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10. Hemostatic factor levels and cognitive decline in older adults:The Cardiovascular Health Study

Author

Harrington, Laura B., Ehlert, Alexa N., Thacker, Evan L., Jenny, Nancy S., Lopez, Oscar, Cushman, Mary, Fitzpatrick, Annette, Mukamal, Kenneth J., Jensen, Majken K., Harrington, Laura B., Ehlert, Alexa N., Thacker, Evan L., Jenny, Nancy S., Lopez, Oscar, Cushman, Mary, Fitzpatrick, Annette, Mukamal, Kenneth J., and Jensen, Majken K.

Abstract

Background Hemostasis is a key factor in cerebrovascular disease, but the association of hemostatic factors with cognitive decline is unclear.Objective To prospectively evaluate associations of 20 hemostatic factor levels with changes in cognition during >= 8 years of follow-up in the Cardiovascular Health Study (CHS) of older adults.Methods We included participants of an existing CHS cross-sectional substudy (n = 400) with hemostatic factors measured in 1989-1990. Between 1989-1990 and 1998-1999, cognitive function was measured using the Modified Mini-Mental State Examination (3MSE) and Digit Symbol Substitution Tests. Mixed-effects linear regression models estimated change in cognitive function over time, adjusting for sociodemographic and clinical factors and APOE genotype, using Bonferroni adjustment. We also derived principal components to account for the interrelationship among factors.Results Of 20 factors evaluated individually, only higher levels of plasmin-alpha(2)-antiplasmin complex (PAP), tissue factor pathway inhibitor (TFPI), and lower factor X (FXc) levels were associated with faster cognitive decline, estimated by annual change in 3MSE points (1 standard deviation PAP beta = -0.65, 95% confidence interval [CI]: -1.08 to -0.21; TFPI beta = -0.55, 95% CI: -0.90 to -0.19; FXc beta = 0.52, 95% CI: 0.21-0.84). One of four principal components, loading positively on D-dimer, prothrombin fragment 1.2 (F1.2), and PAP was significantly associated with change in 3MSE.Conclusions Levels of PAP, TPFI, and FXc and a combination of factors driven by PAP, D-dimer, and F1.2 were associated with cognitive decline. Whether these findings can be used to improve dementia prevention or prediction requires further study.

Published
2021

13. Abstract 029: Cardiovascular Health and Cognitive Decline in Older Adults: The Cardiovascular Health Study

Author

MaWhinney, Kristine, primary, Tounkara, Mamadou D, additional, Evans, Kirsten, additional, Startup, Emily, additional, Ehlert, Alexa, additional, Covey, Emarie, additional, Westra, Jordan, additional, Blades, Natalie J, additional, Dhamoon, Mandip S, additional, Gonzalez, Hector M, additional, Imamura, Fumiaki, additional, Kuzma, Elzbieta, additional, Llewellyn, David J, additional, Novilla, M Lelinneth B, additional, Scrobotovici, Monica, additional, Longstreth, W T, additional, and Thacker, Evan L, additional

Published
2019
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14. Abstract P002: Seven-Year Changes in Cardiovascular Health in Older Adults: The Cardiovascular Health Study

Author

Tounkara, Mamadou D, primary, MaWhinney, Kristine, additional, Evans, Kirsten, additional, Startup, Emily, additional, Ehlert, Alexa, additional, Covey, Emarie, additional, Westra, Jordan, additional, Blades, Natalie J, additional, Dhamoon, Mandip S, additional, Gonzalez, Hector M, additional, Imamura, Fumiaki, additional, Kuzma, Elzbieta, additional, Llewellyn, David J, additional, Novilla, M Lelinneth B, additional, Scrobotovici, Monica, additional, Longstreth, W T, additional, and Thacker, Evan L, additional

Published
2019
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19. Antiepileptic Drug Management in Hospitalized Epilepsy Patients With Nil Per Os Diets: A Retrospective Review

Author

Bank, Anna M., Lee, Jong Woo, Ehlert, Alexa N., and Berkowitz, Aaron L.

Abstract

Background and Purpose: Antiepileptic drug (AED) management in patients with epilepsy who cannot take their usual oral medications is a common neurologic dilemma in the hospital setting. Strategies to maintain seizure control in patients with nil per os (NPO, nothing by mouth) diet orders include continuation of oral AEDs despite NPO nutrition orders, administration of intravenous AED(s), or temporary administration of benzodiazepines. The frequency with which these strategies are used and their effectiveness in preventing in-hospital seizures is unknown.Methods: We conducted a retrospective cohort study to determine AED management strategies and seizure frequency in hospitalized epilepsy patients with NPO diet status admitted to an academic medical center between 2001 and 2016. Clinical documentation was reviewed. Antiepileptic drug selection (medication and route of administration) and presence or absence of seizures were recorded.Results: We identified 199 admissions during which epilepsy patients had NPO diet orders. Antiepileptic drug management strategies included continuation of oral medications (50.3% of admissions), intravenous AED monotherapy (22.1%), intravenous AED polytherapy (12.6%), benzodiazepines (1.0%), holding AEDs (4.5%), or a combination (9.5%). Seizures occurred during 14 admissions. Treatment with AED polytherapy prior to admission and changing the patient’s AED regimen during admission were associated with increased odds of seizures during admission (P= .0028; P= .0114).Conclusions: These results suggest that patients’ home oral AED regimens should be continued when possible in order to minimize the frequency of seizures during hospitalizations.

Published
2019
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20. Administrative Billing Codes Accurately Identify Occurrence of Electrical Cardioversion and Ablation/Maze Procedures in Atrial Fibrillation Patients.

Author

Ehlert, Alexa N., Heckbert, Susan R., Wiggins, Kerri L., and Thacker, Evan L.

Abstract

Introduction: Administrative billing codes for electrical cardioversion and ablation/maze procedures may be useful for research on atrial fibrillation (AF) progression and treatment if the codes are sufficiently accurate relative to medical record documentation. Hypothesis: We hypothesized that administrative billing codes for electrical cardioversion and ablation/maze procedures would accurately identify the occurrence of those procedures. Methods: We studied adults ages 30-84 years who experienced new onset AF between 10/2001 and 12/2004, and were patients in Group Health, an integrated healthcare system in Washington state. Using medical record review as the gold standard, we assessed the accuracy of administrative billing codes for detecting the occurrence of electrical cardioversion and ablation/maze procedures. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each billing code separately, and collectively for each procedure. Results: Of 1953 study participants with new onset AF, during a mean of 1.5 (SD 0.7) years of follow-up after AF onset, 470 (24%) experienced electrical cardioversion and 44 (2%) experienced ablation/maze procedures according to medical records. For cardioversion, CPT code 92960 performed better than ICD-9 codes 99.61 and 99.62, with higher sensitivity, PPV, and NPV, but slightly lower specificity. For ablation/maze, CPT code 93651 and ICD-9 code 37.34 performed identically, yielding higher sensitivity and PPV than ICD-9 code 37.33. For cardioversion and ablation/maze procedures, combining three codes improved sensitivity and NPV while maintaining high specificity and PPV relative to individual codes. (See Table.) Conclusions: Administrative billing data accurately identify electrical cardioversion and ablation/maze procedures, and can be used in place of medical record review. Our findings apply to integrated health systems or other settings where administrative billing databases are available. [ABSTRACT FROM AUTHOR]

Published
2017
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