full Text
- View/download PDF
113. Use of Drugs Known to Cause Fetal Harm Among Women Delivering Infants in Haiti
- Author
-
Jules, Astride, primary, Kaltenbach, Lisa A., additional, Arbogast, Patrick G., additional, Caples, T. Lynne, additional, Po’e, Eli K., additional, and Cooper, William O., additional
- Published
- 2010
- Full Text
- View/download PDF
114. Adherence to disease-modifying antirheumatic drugs and the effects of exposure misclassification on the risk of hospital admission
- Author
-
Grijalva, Carlos G., primary, Kaltenbach, Lisa, additional, Arbogast, Patrick G., additional, Mitchel, Edward F., additional, and Griffin, Marie R., additional
- Published
- 2010
- Full Text
- View/download PDF
115. Initiation of rheumatoid arthritis treatments and the risk of serious infections
- Author
-
Grijalva, Carlos G., primary, Kaltenbach, Lisa, additional, Arbogast, Patrick G., additional, Mitchel, Edward F., additional, and Griffin, Marie R., additional
- Published
- 2009
- Full Text
- View/download PDF
116. Selected Community Characteristics and Underage Drinking
- Author
-
Song, Eun-Young, primary, Reboussin, Beth A., additional, Foley, Kristie Long, additional, Kaltenbach, Lisa A., additional, Wagoner, Kimberly G., additional, and Wolfson, Mark, additional
- Published
- 2009
- Full Text
- View/download PDF
117. Care and Outcomes of Asian-American Acute Myocardial Infarction Patients: Findings From the American Heart Association Get With The Guidelines-Coronary Artery Disease Program.
- Author
-
Feng Qian, Ling, Frederick S., Deedwania, Prakash, Hernandez, Adrian F., Fonarow, Gregg C., Cannon, Christopher P., Peterson, Eric D., Peacock, W. Frank, Kaltenbach, Lisa A., Laskey, Warren K., Schwamm, Lee H., and Bhatt, Deepak L.
- Subjects
TRENDS ,MYOCARDIAL infarction treatment ,EVIDENCE-based medicine ,HEALTH outcome assessment - Abstract
The article discusses research on the use of and trends in evidence-based care acute myocardial infarction (AMI) processes and outcome in Asian-American and White patients in the U.S. The study made use of data from the Get With the Fuidelines-Coronary Arter Disease (GWTG-CAD) program of the American Heart Association (AHA). It found that Asian-Americans were less likely to undergo smoking cessation counseling.
- Published
- 2012
- Full Text
- View/download PDF
118. Adherence to diseasemodifying antirheumatic drugs and the effects of exposure misclassification on the risk of hospital admission
- Author
-
Grijalva, Carlos G., Kaltenbach, Lisa, Arbogast, Patrick G., Mitchel, Edward F., and Griffin, Marie R.
- Abstract
ObjectiveTo describe the effect of different exposure classification strategies for diseasemodifying antirheumatic drugs DMARDs on drugoutcome associations.MethodsWe studied the association between DMARD initiation and allcause hospitalizations in patients with rheumatoid arthritis RA, 1995–2005. Initiators of DMARDs and oral glucocorticoids were followed for ≤180 days. We compared 2 strategies for exposure classification: a persistent exposure required PER approach, in which followup stopped when the regimen changed; and a persistent exposure ignored PEI approach, in which followup continued despite regimen changes. For PEI, adherence was assessed using the medication possession ratio. Allcause hospitalization risk was compared among RA regimen initiators using Cox models and methotrexate as the reference.ResultsWe identified 28,906 episodes of medication initiation. In PER analyses, tumor necrosis factor α antagonists did not increase hospitalization risk compared with methotrexate, whereas leflunomide did hazard ratio HR 1.36, 95 confidence interval 95 CI 1.1–1.67. Glucocorticoids increased hospitalization risk HR 1.29, 1.54, and 2.03 for low, medium, and high doses, respectively. PEI results were similar to PER except that infliximab initiation increased the risk of hospitalization compared with methotrexate HR 1.46, 95 CI 1.19–1.8, and most other effects were closer to the null. In PEI, adherence ranged from 73 for etanercept to 6 for glucocorticoids and adherence to methotrexate was 59.ConclusionCompared with methotrexate initiation, leflunomide or glucocorticoid initiation consistently increased allcause hospitalizations in the first 180 days of use. Most PER and PEI estimates were similar; observed differences in risk between these methods were likely due to differences in adherence.
- Published
- 2010
- Full Text
- View/download PDF
119. Nonsystem Reasons for Delay in Door-to-Balloon Time and Associated In-Hospital Mortality A Report From the National Cardiovascular Data Registry
- Author
-
Swaminathan, Rajesh V., Wang, Tracy Y., Kaltenbach, Lisa A., Kim, Luke K., Minutello, Robert M., Bergman, Geoffrey, Wong, S. Chiu, and Feldman, Dmitriy N.
- Subjects
STEMI ,delay ,mortality ,door-to-balloon time - Abstract
ObjectivesThe goal of this study was to characterize nonsystem reasons for delay in door-to-balloon time (D2BT) and the impact on in-hospital mortality.BackgroundStudies have evaluated predictors of delay in D2BT, highlighting system-related issues and patient demographic characteristics. Limited data exist, however, for nonsystem reasons for delay in D2BT.MethodsWe analyzed nonsystem reasons for delay in D2BT among 82,678 ST-segment elevation myocardial infarction patients who underwent primary percutaneous coronary intervention within 24 h of symptom onset in the CathPCI Registry from January 1, 2009, to June 30, 2011.ResultsNonsystem delays occurred in 14.7% of patients (n = 12,146). Patients with nonsystem delays were more likely to be older, female, African American, and have greater comorbidities. The in-hospital mortality for patients treated without delay was 2.5% versus 15.1% for those with delay (p < 0.01). Nonsystem delay reasons included delays in providing consent (4.4%), difficult vascular access (8.4%), difficulty crossing the lesion (18.8%), “other” (31%), and cardiac arrest/intubation (37.4%). Cardiac arrest/intubation delays had the highest in-hospital mortality (29.9%) despite the shortest time delay (median D2BT: 84 min; 25th to 75th percentile: 64 to 108 min); delays in providing consent had a relatively lower in-hospital mortality rate (9.4%) despite the longest time delay (median D2BT: 100 min; 25th to 75th percentile: 80 to 131 min). Mortality for delays due to difficult vascular access, difficulty crossing a lesion, and other was also higher (8.0%, 5.6%, and 5.9%, respectively) compared with nondelayed patients (p < 0.0001). After adjustment for baseline characteristics, in-hospital mortality remained higher for patients with nonsystem delays.ConclusionsNonsystem reasons for delay in D2BT in ST-segment elevation myocardial infarction patients presenting for primary percutaneous coronary intervention are common and associated with high in-hospital mortality.
- Full Text
- View/download PDF
120. PERSISTENCE AND DISCONTINUATION OF SGLT-2I AND GLP-1RA AMONG PERSONS WITH TYPE 2 DIABETES AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE TREATED IN US CARDIOLOGY CLINICS: INSIGHTS FROM THE COORDINATE-DIABETES TRIAL.
- Author
-
Nelson, Adam J., Pagidipati, Neha J., Kaltenbach, Lisa, Green, Jennifer, Lopes, Renato D., Al-Khalidi, Hussein, Aroda, Vanita, Cavender, Matthew Aaron, Kirk, Julienne, Lingvay, Ildiko, Magwire, Melissa, Pop-Busui, Rodica, Richardson, Caroline Regina, Leyva, Monica, Webb, Laura, Pandey, Ambarish, Washington, Alana, Gaynor, Tanya, Pak, Jonathan, and McGuire, Darren K.
- Subjects
- *
TYPE 2 diabetes , *CARDIOVASCULAR diseases , *CARDIOLOGY - Published
- 2024
- Full Text
- View/download PDF
121. CHARACTERISTICS OF PERSONS WITH TYPE 2 DIABETES AND ATHEROSCLEROTIC CARDIOVASCULAR DISEASE PRESCRIBED SGLT-2I AND/OR GLP-1RA AMONG CARDIOLOGY CLINICS IN THE US: INSIGHTS FROM A LARGE IMPLEMENTATION TRIAL.
- Author
-
Nelson, Adam J., Pagidipati, Neha J., Kaltenbach, Lisa, Green, Jennifer, Lopes, Renato D., Al-Khalidi, Hussein, Aroda, Vanita, Cavender, Matthew Aaron, Kirk, Julienne, Lingvay, Ildiko, Magwire, Melissa, Pop-Busui, Rodica, Richardson, Caroline Regina, Webb, Laura, Leyva, Monica, Washington, Alana, Pak, Jonathan, Gaynor, Tanya, and Granger, Christopher B.
- Subjects
- *
TYPE 2 diabetes , *CARDIOVASCULAR diseases , *CARDIOLOGY - Published
- 2024
- Full Text
- View/download PDF
122. Abstract 14759: The "Halo Effect" of a P2Y12 Inhibitor Copayment Reduction Intervention on Persistence and Adherence With Other Secondary Prevention Medications: Results From the ARTEMIS Cluster Randomized Clinical Trial.
- Author
-
Fanaroff, Alexander C, Peterson, Eric D, Kaltenbach, Lisa A, Cannon, Christopher P, Choudhry, Niteesh K, Henry, Timothy D, Anstrom, Kevin J, Cohen, David J, Fonseca, Eileen, Khan, Naeem D, Fonarow, Gregg C, and Wang, Tracy Y
- Published
- 2018
123. Abstract 14416: Strategies for Improving the Care of Patients Hospitalized With Heart Failure: Baseline Data From the CONNECT-HF Trial.
- Author
-
Feng, Kent Y, Granger, Bradi B, Fonarow, Gregg C, Pina, Ileana L, Lewis, Eldrin F, Cooper, Lauren B, Allen, Larry A, Kaltenbach, Lisa A, Granger, Christopher B, Hernandez, Adrian F, and DeVore, Adam D
- Published
- 2018
124. Abstract 14117: Method of Assessing Medication Persistence and Clinical Outcomes: A Comparison of Patient Report and Pharmacy Fill Data From the ARTEMIS Trial.
- Author
-
Fanaroff, Alexander C, Peterson, Eric D, Kaltenbach, Lisa A, Fonarow, Gregg C, Choudhry, Niteesh K, Anstrom, Kevin J, Henry, Timothy D, Cohen, David J, Fonseca, Eileen, Khan, Naeem D, Cannon, Christopher P, and Wang, Tracy Y
- Published
- 2018
125. Unplanned 30-Day Readmission Risk Among Patients with Acute Myocardial Infarction: A Report from TRANSLATE-ACS
- Author
-
Hess, Connie N., Wang, Tracy Y., Kaltenbach, Lisa, Honeycutt, Emily, Messenger, John C., Smith, William T., Zettler, Marjorie E., Mark B Effron, Henry, Timothy D., Peterson, Eric D., and Fonarow, Gregg C.
126. Black race, sex, and extrapulmonary tuberculosis risk: an observational study
- Author
-
Holt Erin, Marie R. Griffin, Kaltenbach Lisa, Patrick G. Arbogast, Timothy R. Sterling, Christina T. Fiske, and Jon Warkentin
- Subjects
Adult ,Male ,medicine.medical_specialty ,Tuberculosis ,Population ,Prevalence ,Disease ,Logistic regression ,lcsh:Infectious and parasitic diseases ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Medical microbiology ,Risk Factors ,Internal medicine ,medicine ,Humans ,lcsh:RC109-216 ,030212 general & internal medicine ,education ,Aged ,education.field_of_study ,business.industry ,Incidence ,Incidence (epidemiology) ,Middle Aged ,medicine.disease ,Tennessee ,3. Good health ,Black or African American ,Infectious Diseases ,030228 respiratory system ,Tropical medicine ,Immunology ,Female ,business ,Research Article - Abstract
Background Extrapulmonary tuberculosis is likely a marker of underlying immune compromise. Our objective was to determine race and sex differences in extrapulmonary tuberculosis risk in order to identify the optimal population in which to assess for host factors associated with extrapulmonary tuberculosis. Methods We performed an observational study of all tuberculosis cases reported to the Tennessee Department of Health, January 1, 2000 to December 31, 2006. We compared the incidence of extrapulmonary tuberculosis by race and sex. We also examined risk factors associated with extrapulmonary disease among all persons with tuberculosis. Results Extrapulmonary tuberculosis incidence per 100,000 population was 5.93 in black men, 3.21 in black women, 1.01 in non-black men, and 0.58 in non-black women. Among those with tuberculosis, black women were most likely to have extrapulmonary disease (38.6%), followed by black men (28.1%), non-black women (24.6%) and non-black men (21.1%). In multivariate logistic regression among persons with tuberculosis, black women (OR 1.82 (95% CI 1.24-2.65), p = 0.002), black men (OR 1.54 (95% CI 1.13-2.09, p = 0.006), foreign birth (OR 1.55 (95% CI 1.12-2.14), p = 0.009), and HIV infection (OR 1.45 (95% CI 0.99-2.11), p = 0.06) were associated with extrapulmonary tuberculosis. Conclusions Black men and black women had the highest incidence of extrapulmonary tuberculosis, and high odds of extrapulmonary disease among persons with tuberculosis. These data suggest that factors in addition to tuberculosis exposure contribute to extrapulmonary tuberculosis risk in blacks.
- Full Text
- View/download PDF
127. Abstract 21.
- Author
-
Prvu Bettger, Janet, Kaltenbach, Lisa, Reeves, Mathew, Smith, Eric E, Fonarow, Gregg C, Schwamm, Lee H, and Peterson, Eric D
- Published
- 2012
128. INTERVENTION TO IMPROVE GUIDELINE-BASED CARE FOR DIABETES AND CARDIOVASCULAR DISEASE IS EFFECTIVE IN BLACK AND HISPANIC POPULATIONS.
- Author
-
Green, Jennifer, Nelson, Adam J., Pagidipati, Neha J., Kaltenbach, Lisa, Lopes, Renato D., Al-Khalidi, Hussein, Kondamudi, Nitin, Khan, Waqar A., Weston, Patrick, Aroda, Vanita, Cavender, Matthew Aaron, Kirk, Julienne, Lingvay, Ildiko, Magwire, Melissa, PopBusui, Rodica, Richardson, Caroline Regina, Webb, Laura, Leyva, Monica, Washington, Alana, and Pak, Jonathan
- Subjects
- *
CARDIOVASCULAR diseases , *DIABETES - Published
- 2024
- Full Text
- View/download PDF
129. Remote Follow-up in a Heart Failure Pragmatic Trial: Insights From the CONNECT-HF.
- Author
-
Shoji S, Kaltenbach LA, Granger BB, Fonarow GC, Al-Khalidi HR, Albert NM, Butler J, Allen LA, Felker GM, Harrison RW, Fudim M, Nelson AJ, Granger CB, Hernandez AF, and Devore AD
- Abstract
Background: Randomized controlled trials typically require study-specific visits, which can burden participants and sites. Remote follow-up, such as centralized call centers for participant-reported or site-reported, holds promise for reducing costs and enhancing the pragmatism of trials. In this secondary analysis of the CONNECT-HF (Care Optimization Through Patient and Hospital Engagement For HF) trial, we aimed to evaluate the completeness and validity of the remote follow-up process., Methods and Results: The CONNECT-HF trial evaluated the effect of a post-discharge quality-improvement intervention for heart failure compared to usual care for up to 1 year. Suspected events were reported either by participants or by health care proxies through a centralized call center or by sites through medical-record queries. When potential hospitalization events were suspected, additional medical records were collected and adjudicated. Among 5942 potential hospitalizations, 18% were only participant-reported, 28% were reported by both participants and sites, and 50% were only site-reported. Concordance rates between the participant/site reports and adjudication for hospitalization were high: 87% participant-reported, 86% both, and 86% site-reported. Rates of adjudicated heart failure hospitalization events among adjudicated all-cause hospitalization were lower but also consistent: 45% participant-reported, 50% both, and 50% site-reported., Conclusions: Participant-only and site-only reports missed a substantial number of hospitalization events. We observed similar concordance between participant/site reports and adjudication for hospitalizations. Combining participant-reported and site-reported outcomes data is important to capture and validate hospitalizations effectively in pragmatic heart failure trials., Competing Interests: Disclosures ADV reports research funding through his institution from Biofourmis, Bodyport, Cytokinetics, American Regent, NIH and NHLBI, Novartis, and Story Health, and provides consulting services for and/or receives honoraria from Abiomed, Cardionomic, LivaNova, Natera, NovoNordisk, Story Health, and Zoll. GF reports consulting for Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Eli Lilly, Johnson & Johnson, Medtronic, Merck, Novartis, and Pfizer. NA reports research funding through her institution from Roche and AstraZeneca, and consulting for Abiomed, American Regent, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Daiichi Sanyko, Eli Lilly, and Lexicon. JB is a consultant for Abbott, American Regent, Amgen, Applied Therapeutic, AskBio, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardiac Dimension, Cardiocell, Cardior, CSL Bearing, CVRx, Cytokinetics, Daxor, Edwards, Element Science, Faraday, Foundry, G3P, Innolife, Impulse Dynamics, Imbria, Inventiva, Ionis, Lexicon, Lilly, LivaNova, Janssen, Medtronics, Merck, Occlutech, Owkin, Novartis, Novo Nordisk, Pfizer, Pharmacosmos, Pharmain, Prolaio, Regeneron, Renibus, Roche, Salamandra, Sanofi, SC Pharma, Secretome, Sequana, SQ Innovation, Tenex, Tricog, Ultromics, Vifor, and Zoll. AN reports consulting for Amgen, Boehringer Ingelheim, Eli Lilly, Novartis, Vaxxinity, and Novo Nordisk. MF has no relevant disclosures., (Copyright © 2024 Elsevier Inc. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
130. Access to Mobile Health Interventions Among Patients Hospitalized With Heart Failure: Insights Into the Digital Divide From the CONNECT-HF mHealth Substudy.
- Author
-
Diamond JE, Kaltenbach LA, Granger BB, Fonarow GC, Al-Khalidi HR, Albert NM, Butler J, Allen LA, Lanfear DE, Thibodeau JT, Granger CB, Hernandez AF, Ariely D, and DeVore AD
- Subjects
- Humans, Patients, Heart Failure diagnosis, Heart Failure therapy, Digital Divide, Mobile Applications, Telemedicine
- Abstract
Competing Interests: Disclosures Dr Bradi B. Granger reports research funding through her institution from the American Heart Association, AstraZeneca, the Centers for Disease Control, the Alpha Phi Foundation, and the National Institutes of Health (NIH). Dr Fonarow reports consulting for Abbott, Amgen, AstraZeneca, Bayer, Cytokinetics, Eli Lilly, Janssen, Medtronic, Merck, Novartis, and Pfizer. Dr Albert reports consulting for American Regent, AstraZeneca, Boehringer Ingelheim, Boston Scientific, Cytokinetics, Eli Lilly, and Merck and received research support from AstraZeneca and Novartis. Dr Butler has served as a consultant for Abbott, American Regent, Amgen, Applied Therapeutic, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardiac Dimension, Cardior, CVRx, Cytokinetics, Edwards, Element Science, Innolife, Impulse Dynamics, Imbria, Inventiva, Lexicon, Lilly, LivaNova, Janssen, Medtronic, Merck, Occlutech, Novartis, Novo Nordisk, Pfizer, Pharmacosmos, Pharmain, Roche, Sequana, SQ Innovation, and Vifor. Dr Allen received grant funding from the NIH and the Patient Centered Outcomes Research Institute and consulting fees from ACI Clinical, Boston Scientific, Cytokinetics, and Novartis. Dr Lanfear is a consultant for Abbott Laboratories, Amgen, AstraZeneca, Cytokinetics, Illumina, Janssen, Martin Pharmaceuticals, Vicardia, and the Duke Clinical Research Institute (Novartis) and has participated in clinical research from Amgen, AstraZeneca, Bayer, Critical Diagnostics, Illumina, Lilly, Somalogic, and Janssen. Dr DeVore reports research funding through his institution from Biofourmis, Bodyport, Cytokinetics, American Regent Inc, NIH, the National Heart, Lung, and Blood Institute, Novartis, and Story Health and also provides consulting services for and receives honoraria from Abiomed, Cardionomic, LivaNova, Natera, NovoNordisk, Story Health, and Zoll. The other authors report no conflicts.
- Published
- 2024
- Full Text
- View/download PDF
131. Off-Label Dosing of Direct Oral Anticoagulants Among Inpatients With Atrial Fibrillation in the United States.
- Author
-
Sandhu A, Kaltenbach LA, Chiswell K, Shimoga V, Ashur C, Pribish A, Fonarow GC, Piccini JP Sr, Ho PM, Varosy PD, and Hess PL
- Subjects
- Humans, Female, United States epidemiology, Male, Off-Label Use, Inpatients, Rivaroxaban, Anticoagulants, Administration, Oral, Atrial Fibrillation diagnosis, Atrial Fibrillation drug therapy, Atrial Fibrillation epidemiology, Stroke drug therapy
- Abstract
Background: Among patients hospitalized for atrial fibrillation, the frequency of off-label direct oral anticoagulant (DOAC) dosing, associated factors, hospital-level variation, and temporal trends in contemporary practice are unknown., Methods: Using the Get With The Guidelines-Atrial Fibrillation registry, patients admitted from January 1, 2014, to March 31, 2020, and discharged on DOACs were stratified according to receipt of underdosing, overdosing, or recommended dosing. Factors associated with off-label dosing (defined as underdosing or overdosing) were identified using logistic regression. Median odds ratio (OR) and time-series analyses were used to assess hospital-level variation and temporal trends, respectively., Results: Of 22 470 patients (70.1±12.1 years, 48.1% female, 82.5% White) prescribed a DOAC at discharge from hospitalization for atrial fibrillation (66% apixaban, 29% rivaroxaban, and 5% dabigatran), underdosing occurred among 2006 (8.9%), overdosing among 511 (2.3%), and recommended dosing among 19 953 (88.8%). The overall rate of off-label dosing was 11.2%. Patient-related factors associated with off-label dose included age (underdosing: OR, 1.06 per 1-year increase [95% CI, 1.06-1.07]; overdosing: OR, 1.07 per 1-year increase [95% CI, 1.06-1.09]), dialysis dependence (underdosing: OR, 5.50 [95% CI, 3.76-8.05]; overdosing: OR, 5.47 [95% CI, 2.74-10.88]), female sex (overdosing: OR, 0.79 [95% CI, 0.63-0.99]), and weight (overdosing: OR, 0.96 per 1-kg increase [95% CI, 0.95-1.00]). Across hospitals, the adjusted median OR for off-label DOAC dose was 1.45 (95% CI, 1.34-1.65; underdosing: OR, 1.52 [95% CI, 1.39-1.76]; overdosing: OR, 1.32 [95% CI, 1.20-1.84]), indicating significant hospital-level variation. Over the study period, recommended dosing significantly increased over time (81.9%-90.9%; P <0.0001 for trend) with a corresponding decline in underdosing (14.4%-6.6%; P <0.0001 for trend) and overdosing (3.8%-2.5%; P =0.001 for trend)., Conclusions: Over 1 in 10 patients hospitalized for atrial fibrillation are discharged on an off-label DOAC dose with significant variation across hospitals. While the proportion of patients receiving recommended dosing has significantly improved over time, opportunities to improve DOAC dosing persist., Competing Interests: Disclosures None.
- Published
- 2023
- Full Text
- View/download PDF
132. Coordinating Cardiology clinics randomized trial of interventions to improve outcomes (COORDINATE) - Diabetes: rationale and design.
- Author
-
Nelson AJ, Pagidipati NJ, Kelsey MD, Ardissino M, Aroda VR, Cavender MA, Lopes RD, Al-Khalidi HR, Braceras R, Gaynor T, Kaltenbach LA, Kirk JK, Lingvay I, Magwire ML, O'Brien EC, Pak J, Pop-Busui R, Richardson CR, Levya M, Senyucel C, Webb L, McGuire DK, Green JB, and Granger CB
- Subjects
- Humans, Glucagon-Like Peptide-1 Receptor, Hypoglycemic Agents therapeutic use, United States, Cardiology Service, Hospital organization & administration, Cardiology methods, Cardiovascular Diseases prevention & control, Cardiovascular Diseases drug therapy, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 drug therapy, Sodium-Glucose Transporter 2 Inhibitors therapeutic use
- Abstract
Several medications that are proven to reduce cardiovascular events exist for individuals with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease, however they are substantially underused in clinical practice. Clinician, patient, and system-level barriers all contribute to these gaps in care; yet, there is a paucity of high quality, rigorous studies evaluating the role of interventions to increase utilization. The COORDINATE-Diabetes trial randomized 42 cardiology clinics across the United States to either a multifaceted, site-specific intervention focused on evidence-based care for patients with T2DM or standard of care. The multifaceted intervention comprised the development of an interdisciplinary care pathway for each clinic, audit-and-feedback tools and educational outreach, in addition to patient-facing tools. The primary outcome is the proportion of individuals with T2DM prescribed three key classes of evidence-based medications (high-intensity statin, angiotensin converting enzyme inhibitor or angiotensin receptor blocker, and either a sodium/glucose cotransporter-2 inhibitor (SGLT-2i) inhibitor or glucagon-like peptide 1 receptor agonist (GLP-1RA) and will be assessed at least 6 months after participant enrollment. COORDINATE-Diabetes aims to identify strategies that improve the implementation and adoption of evidence-based therapies., Competing Interests: Conflict of interest None reported, (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
133. Comparing the Classification of Percutaneous Coronary Interventions Using the 2012 and 2017 Appropriate Use Criteria: Insights From 245,196 Patients in the NCDR CathPCI Registry.
- Author
-
Nelson AJ, Inohara T, Rao SV, Kaltenbach LA, Wojdyla D, and Wang TY
- Subjects
- Humans, United States epidemiology, Patient Selection, Registries, Hospitals, Percutaneous Coronary Intervention adverse effects
- Abstract
Background: Appropriate use criteria (AUC) have been developed to promote the rational use of percutaneous coronary intervention (PCI) among clinicians and to provide benchmarking feedback to hospitals. The original AUC were published in 2012 and subsequently updated in 2017 to reflect emerging, contemporary evidence however the degree to which the updated guidance re-classifies PCI appropriateness is unknown., Methods: Elective PCI cases from March 1, 2018 until June 30, 2021 were identified from within the NCDR CathPCI database. PCI cases were classified as 'appropriate,' 'uncertain' or 'inappropriate' under 2012 AUC and 'appropriate,' 'may be appropriate' or 'rarely appropriate' under 2017 AUC; those with missing data elements were termed 'not mappable.' Groups that 'remained appropriate' (appropriate in both 2012 and 2017), 'became non-appropriate' ('appropriate' in 2012 but became either 'may be appropriate' or 'rarely appropriate in 2017) and 'became appropriate' ('appropriate' in 2017 but were 'uncertain' or 'inappropriate' in 2012) were descriptively compared. Concordance was assessed by calculation of Cohen's Kappa., Results: A total of 245,196 patients underwent elective PCI across 1669 centers. By 2012 AUC, 44% were classified 'appropriate,' 28% were 'uncertain' and 16% were 'inappropriate' compared with 2017 AUC which considered 34% 'appropriate', 56% may be 'appropriate' and 4% 'rarely appropriate'. Overall fair agreement was observed with a Kappa statistic of 0.40 (95%CI 0.396-0.403). Compared with PCI that 'remained appropriate' under the 2017 AUC, PCI that 'became non-appropriate' in 2017 were more likely to be asymptomatic, less likely to be on anti-anginals and less likely to have complex lesions. Compared with PCI that 'became non-appropriate', PCI that 'became appropriate' had a higher proportion of atypical and non-anginal symptoms and were less likely to have had positive functional tests. Procedural related outcomes were similar across all groups. A total of 29 429 PCI (12.0%) were not mappable by 2012 AUC while 16 077 (6.6%) were not mappable by 2017 AUC., Conclusions: In this contemporary analysis of patients undergoing PCI in the United States, only fair agreement between the 2012 and updated 2017 AUC was observed. While some of this reflects the intention of the updated guidance, the large proportion that were considered 'maybe appropriate' or who 'became non-appropriate' reflect the difficulties of documenting and implementing contemporary AUC guidance., Competing Interests: Conflict of interest The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents. AJN, Consulting honoraria from Boehringer Ingelheim, AstraZeneca and Amgen. TI: Nil. SVR: Nil. LAK: Nil. DW: Nil. TYW: research grants provided to the Duke Clinical Research Institute from Amgen, AstraZeneca, Bristol Meyers Squibb, Cyrolife, Novartis, Pfizer, Portola, and Regeneron. She has also received consulting honoraria from Grifols and Gilead., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
134. Does the Effectiveness of a Medicine Copay Voucher Vary by Baseline Medication Out-Of-Pocket Expenses? Insights From ARTEMIS.
- Author
-
Rymer JA, Kaltenbach LA, Peterson ED, Cohen DJ, Fonarow GC, Choudhry NK, Henry TD, Cannon CP, and Wang TY
- Subjects
- Humans, Health Expenditures, Medication Adherence, Treatment Outcome, Myocardial Infarction drug therapy, Purinergic P2Y Receptor Antagonists therapeutic use
- Abstract
Background Persistence to P2Y12 inhibitors after myocardial infarction (MI) remains low. Out-of-pocket cost is cited as a factor affecting medication compliance. We examined whether a copayment intervention affected 1-year persistence to P2Y12 inhibitors and clinical outcomes. Methods and Results In an analysis of ARTEMIS (Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study), patients with MI discharged on a P2Y12 inhibitor were stratified by baseline out-of-pocket medication burden: low ($0-$49 per month), intermediate ($50-$149 per month), and high (≥$150 per month). The impact of the voucher intervention on 1-year P2Y12 inhibitor persistence was examined using a logistic regression model with generalized estimating equations. We assessed the rates of major adverse cardiovascular events among the groups using a Kaplan-Meier estimator. Among 7351 MI-treated patients at 282 hospitals, 54.2% patients were in the low copay group, 32.0% in the middle copay group, and 13.8% in the high copay group. Patients in higher copay groups were more likely to have a history of prior MI, heart failure, and diabetes compared with the low copay group (all P <0.0001). Voucher use was associated with a significantly higher likelihood of 1-year P2Y12 inhibitor persistence regardless of copayment tier (low copay with versus without voucher: adjusted odds ratio [OR], 1.44 [95% CI, 1.25-1.66]; middle copay: adjusted OR, 1.63 [95% CI, 1.37-1.95]; high copay group: adjusted OR, 1.41 [95% CI, 1.05-1.87]; P interaction=0.42). Patients in the high copay group without a voucher had similar risk of 1-year major adverse cardiovascular events compared with patients in the high copay group with a voucher (adjusted hazard ratio, 0.89 [95% CI, 0.66-1.21]). Conclusions Medication copayment vouchers were associated with higher medication persistence at 1 year following an MI, regardless of out-of-pocket medication burden. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02406677.
- Published
- 2022
- Full Text
- View/download PDF
135. The Association of Digital Health Application Use With Heart Failure Care and Outcomes: Insights From CONNECT-HF.
- Author
-
Rao VN, Kaltenbach LA, Granger BB, Fonarow GC, Al-Khalidi HR, Albert NM, Butler J, Allen LA, Lanfear DE, Ariely D, Miller JM, Brodsky MA, Lalonde TA, Lafferty JC, Granger CB, Hernandez AF, and Devore AD
- Subjects
- Hospitalization, Humans, Prospective Studies, Stroke Volume, United States epidemiology, Heart Failure diagnosis, Heart Failure drug therapy, Heart Failure epidemiology
- Abstract
Background: It is unknown whether digital applications can improve guideline-directed medical therapy (GDMT) and outcomes in heart failure with reduced ejection fraction (HFrEF)., Methods and Results: Care Optimization Through Patient and Hospital Engagement Clinical Trial for Heart Failure trial (CONNECT-HF) included an optional, prospective ancillary study of a mobile health application among patients hospitalized due to HFrEF. Digital users were matched to nonusers from the usual-care group. Coprimary outcomes included change in opportunity-based composite HF quality scores and HF rehospitalization or all-cause mortality. Among 2431 patients offered digital applications across the United States, 1526 (63%) had limited digital access or insufficient data, 425 (17%) were digital users, and 480 (20%) declined use. Digital users were similar in age to those who declined use (mean 58 vs 60 years; P = 0.031). Digital users (n = 368) vs matched nonusers (n = 368) had improved composite HF quality scores (48.0% vs 43.6%; + 4.76% [3.27-6.24]; P = 0.001) and composite clinical outcomes (33.0% vs 39.6%; HR 0.76 [0.59-0.97]; P = 0.027)., Conclusions: Among participants in the CONNECT-HF trial, use of digital applications was modest but was associated with higher HF quality-of-care scores, including use of GDMT and better clinical outcomes. Although cause and effect cannot be determined from this study, the application of technology to guide GDMT use and dosing among patients with HFrEF warrants further investigation., Competing Interests: Disclosures Dr. Rao is supported by an NIH training grant (5T32HL069749-18). Dr. Fonarow reports consulting for Abbott, Amgen, Bayer, Janssen, Medtronic, and Novartis. Dr. Albert reports consulting for Novartis. Dr. Lewis receives research funding from Novartis, Merck, Sanofi AstraZeneca and reports consulting for Novartis, Merck, and Dal-Cor. Dr Butler receives research support from and/or reports consulting for Abbott, Adrenomed, Amgen, Array, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squib, CVRx, G3 Pharmaceutical, Impulse Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis, NovoNordisk, Relypsa, Roche, V-Wave Limited, and Vifor. Dr Allen receives research funding from NIH, PCORI, and AHA, and consulting fees from ACI Clinical, Amgen/Cytokinetics, and Boston Scientific. Dr. Lanfear receives research funding from Amgen, Bayer, the NHLBI, Novartis, and Critical Diagnostics, and reports consulting for Amgen, Abbot Diagnostics, Abiomed, Ortho Diagnostics, Janssen, Hridaya, and the Duke Clinical Research Institute (Akros). Dr. Hernandez receives research funding from American Regent, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, GlaxoSmithKline, Merck, Novartis, Verily, and reports consulting for AstraZeneca, Bayer, Boehringer-Ingelheim, Boston Scientific, Cytokinetics, Merck, Myokardia and Novartis. Dr DeVore reports research funding through his institution from the American Heart Association, Amgen, AstraZeneca, Bayer, Intra-Cellular Therapies, American Regent, the NHLBI, Novartis and PCORI; he also provides consulting services for Amgen, AstraZeneca, Bayer, CareDx, InnaMed, LivaNova, Mardil Medical, Novartis, Procyrion, scPharmaceuticals, Story Health, and Zoll. He has also received nonfinancial support from Abbott for educational activities. The other authors have no disclosures., (Copyright © 2022. Published by Elsevier Inc.)
- Published
- 2022
- Full Text
- View/download PDF
136. Patterns of care for first-detected atrial fibrillation: Insights from the Get With The Guidelines® - Atrial Fibrillation registry.
- Author
-
Kir D, Zhang S, Kaltenbach LA, Fonarow GC, Matsouaka RA, Piccini JP, and Desai NR
- Subjects
- Aged, Anticoagulants therapeutic use, Humans, Quality of Life, Registries, Risk Factors, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Atrial Fibrillation therapy, Heart Failure complications, Stroke
- Abstract
Background: Despite multiple trials comparing rate with rhythm control, there is no consensus on the optimal management of first-detected atrial fibrillation (AF)., Objective: We analyzed current patterns of care for first-detected AF in the nationwide Get With The Guidelines® - Atrial Fibrillation registry., Methods: Patients hospitalized with first-detected AF from 2013 to 2019 were included, and a descriptive analysis was performed comparing planned rate with rhythm control. Multivariable logistic regression analysis was performed to identify predictors for choosing rhythm over rate control., Results: Of the 86,759 patients with AF, 17.8% (15,473) had first-detected AF; 11,685 patients were included from 126 sites. Overall, 51.3% (5999) of patients were treated with rate control and 48.7% (5686) with rhythm control at admission. Patients with planned rhythm control had a shorter length of stay and were more likely to be discharged home than a facility. A higher percentage of patients with planned rhythm control were discharged on anticoagulation than those with planned rate control (75.6% vs 70.9%) despite a higher underlying stroke risk in the rate control group (higher median CHA
2 DS2 -VASc score 4; Q1-Q3 2-5 for rate control vs 3; Q1-Q3 2-4 for rhyhtm control; P < .001). While Hispanic ethnicity, Medicaid insurance, age >70 years, and liver disease decreased the likelihood of rhythm control, factors such as heart failure, stroke, or prior bleeding diathesis had no association with the chosen treatment strategy., Conclusion: Less than half of the patients with first-detected AF receive rhythm control at admission. Given recent trial results, further studies should assess the long-term impact of rhythm control on patients' symptoms and quality of life, cardiovascular morbidity, and mortality., (Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)- Published
- 2022
- Full Text
- View/download PDF
137. Percutaneous Coronary Intervention Operator Profiles and Associations With In-Hospital Mortality.
- Author
-
Doll JA, Nelson AJ, Kaltenbach LA, Wojdyla D, Waldo SW, Rao SV, and Wang TY
- Subjects
- Hospital Mortality, Humans, Registries, Risk Factors, Shock, Cardiogenic etiology, Treatment Outcome, Percutaneous Coronary Intervention adverse effects, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction therapy
- Abstract
Background: Percutaneous coronary intervention is performed by operators with differing experience, technique, and case mix. It is unknown if operator practice patterns impact patient outcomes. We sought to determine if a cluster algorithm can identify distinct profiles of percutaneous coronary intervention operators and if these profiles are associated with patient outcomes., Methods: Operators performing at least 25 annual procedures between 2014 and 2018 were clustered using an agglomerative hierarchical clustering algorithm. Risk-adjusted in-hospital mortality was compared between clusters., Results: We identified 4 practice profiles among 7706 operators performing 2 937 419 procedures. Cluster 1 (n=3345) demonstrated case mix and practice patterns similar to the national median. Cluster 2 (n=1993) treated patients with lower clinical acuity and were less likely to use intracoronary diagnostics, atherectomy, and radial access. Cluster 3 (n=1513) had the lowest case volume, were more likely to work at rural hospitals, and cared for a higher proportion of patients with ST-segment-elevation myocardial infarction and cardiogenic shock. Cluster 4 (n=855) had the highest case volume, were most likely to treat patients with high anatomic complexity and use atherectomy, intracoronary diagnostics, and mechanical support. Compared with cluster 1, adjusted in-hospital mortality was similar for cluster 2 (estimated difference, -0.03 [95% CI, -0.10 to 0.04]), higher for cluster 3 (0.14 [0.07-0.22]), and lower for cluster 4 (-0.15 [-0.24 to -0.06])., Conclusions: Distinct percutaneous coronary intervention operator profiles are differentially associated with patient outcomes. A phenotypic approach to physician assessment may provide actionable feedback for quality improvement.
- Published
- 2022
- Full Text
- View/download PDF
138. Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach.
- Author
-
Manly DA, Karrowni W, Rymer JA, Kaltenbach LA, Swaminathan RV, Messenger JC, Abbott JD, Seto A, Panetta C, Brilakis E, Nikolakopoulos I, Gilchrist IC, Kaul P, Dakik H, and Rao SV
- Subjects
- Cardiac Catheterization, Coronary Artery Bypass, Femoral Artery diagnostic imaging, Humans, Radial Artery diagnostic imaging, Risk Factors, Treatment Outcome, United States, Catheterization, Peripheral, Percutaneous Coronary Intervention
- Abstract
Objectives: The aims of this study were to examine rates of radial artery access in post-coronary artery bypass grafting (CABG) patients undergoing diagnostic catherization and/or percutaneous coronary intervention (PCI), whether operators with higher procedural volumes and higher percentage radial use were more likely to perform diagnostic catherization and/or PCI via the radial approach in post-CABG patients, and clinical and procedural outcomes in post-CABG patients who undergo diagnostic catherization and/or PCI via the radial or femoral approach., Background: There are limited data comparing outcomes of patients with prior CABG undergoing transradial or transfemoral diagnostic catheterization and/or PCI., Methods: Using the National Cardiovascular Data Registry CathPCI Registry, all diagnostic catheterizations and PCIs performed in patients with prior CABG from July 1, 2009, to March 31, 2018 (n = 1,279,058, 1,173 sites) were evaluated. Temporal trends in transradial access were examined, and mortality, bleeding, vascular complications, and procedural metrics were compared between transradial and transfemoral access., Results: The rate of transradial access increased from 1.4% to 18.7% over the study period. Transradial access was associated with decreased mortality (adjusted odds ratio [OR]: 0.83; 95% confidence interval [CI]: 0.75 to 0.91), decreased bleeding (OR: 0.57; 95% CI: 0.51 to 0.63), decreased vascular complications (OR: 0.38; 95% CI: 0.30 to 0.47), increased PCI procedural success (OR: 1.11; 95% CI: 1.06 to 1.16; p < 0.0001), and significantly decreased contrast volume across all procedure types. Transradial access was associated with shorter fluoroscopy time for PCI-only procedures but longer fluoroscopy time for diagnostic procedures plus ad hoc PCI and diagnostic procedures only. Operators with a higher rate of transradial access in non-CABG patients were more likely to perform transradial access in patients with prior CABG., Conclusions: The rate of transradial artery access in patients with prior CABG undergoing diagnostic catheterization and/or PCI has increased over the past decade in the United States, and it was more often performed by operators using a transradial approach in non-CABG patients. Compared with transfemoral access, transradial access was associated with improved clinical outcomes in patients with prior CABG., Competing Interests: Funding Support and Author Disclosures The American College of Cardiology National Cardiovascular Data Registry is an initiative of the American College of Cardiology Foundation. This research was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry. Dr. Rymer has received research grants from Boston Scientific and Abbott Pharmaceuticals. Dr. Swaminathan receives research support from ACIST Medical; and provides consulting services for Medtronic. Dr. Abbott has received grant support with no personal compensation from Sinomed, CSL Behring, AstraZeneca, Bristol Myers Squibb, and Abbott Vascular; and provides consulting services for Recor and Philips. Dr. Gilchrist provides consulting services for Cardinal Health and Terumo Medical Corporation. Dr. Panetta is the co-owner of the medical device company LP Medical. Dr. Brilakis provides consulting services for Abbott Vascular, the American Heart Association (associate editor, Circulation), Amgen, Biotronik, Boston Scientific, Cardiovascular Innovations Foundation (Board of Directors), ControlRad, CSI, Ebix, Elsevier, GE Healthcare, InfraRedx, Medtronic, Siemens, and Teleflex; receives research support from Regeneron and Siemens; and is a shareholder in MHI Ventures. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
139. Copayment Reduction Voucher Utilization and Associations With Medication Persistence and Clinical Outcomes: Findings From the ARTEMIS Trial.
- Author
-
Fanaroff AC, Peterson ED, Kaltenbach LA, Anstrom KJ, Fonarow GC, Henry TD, Cannon CP, Choudhry NK, Cohen DJ, Atreja N, Bhalla N, Eudicone JM, and Wang TY
- Subjects
- Aged, Female, Health Knowledge, Attitudes, Practice, Humans, Male, Middle Aged, Myocardial Infarction mortality, Time Factors, Treatment Outcome, United States, Cost Sharing economics, Drug Costs, Health Expenditures, Medication Adherence, Myocardial Infarction drug therapy, Myocardial Infarction economics, Platelet Aggregation Inhibitors economics, Platelet Aggregation Inhibitors therapeutic use, Purinergic P2Y Receptor Antagonists economics, Purinergic P2Y Receptor Antagonists therapeutic use
- Abstract
Background: Cost is frequently cited as a barrier to optimal medication use, but the extent to which copayment assistance interventions are used when available, and their impact on evidence-based medication persistence and major adverse cardiovascular events is unknown., Methods and Results: The ARTEMIS trial (Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study) randomized 301 hospitals to usual care versus the ability to provide patients with vouchers that offset copayment costs when filling P2Y
12 inhibitors in the 1 year post-myocardial infarction. In the intervention group, we used multivariable logistic regression to identify patient and medication cost characteristics associated with voucher use. We then used this model to stratify both intervention and usual care patients by likelihood of voucher use, and examined the impact of the voucher intervention on 1-year P2Y12 inhibitor persistence (no gap in pharmacy supply >30 days) and major adverse cardiovascular events (all-cause death, myocardial infarction, or stroke). Among 10 102 enrolled patients, 6135 patients were treated at hospitals randomized to the copayment intervention. Of these, 1742 (28.4%) never used the voucher, although 1729 (99.2%) voucher never-users filled at least one P2Y12 inhibitor prescription in the 1 year post-myocardial infarction. Characteristics most associated with voucher use included: discharge on ticagrelor, planned 1-year course of P2Y12 inhibitor treatment, white race, commercial insurance, and higher out-of-pocket medication costs (c-statistic 0.74). Applying this propensity model to stratify all enrolled patients by likelihood of voucher use, the intervention improved medication persistence the most in patients with high likelihood of voucher use (adjusted interaction P =0.03, odds ratio, 1.86 [95% CI, 1.48-2.33]). The intervention did not significantly reduce major adverse cardiovascular events in any voucher use likelihood group, although the odds ratio was lowest (0.86 [95% CI, 0.56-1.16]) among patients with high likelihood of voucher use (adjusted interaction P =0.04)., Conclusions: Among patients discharged after myocardial infarction, those with higher copayments and greater out-of-pocket medication costs were more likely to use a copayment assistance voucher, but some classes of patients were less likely to use a copayment assistance voucher. Patients at low likelihood of voucher use benefitted least from copayment assistance, and other interventions may be needed to improve medication-taking behaviors and clinical outcomes in these patients. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02406677.- Published
- 2020
- Full Text
- View/download PDF
140. Impact of a Copayment Reduction Intervention on Medication Persistence and Cardiovascular Events in Hospitals With and Without Prior Medication Financial Assistance Programs.
- Author
-
Doll JA, Kaltenbach LA, Anstrom KJ, Cannon CP, Henry TD, Fonarow GC, Choudhry NK, Fonseca E, Bhalla N, Eudicone JM, Peterson ED, and Wang TY
- Subjects
- Aged, Cost-Benefit Analysis, Female, Humans, Male, Middle Aged, Myocardial Infarction drug therapy, Platelet Aggregation Inhibitors therapeutic use, Purinergic P2Y Receptor Antagonists therapeutic use, Quality Improvement economics, Quality Indicators, Health Care economics, Time Factors, Treatment Outcome, United States, Deductibles and Coinsurance economics, Drug Costs, Health Expenditures, Medication Adherence, Myocardial Infarction economics, Platelet Aggregation Inhibitors economics, Purinergic P2Y Receptor Antagonists economics
- Abstract
Background Hospitals commonly provide a short-term supply of free P2Y
12 inhibitors at discharge after myocardial infarction, but it is unclear if these programs improve medication persistence and outcomes. The ARTEMIS (Affordability and Real-World Antiplatelet Treatment Effectiveness After Myocardial Infarction Study) trial randomized hospitals to usual care versus waived P2Y12 inhibitor copayment costs for 1-year post-myocardial infarction. Whether the impact of this intervention differed between hospitals with and without pre-existing medication assistance programs is unknown. Methods and Results In this post hoc analysis of the ARTEMIS trial, we examined the associations of pre-study free medication programs and the randomized copayment voucher intervention with P2Y12 inhibitor persistence (measured by pharmacy fills and patient report) and major adverse cardiovascular events using logistic regression models including a propensity score. Among 262 hospitals, 129 (49%) offered pre-study free medication assistance. One-year P2Y12 inhibitor persistence and major adverse cardiovascular events risks were similar between patients treated at hospitals with and without free medication programs (adjusted odds ratio 0.93, 95% CI, 0.82-1.05 and hazard ratio 0.92, 95% CI, 0.80-1.07, respectively). The randomized copayment voucher intervention improved persistence, assessed by pharmacy fills, in both hospitals with (53.6% versus 44.0%, adjusted odds ratio 1.45, 95% CI, 1.20-1.75) and without (59.0% versus 48.3%, adjusted odds ratio 1.46, 95% CI, 1.25-1.70) free medication programs ( Pinteraction =0.71). Differences in patient-reported persistence were not significant after adjustment. Conclusions While hospitals commonly report the ability to provide free short-term P2Y12 inhibitors, we did not find association of this with medication persistence or major adverse cardiovascular events among patients with insurance coverage for prescription medication enrolled in the ARTEMIS trial. An intervention that provided copayment assistance vouchers for 1 year was successful in improving medication persistence in hospitals with and without pre-existing short-term medication programs. Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02406677.- Published
- 2020
- Full Text
- View/download PDF
141. Trends in Usage and Clinical Outcomes of Coronary Atherectomy: A Report From the National Cardiovascular Data Registry CathPCI Registry.
- Author
-
Beohar N, Kaltenbach LA, Wojdyla D, Pineda AM, Rao SV, Stone GW, Leon MB, Sanghvi KA, Moses JW, and Kirtane AJ
- Subjects
- Aged, Aged, 80 and over, Atherectomy, Coronary adverse effects, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease mortality, Female, Hospital Mortality trends, Humans, Male, Middle Aged, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Registries, Risk Factors, Severity of Illness Index, Time Factors, Treatment Outcome, United States, Vascular Calcification diagnostic imaging, Vascular Calcification mortality, Atherectomy, Coronary trends, Cardiologists trends, Cardiology Service, Hospital trends, Coronary Artery Disease therapy, Healthcare Disparities trends, Percutaneous Coronary Intervention trends, Practice Patterns, Physicians' trends, Vascular Calcification therapy
- Abstract
Background: Adjunctive coronary atherectomy (CA) can be utilized in treating severely calcified coronary lesions; however, the temporal trends, patient selection, and variation in use of CA have not been well described. We sought to assess the trends in usage, interhospital variability, and outcomes with CA among patients undergoing percutaneous coronary intervention (PCI)., Methods: All patients undergoing PCI in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009 to December 31, 2016 (N=3 864 377) were analyzed based on utilization of either rotational or orbital CA. Intervals using date of index CA grouped into 2009 Q3 to 2010, 2011 to 2012, 2013 to 2014, and 2015 to 2016 and hospital-level quartiles based on annual CA volumes were evaluated. The primary outcome measure was in-hospital major adverse cardiac events defined as a composite of all-cause mortality, periprocedural myocardial infarction, or stroke. Independent variables associated with outcomes were determined., Results: CA represented 1.7% (n=65 033) of the total PCI volume. Among hospitals performing PCI (n=1672), 577 (34.5%) did not perform any CA. Patients treated with CA were elderly, more often male, and had a history of diabetes, prior myocardial infarction, PCI, and coronary artery bypass grafting. The utilization of CA increased from 1.1% in Q3 2009 to 3.0% in Q4 of 2016 (5% quarterly increase in odds of CA; OR [95% CI], 1.05 [1.04-1.06], P <0.001). Among patients undergoing CA, there was a temporal decline in major adverse cardiac events (0.98 [0.97-0.99], P <0.001) and myocardial infarction (0.97 [0.96-0.98], P <0.001). In adjusted analyses, increasing hospital CA volume was associated with lower mortality (0.85 [0.76-0.96], P =0.01) and lower rates of PCI failure or complication requiring coronary artery bypass grafting (0.67 [0.56-0.79], P <0.001) but was associated with small increase in coronary perforation (1.18 [1.04-1.35], P <0.01)., Conclusions: Although CA is performed infrequently, its use has increased over time. After accounting for potential confounders, higher CA volume was associated with lower risk of major adverse events counterbalanced by small risk of coronary perforation.
- Published
- 2020
- Full Text
- View/download PDF
142. Examining the Operator Learning Curve for Percutaneous Coronary Intervention of Chronic Total Occlusions.
- Author
-
Young MN, Secemsky EA, Kaltenbach LA, Jaffer FA, Grantham JA, Rao SV, and Yeh RW
- Subjects
- Aged, Chronic Disease, Coronary Occlusion diagnostic imaging, Coronary Occlusion mortality, Female, Humans, Male, Middle Aged, Registries, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Workload, Cardiologists, Clinical Competence, Coronary Occlusion therapy, Learning Curve, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality
- Abstract
Background: Advances in chronic total occlusion percutaneous coronary intervention (CTO PCI) techniques have led to increased procedural success rates among operators. While utilization of CTO PCI has disseminated widely, the learning curve for new operators has not been well-defined., Methods: Between July 2009 and December 2015, 93 875 CTO PCI cases were extracted from the CathPCI Registry. We delineated a cohort of new CTO operators performing <10 CTO PCI cases per given year. In-hospital outcomes for subsequent CTO PCIs were stratified by the number of prior cases accrued by each operator. Multivariable regression models were used to estimate differences in outcomes with increasing experience. The primary outcome was major adverse cardiovascular events defined as the composite of death, myocardial infarction, stroke, tamponade, or urgent coronary artery bypass grafting., Results: Among 70 916 cases performed by 7251 new operators, procedure success rate was 61.4% and major adverse cardiovascular event rate was 4.2%. Meanwhile, the rate of major bleeding was 4.0%, myocardial infarction 2.0%, mortality 0.6%, tamponade 0.3%, and renal failure 0.2%. Adjusted regression models demonstrated piecewise linear improvements in guidewire crossing, stent placement, and procedure success with accrued volume, albeit with increased contrast use, fluoroscopy time, and bleeding. Major adverse cardiovascular event rates were stable beyond the 12th case (odds ratio per 5 case increase 1.00; 95% CI, 0.98-1.03, P=0.7980)., Conclusions: Among a large number of new CTO PCI operators in the United States, there exists an experiential learning curve for procedural success. However, there were higher rates of bleeding despite case experience, while major adverse cardiovascular events remained relatively unchanged after initiation.
- Published
- 2019
- Full Text
- View/download PDF
143. Comparison of Rates of Bleeding and Vascular Complications Before, During, and After Trial Enrollment in the SAFE-PCI Trial for Women.
- Author
-
Rymer JA, Kaltenbach LA, Kochar A, Hess CN, Gilchrist IC, Messenger JC, Harrington RA, Jolly SS, Jacobs AK, Abbott JD, Wojdyla DM, Krucoff MW, and Rao SV
- Subjects
- Aged, Catheterization, Peripheral mortality, Comorbidity, Female, Hemorrhage mortality, Humans, Middle Aged, Patient Selection, Percutaneous Coronary Intervention mortality, Prospective Studies, Punctures, Registries, Risk Assessment, Risk Factors, Sex Factors, Time Factors, Treatment Outcome, United States, Vascular System Injuries mortality, Catheterization, Peripheral adverse effects, Femoral Artery injuries, Hemorrhage etiology, Percutaneous Coronary Intervention adverse effects, Radial Artery injuries, Vascular System Injuries etiology
- Abstract
Background: SAFE-PCI for Women (Study of Access Site for Enhancement of PCI for Women), a randomized controlled trial comparing radial and femoral access in women undergoing cardiac catheterization or percutaneous coronary intervention (PCI), was terminated early for lower than expected event rates. Whether this was because of patient selection or better access site practice among trial patients is unknown., Methods and Results: SAFE-PCI was conducted within the National Cardiovascular Data Registry CathPCI registry. Using the National Cardiovascular Research Infrastructure Identification, PCI date, and age, patients enrolled in SAFE-PCI were compared with trial-eligible female CathPCI registry patients 1 year before, during, and 1 year after SAFE-PCI enrollment. Patient and procedure characteristics, predicted bleeding and mortality, and post-PCI bleeding were compared between groups. Enrolled SAFE-PCI patients and registry patients from the 3 time periods were linked to Centers for Medicare and Medicaid Services data to compare 30-day death and unplanned revascularization rates. At 54 SAFE-PCI sites, there were 496 SAFE-PCI trial patients with a PCI visit within the CathPCI registry. There were 24 958 registry patients from 1 year before and 1 year after SAFE-PCI enrollment and 15 904 trial-eligible registry patients during trial enrollment. Trial patients were younger, had lower predicted bleeding and mortality, and had lower rates of post-PCI bleeding within 72 hours compared with registry patients. Among 12 212 Centers for Medicare and Medicaid Services-linked patients, there were no significant differences in 30-day death and unplanned revascularization among the 4 groups., Conclusions: Lower predicted risk of bleeding and mortality among SAFE-PCI trial patients compared with registry patients suggests that lower-risk patients were selectively enrolled for the trial. These data demonstrate how registry-based randomized trials may offer methods for enrollment feedback to curb selection bias in recruitment., Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01406236.
- Published
- 2019
- Full Text
- View/download PDF
144. Relationship Between Operator Volume and Long-Term Outcomes After Percutaneous Coronary Intervention.
- Author
-
Fanaroff AC, Zakroysky P, Wojdyla D, Kaltenbach LA, Sherwood MW, Roe MT, Wang TY, Peterson ED, Gurm HS, Cohen MG, Messenger JC, and Rao SV
- Subjects
- Aged, Aged, 80 and over, Databases, Factual, Female, Hospital Mortality trends, Humans, Male, Medicare, Patient Readmission trends, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Registries, Retreatment trends, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, United States, Hospitals, High-Volume trends, Hospitals, Low-Volume trends, Outcome and Process Assessment, Health Care trends, Percutaneous Coronary Intervention trends, Practice Patterns, Physicians' trends, Workload
- Abstract
Background: Although many studies show an inverse association between operator procedural volume and short-term adverse outcomes after percutaneous coronary intervention (PCI), the association between procedural volume and longer-term outcomes is unknown., Methods: Using the National Cardiovascular Data Registry CathPCI registry data linked with Medicare claims data, we examined the association between operator PCI volume and long-term outcomes among patients ≥65 years of age. Operators were stratified by average annual PCI volume (counting PCIs performed in patients of all ages): low- (<50 PCIs), intermediate- (50-100), and high- (>100) volume operators. One-year unadjusted rates of death and major adverse coronary events (MACEs; defined as death, readmission for myocardial infarction, or unplanned coronary revascularization) were calculated with Kaplan-Meier methods. The proportional hazards assumption was not met, and risk-adjusted associations between operator volume and outcomes were calculated separately from the time of PCI to hospital discharge and from hospital discharge to 1-year follow-up., Results: Between July 1, 2009, and December 31, 2014, 723 644 PCI procedures were performed by 8936 operators: 2553 high-, 2878 intermediate-, and 3505 low-volume operators. Compared with high- and intermediate-volume operators, low-volume operators more often performed emergency PCI, and their patients had fewer cardiovascular comorbidities. Over 1-year follow-up, 15.9% of patients treated by low-volume operators had a MACE compared with 16.9% of patients treated by high-volume operators ( P=0.004). After multivariable adjustment, intermediate- and high-volume operators had a significantly lower rate of in-hospital death than low-volume operators (odds ratio, 0.91; 95% CI, 0.86-0.96 for intermediate versus low; odds ratio, 0.79; 95% CI, 0.75-0.83 for high versus low). There were no significant differences in rates of MACEs, death, myocardial infarction, or unplanned revascularization between operator cohorts from hospital discharge to 1-year follow-up (adjusted hazard ratio for MACEs, 0.99; 95% CI, 0.96-1.01 for intermediate versus low; hazard ratio, 1.01; 95% CI, 0.99-1.04 for high versus low)., Conclusions: Unadjusted 1-year outcomes after PCI were worse for older adults treated by operators with higher annual volume; however, patients treated by these operators had more cardiovascular comorbidities. After risk adjustment, higher operator volume was associated with lower in-hospital mortality and no difference in postdischarge MACEs.
- Published
- 2019
- Full Text
- View/download PDF
145. Usefulness of Antithrombotic Therapy in Patients With Atrial Fibrillation and Acute Myocardial Infarction.
- Author
-
Guimarães PO, Zakroysky P, Goyal A, Lopes RD, Kaltenbach LA, and Wang TY
- Subjects
- Aged, Female, Humans, Male, Registries, Retrospective Studies, United States, Anticoagulants therapeutic use, Atrial Fibrillation drug therapy, Coronary Artery Disease drug therapy, Fibrinolytic Agents therapeutic use, Myocardial Infarction drug therapy, Stroke prevention & control
- Abstract
To examine patterns of preadmission and discharge antithrombotic therapies in coronary artery disease (CAD) and atrial fibrillation (AF) patients admitted for acute myocardial infarction (AMI), we performed a retrospective analysis of the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines (ACTION Registry-GWTG), which captures consecutive AMI patients treated at participating US hospitals. We included patients with CAD, AF, and CHA
2 DS2 -VASc score ≥2 admitted for AMI (07/01/2013-09/30/2016). In the 15,034 AMI patients with previous AF and CAD, median age was 75; 32% were female. Preadmission, 32% of patients were on P2Y12 inhibitors, 36% were anticoagulated, 72% were on aspirin, and 5% were on triple therapy. At discharge post-AMI, 73% were prescribed P2Y12 inhibitors and 41% anticoagulation. Discharge anticoagulation use did not vary directly with CHA2 DS2 -VASc score; 16% of previously anticoagulated patients had discontinued anticoagulation at discharge. In patients receiving anticoagulants at discharge, 27% used nonvitamin K antagonist oral anticoagulants. Triple therapy was prescribed in 23% at discharge; 27% of these were with nonvitamin K antagonist oral anticoagulants and 14% with prasugrel or ticagrelor. P2Y12 inhibitors and anticoagulants without aspirin were used in 2%. In conclusion, patients with previous CAD and AF are undertreated for both recurrent ischemic events and stroke prevention. After AMI hospitalization, P2Y12 inhibition was preferentially selected over oral anticoagulation., (Copyright © 2018 Elsevier Inc. All rights reserved.)- Published
- 2019
- Full Text
- View/download PDF
146. Adverse Change in Employment Status After Acute Myocardial Infarction: Analysis From the TRANSLATE-ACS Study.
- Author
-
Warraich HJ, Kaltenbach LA, Fonarow GC, Peterson ED, and Wang TY
- Subjects
- Absenteeism, Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome economics, Acute Coronary Syndrome epidemiology, Aged, Cost of Illness, Depression epidemiology, Drug Costs, Female, Health Expenditures, Health Status, Humans, Longitudinal Studies, Male, Medication Adherence, Middle Aged, Myocardial Infarction diagnosis, Myocardial Infarction economics, Myocardial Infarction epidemiology, Platelet Aggregation Inhibitors adverse effects, Platelet Aggregation Inhibitors economics, Purinergic P2Y Receptor Antagonists adverse effects, Purinergic P2Y Receptor Antagonists economics, Quality of Life, Registries, Retirement, Return to Work, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Unemployment, United States epidemiology, Acute Coronary Syndrome therapy, Employment, Myocardial Infarction therapy, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention economics, Platelet Aggregation Inhibitors therapeutic use, Purinergic P2Y Receptor Antagonists therapeutic use
- Abstract
Background: Inability to resume employment after acute myocardial infarction (MI) has important implications for patients. We sought to assess the prevalence of and outcomes associated with adverse change in employment after MI in a national US cohort., Methods and Results: The TRANSLATE-ACS study (Treatment with Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome) assessed employment status at baseline and 1 year among 9319 patients with MI (mean age, 60.8 years; SD, 11.3; 27.3% women) enrolled at 233 US hospitals. We defined adverse change in employment as patients working at baseline but working less or not working at 1-year post-MI. In multivariable models, we assessed factors associated with adverse change in employment and its association with patient-reported depression, health status, persistence to evidence-based medications prescribed at discharge, and financial hardship affording medications. Half of the patients (51%; n=4730) were employed at the time of MI. By 1 year, 10% (n=492) of these reported an adverse change in employment, with 3% (n=143) working less and 7% (n=349) no longer working (only 27 of 349 reported retirement). Factors significantly associated with adverse change in employment included a number of unplanned readmissions, postdischarge bleeding complications, hypertension, and smoking. At 1 year, patients with an adverse change in employment were more likely to report depression (Patient Health Questionnaire 2 score >3: 27.4% versus 16.7%), lower health status (mean EuroQoL visual analogue scale: 73 [SD, 17.8] versus 78 [SD, 14.8]), and moderate-extreme financial hardship with medication costs (41.0% versus 28.4%; all P <0.001). There was no difference in persistence to evidence-based medications prescribed at discharge., Conclusions: Patients who experienced an adverse change in employment after MI reported lower quality of life, increased depression, and more difficulty affording medications. These results underscore the need for interventions to address this patient-centered outcome and its health impact., Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01088503., (© 2018 American Heart Association, Inc.)
- Published
- 2018
- Full Text
- View/download PDF
147. Variation in the Adoption of Transradial Access for ST-Segment Elevation Myocardial Infarction: Insights From the NCDR CathPCI Registry.
- Author
-
Valle JA, Kaltenbach LA, Bradley SM, Yeh RW, Rao SV, Gurm HS, Armstrong EJ, Messenger JC, and Waldo SW
- Subjects
- Aged, Catheterization, Peripheral adverse effects, Catheterization, Peripheral mortality, Chi-Square Distribution, Female, Healthcare Disparities trends, Hemorrhage etiology, Humans, Logistic Models, Male, Middle Aged, Odds Ratio, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Punctures, Registries, Risk Factors, ST Elevation Myocardial Infarction diagnostic imaging, ST Elevation Myocardial Infarction mortality, Time Factors, Treatment Outcome, United States, Catheterization, Peripheral trends, Percutaneous Coronary Intervention trends, Practice Patterns, Physicians' trends, Radial Artery diagnostic imaging, ST Elevation Myocardial Infarction therapy
- Abstract
Objectives: The study sought to define patient, operator, and institutional factors associated with transradial access (TRA) in ST-segment elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI), the variation in use across operators and institutions, and the relationship with mortality and bleeding., Background: TRA for PCI in STEMI is underutilized. Factors associated with TRA are not well described, nor is there variation across operators and institutions or their relationship with outcomes., Methods: The authors used hierarchical logistic regression to identify patient, operator, and institutional characteristics associated with TRA use as well as determine the variation in TRA for STEMI PCI from 2009 to 2015. They also described the relationship between operator- and institution-level use and risk-adjusted bleeding and mortality., Results: Among 692,433 patients undergoing STEMI PCI, 12% (n = 82,618) utilized TRA. TRA increased from 2% to 23% from 2009 to 2015, but with significant geographic variation. Age, sex, cardiogenic shock, cardiac arrest, operators entering practice before 2012, and nonacademically affiliated institutions were associated with lower rates of TRA. There was significant operator and institutional variation, wherein identical patients would have >8-fold difference in odds of TRA for STEMI PCI by changing operators (median odds ratio: 8.7), and >5-fold difference by changing institutions (median odds ratio: 5.1). Greater TRA use across operators was associated with reduced bleeding (rho = -0.053), whereas TRA use across institutions was associated with reduced mortality (rho = -0.077)., Conclusions: Transradial access for STEMI PCI is increasing, but remains underutilized with significant geographic, operator, and institutional variation. These findings suggest an ongoing opportunity to standardize STEMI care., (Published by Elsevier Inc.)
- Published
- 2017
- Full Text
- View/download PDF
148. Management of Persistent Angina After Myocardial Infarction Treated With Percutaneous Coronary Intervention: Insights From the TRANSLATE-ACS Study.
- Author
-
Fanaroff AC, Kaltenbach LA, Peterson ED, Hess CN, Cohen DJ, Fonarow GC, and Wang TY
- Subjects
- Aged, Angina Pectoris diagnosis, Angina Pectoris epidemiology, Cardiovascular Agents adverse effects, Drug Prescriptions, Drug Utilization Review, Female, Humans, Longitudinal Studies, Male, Middle Aged, Non-ST Elevated Myocardial Infarction diagnosis, Non-ST Elevated Myocardial Infarction epidemiology, Patient Discharge, Platelet Aggregation Inhibitors adverse effects, Practice Patterns, Physicians', Prevalence, Purinergic P2Y Receptor Antagonists adverse effects, Risk Factors, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction epidemiology, Time Factors, Treatment Outcome, United States epidemiology, Angina Pectoris therapy, Cardiovascular Agents therapeutic use, Non-ST Elevated Myocardial Infarction therapy, Percutaneous Coronary Intervention adverse effects, Platelet Aggregation Inhibitors therapeutic use, Purinergic P2Y Receptor Antagonists therapeutic use, ST Elevation Myocardial Infarction therapy
- Abstract
Background: Angina has important implications for patients' quality of life and healthcare utilization. Angina management after acute myocardial infarction (MI) treated with percutaneous coronary intervention (PCI) is unknown., Methods and Results: TRANSLATE-ACS (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) was a longitudinal study of MI patients treated with percutaneous coronary intervention at 233 US hospitals from 2010 to 2012. Among patients with self-reported angina at 6 weeks post-MI, we described patterns of angina and antianginal medication use through 1 year postdischarge. Of 10 870 percutaneous coronary intervention-treated MI patients, 3190 (29.3%) reported angina symptoms at 6 weeks post-MI; of these, 658 (20.6%) had daily/weekly angina while 2532 (79.4%) had monthly angina. Among patients with 6-week angina, 2936 (92.0%) received β-blockers during the 1 year post-MI, yet only 743 (23.3%) were treated with other antianginal medications. At 1 year, 1056 patients (33.1%) with 6-week angina reported persistent angina symptoms. Of these, only 31.2% had been prescribed non-β-blocker antianginal medications at any time in the past year. Among patients undergoing revascularization during follow-up, only 25.9% were on ≥1 non-β-blocker anti-anginal medication at the time of the procedure., Conclusions: Angina is present in one third of percutaneous coronary intervention-treated MI patients as early as 6 weeks after discharge, and many of these patients have persistent angina at 1 year. Non-β-blocker antianginal medications are infrequently used in these patients, even among those with persistent angina and those undergoing revascularization., (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
- Published
- 2017
- Full Text
- View/download PDF
149. Multivessel Versus Culprit Vessel-Only Percutaneous Coronary Intervention Among Patients With Acute Myocardial Infarction: Insights From the TRANSLATE-ACS Observational Study.
- Author
-
Ibrahim H, Sharma PK, Cohen DJ, Fonarow GC, Kaltenbach LA, Effron MB, Zettler ME, Peterson ED, and Wang TY
- Subjects
- Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome etiology, Acute Coronary Syndrome mortality, Aged, Angina Pectoris etiology, Angina Pectoris therapy, Coronary Artery Disease complications, Coronary Artery Disease diagnosis, Coronary Artery Disease mortality, Female, Humans, Male, Middle Aged, Non-ST Elevated Myocardial Infarction diagnosis, Non-ST Elevated Myocardial Infarction etiology, Non-ST Elevated Myocardial Infarction mortality, Patient Readmission, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, Platelet Aggregation Inhibitors therapeutic use, Purinergic P2Y Receptor Antagonists therapeutic use, Quality of Life, Risk Factors, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction etiology, ST Elevation Myocardial Infarction mortality, Time Factors, Treatment Outcome, United States, Acute Coronary Syndrome therapy, Coronary Artery Disease therapy, Non-ST Elevated Myocardial Infarction therapy, Percutaneous Coronary Intervention methods, ST Elevation Myocardial Infarction therapy
- Abstract
Background: Among patients with acute myocardial infarction (MI) who have multivessel disease, it is unclear if multivessel percutaneous coronary intervention (PCI) improves clinical and quality-of-life outcomes compared with culprit-only intervention. We sought to compare clinical and quality-of-life outcomes between multivessel and culprit-only PCI., Methods and Results: Among 6061 patients with acute MI who have multivessel disease in the TRANSLATE-ACS (Treatment With Adenosine Diphosphate Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome) study, we used inverse probability-weighted propensity adjustment to study the associations between multivessel and culprit-only intervention during the index PCI and major adverse cardiovascular events, unplanned all-cause readmission, and angina frequency at 6 weeks and 1 year. Multivessel PCI was performed in 1208 (20%) of patients with MI who had multivessel disease. Relative to the culprit-only intervention, patients receiving multivessel PCI were similarly aged and more likely to be seen with non-ST-segment elevation MI or cardiogenic shock. At 6 weeks, the initial multivessel PCI strategy was associated with lower major adverse cardiovascular events and unplanned readmission risks, whereas angina frequency was not significantly different between multivessel and culprit-only PCI. At 1 year, major adverse cardiovascular event risk was persistently lower in the multivessel PCI group (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72-0.99), whereas long-term readmission risk (adjusted hazard ratio, 0.94; 95% confidence interval, 0.84-1.04) and angina frequency were similar between groups (adjusted odds ratio, 1.01; 95% confidence interval, 0.82-1.24). Similar associations were seen when patients with ST-segment elevation MI and non-ST-segment elevation MI were examined separately., Conclusions: Among patients with acute MI who have multivessel disease, multivessel PCI was associated with lower risk of all-cause readmission at 6 weeks and lower risk of major adverse cardiovascular events at 6 weeks and 1 year. However, similar short- and long-term angina frequencies were noted., (© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
- Published
- 2017
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.